When Medicaid was created in the mid 1960s as part of LBJ Great Society legislation. It was created as Health Insurance program that would be run by both the Federal and State Governments. It was a program that would provide Health Insurance for Low Income people, as well as disabled people. Who couldn’t get Health Insurance from anywhere else. Its a bare bones Health Insurer that only provides Health Insurance for peoples needs and in some cases doesn’t fully pay for Health Insurance for all procedures. Its a Health Insurer that most people probably wouldn’t select, unless they had nowhere else to go. And for the most part has met its mission as far as what it was originally designed to do.
The problems with Medicaid are several as I see it. For one the Federal Government doesn’t pay for everything that it originally said it would pay for in the Medicaid Law. But States still have to meet the requirements that they are responsible to cover and pay for. And a lot of times end up having to pay for what the FEDS won’t pay for, that they said that they would pay for. Making Medicaid an Unfunded Mandate. Meaning the FEDS telling States and Localities what they have to cover with their money. And not providing the resources or advice on how to implement it. Medicaid was suppose to be a Federal State Partnership. But States have ended up being the General Partner in providing the resources. While the FEDS have been the General Partner in providing the regulations for the States. Bad partnership. Another issue with Medicaid is that its a large Health Insurer of around 40B$ a year or so perhaps even bigger then that. Without a direct revenue source, people on Medicaid get their Health Insurance for free. With the States and FEDS figuring out to pay for it. And a lot of times that means cutting something else and a lot of time that means cutting key Public Services. One of the issues with the Affordable Care Act of 2010, even though generally speaking I support it. Is to help cover and additional 30M people with Health Insurance. But without a way to pay for, so States are probably going to have to make up this gap. When their budgets are already facing deep shortfalls and cuts.
So what I would like to do to reform Medicaid, is to get it off the FEDS and States backs. So they no longer have to figure out pay for this expensive program. That in a lot of ways is a drain on their budgets. Not by ending it but by reforming it, by making it independent of the Federal and State Governments. By turning it into an independent Non Profit Health Insurer, that would still be targeted for Low Income and disabled people. But would have its own Management and Board of Directors that they would select. And with its own revenue source, paid for by their patients and employers. And for the disabled, people on Welfare or Unemployment Insurance, the government would pay for the part of their Health Insurance. With these people also getting their Earned Income Tax Credit increased to pay for their Health Insurance. Whether its Medicaid or private Health Insurance Medicaid would still be partially owned by the Federal Government. With States having a role in the Medicaid division in their States. As far as regulating but Medicaid would be independent and able to make their own decisions eliminating Red Tape and making it more efficient. Medicaid would be under the same regulations as private Non Profit Health Insurers.
Medicaid is an important Health Insurer providing Health Insurance for the most needy. And needs to stay in business but needs to be reformed to make it more Cost Effective and efficient.