It’s not health care, it’s health care finance
Problem: Trilemma of low cost + high access + high technology (new treatments)
-rising costs ($14,000/yr per family), due to aging population and high technology
-low access (pre-existing conditions, small businesses, lifetime limits, self-employeed)
-1/7 have no insurance (but old and poor do! Plus many with particular diseases)…they just go to the
emergency room, which then charges higher rates on their paying patients.
= 47 million. Mainly seniors ages 65 and older, but also 8 million younger adults with
permanent disabilities. Before Medicare was signed into law in 1965, about half of all seniors lacked
Today, virtually all people ages 65 and over are covered by Medicare.
Medicaid and the State Children’s Health Insurance Program (SCHIP)
= 63 million
Created by Congress in 1965, Medicaid is a public insurance program that provides health coverage to
low-income families and individuals, including children, parents, seniors, and people with disabilities.
Medicaid is funded jointly by the federal government and the states. Each state operates its own
Medicaid program within federal guidelines. Because the federal guidelines are broad, states have a
great deal of flexibility in designing and administering their programs. As a result, Medicaid eligibility
and benefits can and often do vary widely from state to state. In 2008, Medicaid is projected to provide
health coverage for nearly 63 million low-income Americans over the course of the year, including 31
million children, 17 million adults (mostly low-income working parents), 6 million seniors, and 10
million persons with disabilities.
In order to receive guaranteed federal funding, states must cover certain “mandatory” populations:
* children under age 6 with income below 133 percent of the federal poverty line (in 2008, the
poverty line was $17,600 for a family of three);
* children aged 6-18 with income below the poverty line;
* pregnant women with income below 133 percent of the poverty line;
* parents whose income is within the state’s eligibility limit for cash assistance that was in place
prior to welfare reform; and