Social Welfare Policy and Macro Practice: Medicaid as Part of the War on Poverty.

Tuesday, November 22, 2016

Medicaid as Part of the War on Poverty.

This is a student paper about Medicaid.

“This administration today, here and now, declares unconditional war on poverty in America.” these words spoken by President Lyndon B. Johnson began an era of change for our country. It was during his first State of the Union address that he spoke them and started the War on Poverty. This war would continue to rage on for years. New programs would be formed such as Head Start, which would make sure that some children of poor families had access to early education, and the Food Stamps Program, whose goal was to provide nourishment for those who could not afford it. Another of these programs was the Medicaid program. This program would provide healthcare at no cost to those that desperately needed it. Children of poor families, the elderly, and the disabled would all be covered under this new program.

It was in 1964, after the assassination of President John F. Kennedy, that Lyndon B. Johnson was sworn into office. During the time of Johnson’s presidency, the war in Vietnam was in full swing. Soldiers were dying in record numbers and Johnson signed a bill to send more soldiers to fight. These soldiers would often return from war and need medical care. Also, the Civil Rights Movement was gaining momentum. Martin Luther King Jr. was becoming a well known name, and in 1965 he led the now famous march from Selma to Montgomery, Alabama. It was that year Johnson signed bills that would help change American history forever. One of those was the Voting Rights Act, which gave African Americans the (practical) right to vote (which they had had in theory since the passage of the 15th Amendment in 1870). Another was the bill that amended the Social Security Act of 1935 and created the Medicaid program. This program was designed to ensure that with the help of the federal government, individuals that lived below the federal poverty line would be given free healthcare by their state. After this legislation was passed, Illinois, along with many other states, accepted the program.

While the original purpose of the program was only to provide healthcare for the children of poor families, the elderly, and the disabled living in poverty, many reforms were made over the years to increase the number of people that receive the benefits of the program. Over the years, many changes to the program have been made at the federal level and the states have had the opportunity to expand on those changes and cover more people than the federal government requires. Many times, Illinois has been one of the states that has gone above and beyond by opening the program to more people. For example, the federal requirement for eligibility states that:

"The minimum income level of 133% of the federal poverty level for nearly all people under 65" qualifies a person for medicaid. In Illinois, those percentages go as high as 208% of the federal poverty level." (medicaid.gov)

In fact, as of 2016, the eligibility requirements for Medicaid in the state of Illinois are as follows:

"Children ages 0-18 with family income levels up to 142% of the Federal Poverty Level (FPL).

Pregnant women with family income up to 208% of the FPL.

Adults with family income up to 133% of the FPL." (healthinsurance.org)

As long as a person meets the income requirements put forth by the state and is under the age of 65, he or she is eligible for enrollment in the Medicaid program.

Once a person is enrolled in the Medicaid program he or she will begin receiving a wide range of benefits. These benefits may include, but are not limited to: necessary doctors visits, prescriptions for both drugs and medical devices, yearly check-ups, required immunizations, preventative health screenings and family planning. All of these services and more, such as dental work, are all offered to the Medicaid client at no cost to him or her. Each states' medicaid program is funded by the state and federal government. While it varies by state the federal government funds, on average, a little more than half of the program and the state covers the rest. A bill to fund the Medicaid program through the use of block grants was vetoed by President Bill Clinton in 1995.

Illinois Medicaid has issues with their program. One of these is that it is hard to find providers that take the insurance provided by the Medicaid program. Clients that use the program are having to sometimes travel an upwards of 100 miles away from their homes in order to find a doctor. Another issue is the limited coverage. While Illinois allows more people to be eligible for the program, the services that are offered, such as dental, are the bare minimum. For instance; the dental plan in Illinois only covers preventative care and cleaning. If the client is in need of any type of orthodontic services or dentures, he or she is unable to receive them under the current Medicaid plan. This is also true of their general health plan. Anything that the state deems as cosmetic or unnecessary, is not covered.

There are many good things and a few bad things about the current Illinois Medicaid plans. Since it was implemented in the 60s, the program has helped thousands of people receive health care coverage. While the plan may need to be overhauled and coverage expanded, it is still a much needed program that helps ensure that all those in Illinois that were previously unable to afford health care are covered.

Here are some more details about the relative size of Medicaid nationally and in Illinois:

Nationally, I think about 72 million people are getting health insurance through Medicaid (The figure of 72 million comes from the Henry J. Kaiser Family Foundation http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/ ).

Some older numbers from back before the ACA boosted enrollment by so many millions in states where the program expanded, when the enrollment was merely 59 million, showed a break-down of enrollments like this:

31 million children
11 million non-elderly non-disabled adults
8.8 million non-elderly individuals with disabilities
3.7 million people with disabilities who are enrolled in Medicare (elderly)
4.6 million low-income seniors (see https://www.medicaid.gov/medicaid-chip-program-information/by-population/by-population.html )

The expansion of Medicaid will have increased the proportion of recipients who are adults; this is because before the Patient Protection and Affordable Care Act, poor families with children or disabled persons could often benefit from Medicaid, but poor households in which no one was disabled and no children were living could usually not qualify for Medicaid. Medicaid expansion allowed many of these low-income non-disabled adults who have no dependent children to qualify for Medicaid.

Federal Medicaid expenditure in 2015 were about $332 billion (http://www.hhs.gov/about/budget/fy2015/budget-in-brief/cms/medicaid/index.html#)

There are about 3.2 million people in Illinois who receive health insurance through Medicaid.

I believe in Illinois about $8 billion (or perhaps it's up to $8.5 billion now) gets allocated for health care expenditures, and the vast majority of that goes to Medicaid or the Health Care Management Organizations that handle health insurance for nearly two-thirds of Illinois persons receiving Medicaid. That is about a quarter of the state budget. Even so, the last I heard, the state has debts approaching $600 million that it owes to health care providers who have accepted Medicaid payments for services.