It's time to create a program that extends health coverage to the poor much like Medicare insures older Americans.

You might think that such a program already exists: Medicaid. In political rhetoric and casual conversation Medicaid is referred to as an insurance program for those with low incomes. That is not the case.

Medicaid is a patchy social safety net covering mostly children, the disabled and pregnant women. Some parents qualify for Medicaid but are subject to strict income tests. A family of four, for example, may not earn more than $594 per month or have more than $3,000 in assets such as a savings account.

Coverage is better for children. A family of four earning up to $3,534 per month can get Medicaid for their children from birth to five years old. Once that child reaches six then the monthly income limit drops by several hundred dollars. In some cases families with higher incomes can qualify for Medicaid with a deductible.

As you can see, qualifying for Medicaid is no easy task. Even experts have trouble discerning whether or not a particular person without insurance qualifies for the program. If we pass comprehensive health reform, this would change.

Under the health care bill passed by the Senate, which is the piece of reform legislation still alive, Medicaid would cover all those with incomes below 133 percent of federal poverty level. For a single individual that's $14,404 per year. For a family of four it's $29,327 per year. There would be no more asset limits.

This would make Medicaid a program that truly covers low-income Americans. It would also create a strong social safety net to catch anyone in economic free fall.

The Senate health reform legislation would also begin lifting the Medicaid burden off of states.

Medicaid is funded by state and federal governments. The feds pay more than half of North Carolina's Medicaid bill, but Medicaid still eats up 15 percent of the state's budget. That is more than we appropriate to the University of North Carolina system and more than we spend on public safety. Medicaid is an enormous expense for every state.

Reform opponents have made much ado about a "deal" that bill sponsors crafted for the state of Nebraska whereby the federal government would cover the entire cost of covering the newly eligible Medicaid enrollees. But the truth is that the feds would pay most of the tab for almost every state. Michigan, Nevada, Oregon and Rhode Island would essentially get the same deal as Nebraska due to a combination of factors such as high unemployment and low Medicaid enrollment.

In North Carolina, the federal government would cover 95 percent of the costs for our Medicaid expansion. And the expansion would mean that more than 50 percent of North Carolina's uninsured residents would qualify for Medicaid.

Reform could eventually shift almost all Medicaid funding to the federal government. That would be a great relief to North Carolina. We are required to balance the state budget every year, whereas the federal government can borrow money during hard times to keep the economy afloat and continue providing services. During economic downturns people lose jobs and health coverage and Medicaid rolls swell. That forces the state into crisis.

Currently the state's Medicaid program is hundreds of millions over budget. Something has to change.

The good news is that our state has a great Medicaid program called Community Care of North Carolina or "CCNC." CCNC coordinates the care of Medicaid recipients and ensures access to primary care physicians and pediatricians. Medicaid in North Carolina could provide excellent care to low-income residents, if only they could qualify.

After the recent special election in Massachusetts health reform negotiations are in disarray. But the Senate bill sets in motion a range of reforms that are too important to abandon.

And if we are going to retool the health care system, Medicaid is a good place to start.

Adam Linker is a Policy Analyst at the N.C. Health Access Coalition