50 Years of Change — for the Better | Commentary
By Bruce Siegel, Margaret A. Murray and Daniel Hawkins Since 1965, Washington, D.C., and Congress have seen many changes. Back then, we adjusted the “rabbit ears” to get the news clearly on TVs that displayed just a few channels. The National Mall was the site of frequent war protests and civil rights marches. The Cuban Embassy had closed and gas cost 31 cents a gallon.
Medicaid, which just celebrated a remarkable milestone — its 50th birthday — was different, too. As signed into law by President Lyndon B. Johnson on July 30, 1965, Medicaid had a more limited role, covering care for low-income women and their children.
This bold young program has had a steep learning curve, adapting over the past half century to serve a growing population with diverse needs. It also has served as a laboratory for innovations that improve health care quality and value.
Today, Medicaid provides health care to one in every five Americans from all walks of life. The program has touched nearly two-thirds of Americans, either directly or through a family member or friend. Medicaid fills the gaps in health coverage that frequently occur in people’s lives and helps them transition through life events that would otherwise leave them uninsured.
Medicaid’s harshest critics have called Medicaid worse than no insurance at all and warn that it leads to a lifelong dependence on the government. These assertions simply do not stand up to the facts. The average adult covered by Medicaid spends only a portion of any given year enrolled in the program, and when compared with the uninsured, Americans covered by Medicaid have better health outcomes and greater economic security. We know that children with Medicaid coverage live healthier and more productive lives as adults than similarly disadvantaged children without access to the program.
What many people don’t know is that the majority of adults with Medicaid are employed and pay taxes, but work in low-wage jobs that don’t offer health insurance. Medicaid pays the cost of half the deliveries of newborns in the United States every year. Two-thirds of Medicaid’s budget goes to support seniors and people with disabilities. It may come as a surprise that one in five people with Medicare – more than 9 million people – also rely on Medicaid to cover the things that Medicare doesn’t, including nursing home, dental and vision care. Few realize the value Medicaid generates: Coverage for an adult costs an average of $5,671 a year, 20 percent less than the cost of private coverage.
Yet Medicaid does more than just pay the bills. The program has evolved to meet the changing way we deliver and pay for care, and has been a remarkable source of innovation within the American health care system. States have developed models of home and community-based care that have made independent living possible for children and adults who would otherwise be institutionalized. Without support from Medicaid, many rural hospitals would be in danger of closing, leaving all members of these communities underserved.
Medicaid also gives states enormous flexibility in terms of whom they cover, what benefits they provide, and how they deliver health care services. Using federal waivers, states can experiment with new approaches that often lead to changes adopted by the entire country. In the past 50 years, every state has been granted at least one waiver, and most have had many approved.
We know there will be times in people’s lives when they face medical challenges—sometimes serious ones — when we least expect it. A parent caring for a child born with a disability. An adult diagnosed with a chronic condition or disability. A cancer patient who lost their job and their insurance. Many things change in our lives, but a constant for all of us is that we may need medical help, quite possibly at a time when we are most vulnerable.
Over the past half century, much has changed. But Medicaid has been there throughout, proving its value to patients and taxpayers, and evolving to meet the nation’s health care needs. Medicaid has more than proved its worth as a program that saves, improves and prolongs lives—making us a better people, a better society, and a better country. We will continue working to ensure it remains strong and vital for another 50 years.
Bruce Siegel is president and CEO of America’s Essential Hospitals, co-chair of The Partnership for Medicaid; Margaret A. Murray is CEO of the Association for Community Affiliated Plans, Partnership member; and Daniel Hawkins is senior vice president of the National Association of Community Health Centers, chair emeritus of the Partnership.