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Medicaid, the joint federal-state health program for people with low incomes, serves more than 70 million people, covers 1 in every 5 births in the U.S. and foots more than half the nation’s bill for long-term care. Yet Medicaid isn’t one program, it’s 56 separate programs (one for each state plus the District of Columbia and U.S. territories).
Understanding Medicaid isn’t easy, but with plans to overhaul the health system back in the news, it’s critical.
This week KHN’s “What the Health?” podcast takes a deep dive into Medicaid. First, host Julie Rovner talks with Diane Rowland, executive vice president emerita of the Kaiser Family Foundation and one of the nation’s leading experts on the Medicaid program. (KHN is an editorially independent program of the foundation.)
Then, panelists Joanne Kenen of Politico, Tami Luhby of CNN and Margot Sanger-Katz of The New York Times join Rovner for a discussion of some of the top issues facing Medicaid in Washington and the states in 2019.
Among the takeaways from this week’s podcast:
- Fourteen states still have not expanded the federal-state health insurance program for lower-income people.
- In some of these states, Republican governors or state legislators opted against expansion, but voters responded by approving ballot initiatives in favor of it. The result has not necessarily been what voters intended. In states like North Carolina, for instance, where strong political differences between the governor and the legislature have triggered a protracted budget meltdown, it has become an ongoing irritant. In Maine, the expansion was on hold for more than a year after the ballot question’s approval, until the Republican governor was replaced by a Democrat.
- States are also looking at ideas such as coupling expansion with a work requirement as a means to proceed. It is not clear, however, that courts will allow work requirements to go forward.
- Turning federal Medicaid funding into a block grant is also still on the table. The idea dates to at least the 1980s, and it involves giving states a lump sum of money ― less than they would receive otherwise ― in exchange for allowing them more flexibility to run their programs with less federal oversight.
- The last time block grants were seriously considered, however, when Senate Republicans proposed them in 2017, public opinion turned sharply against the idea. People feared that less money would inevitably mean the program would cover fewer people and/or fewer benefits.
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