Signed into law by President Lyndon Johnson on July 30, 1965, Medicaid has provided hundreds of millions of American with access to health insurance and, often, life-saving health care that they would otherwise have not enjoyed because of their limited incomes.
As the Kaiser Family Fund reported last year:
Medicaid is the nation’s public health insurance program for people with low income. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for Americans. The vast majority of Medicaid enrollees lack access to other affordable health insurance. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector.”
The program is organized as a federal-state partnership that provides a great deal of flexibility to the states. As KFF also noted:
The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees.
Of course, the central debate that has surrounded Medicaid for several years concerns the question of expansion under the terms of the Affordable Care Act. Since expansion became available in 2014, 38 states (including the District of Columbia) have now opted to expand Medicaid eligibility to include millions of Americans in the “coverage gap.” People in the gap earn incomes above current Medicaid eligibility threshold but below the lower limit for marketplace premium tax credits that would allow them a realistic chance to afford private health insurance.
Regrettably, North Carolina remains one of the 13 holdout states, though it seems hard to imagine that this won’t change if – as many pundits predict – Democrats win back control of the General Assembly this fall (or come close to doing so).
Here are some other salient numbers about the program in this anniversary week:
72.3 million – number of Americans enrolled in Medicaid, including its sibling, the Children’s Health Insurance Program – CHIP
2.3 million – number enrolled in North Carolina
Up to 634,000 – estimated number of North Carolinians who would gain access to affordable coverage through Medicaid if the state closed its “coverage gap” and expanded Medicaid access pursuant to the ACA. (This estimate pre-dates the onset of the current COVID-19 recession.)
60% – of those in the coverage gap, the estimated share that were members of working families prior to the recession
20% – estimated percentage of non-elderly adult North Carolinians who are currently uninsured
$12,000 – annual income threshold for a parent with two children to be eligible for Medicaid coverage in North Carolina; those earning above that amount are ineligible
$618 – average monthly cost of health insurance premium in North Carolina in 2019
0 – number of non-disabled, non-elderly adults without a child dependent who are eligible for Medicaid in North Carolina
350 – estimated annual number of “excessive deaths” in North Carolina in 2018 due to the failure to expand Medicaid
90% – percentage of the cost of Medicaid expansion at the state level that is covered by the federal government
$100.1 million – estimated net two-year savings in North Carolina state agency budgets if Medicaid had been expanded for the current biennium
70 – of North Carolina’s 80 rural counties, the number that are already designated as “medical deserts” for their lack of primary care availability (rural hospitals are among the loudest advocates for Medicaid expansion in order to help allay their large and growing costs for uncompensated care)
37,000 – estimated number of jobs that would be created in North Carolina as a result of Medicaid expansion
Sources: NC DHHS, the Kaiser Family Foundation, the N.C. Budget & Tax Center, N.C. Hospital Association, Families USA, healthmarkets.com