Medicaid Expansion: The Bigger Picture

With 63 million enrollees, Medicaid provides coverage to low-income families, individuals with disabilities, and elderly individuals on Medicare who need assistance with cost sharing or services not covered under Medicare (dual eligibles).  In 2009, the Medicaid program dished out $346 billion on health care services, or $5492 per enrollee (obviously spending varies per person depending on number and severity of health issues). With this much money being spent, one would expect that quality of care received would be pretty good (at least), and substantially better than those who have no insurance at all.

Unfortunately this is not the case. A recent RAND Corporation study found that there was little difference in the quality of health care received by Medicaid enrollees and uninsured individuals. Another study, which evaluated cancer survival rates by insurance status, found little discrepancy between those who were uninsured and those who had coverage under Medicaid.  While evidence suggests that this program is failing, the Medicaid expansion under the President’s Affordable Care Act increases enrollment through more generous qualification standards for enrollees and increases the share that the federal government pays from an average of 57 percent to 100 percent initially. By 2020 the FMAP ratio will decrease to a 9:1, remaining a large expense for an underperforming program that has expanded well beyond the scope originally envisioned.

What’s more disconcerting about this influx of money to Medicaid is all that fails to recognize. The increase of Medicaid enrollees in recent years represents a much larger societal problem more far reaching than the delivery of health care. The variation of Medicaid spending across states is telling of how complex and different populations are between states, and between neighborhoods for that matter.  In only 3 Metro stops to a northeast section of Washington, DC, there is a 12-year drop in how long you live. Health is much bigger than being covered by a failing program, which the ACA does not acknowledge. Health services are only a piece of a large pie that is health and well-being. We must first understand this before we throw billions of dollars that could be used to better address the overarching societal issues that contribute to one’s overall health.