Helping the poor is not an issue that is exclusive to one side of the political spectrum.
The question is not whether to help those in need but how best to help them. A timely example that illustrates the differing approaches the left and right have on this is the role of Medicaid in the Affordable Care Act.
Medicaid was established in 1965 to provide a health care safety net for certain vulnerable categories of low-income people. In general, this has meant poor women and their children and the elderly and disabled. Since Medicaid is a joint federal-state program, the states share in the cost of the program and in determining the size and scope of the program beyond any federal minimum standards.
The Affordable Care Act allows states to add another category to Medicaid: able-bodied adults, many of whom are without children. The ACA also provides much higher federal funding–as compared to the funding for traditional groups (like moms and kids and the disabled)–to entice the states to expand their program to these able-bodied adults. So it’s not surprising that recent analysis of enrollment by my colleagues at the Heritage Foundation has shown that the vast majority of coverage gains under the ACA have not been a result of the so-called “marketplace” exchange but rather because of an ever-expanding Medicaid program.
But these short-term coverage gains will soon be overshadowed by the longer-term challenges that continue to plague the program and are likely to be exacerbated by the ACA.
First, there’s the demographic challenge: Medicaid enrollment is set to skyrocket. By 2022, there will be over 80 million people on Medicaid, according to the Office of the Actuary at the Center for Medicare and Medicaid Services. As a rough comparison, the Medicare Trustees estimate that there will be 68 million people on Medicare by 2022.
Then there’s the issue that while accounting for just over 25 percent of enrollment, elderly and disabled make up over 65 percent of Medicaid spending.So with all eyes fixed on shuffling people on to Medicaid, there has been little attention to figuring out how to dewire this ticking time bomb.
Finally, there’s the access issue. There have been numerous academic studies that have exposed the fact that Medicaid patients have worse access and outcomes than privately insured patients. For example, a 2003 study found that health outcomes for colorectal, lung, prostate and breast cancer in Kentucky were higher for privately insured than those on Medicaid. A 2010 study found similar results for non-cancer-related illnesses.
Medicaid needs reform, not expansion. Medicaid has its place in providing a safety net. But, it should be a secure safety net, not one filled with holes and patches. Policymakers and advocates for the poor should also begin to think about better ways to serve the poor, recognizing that rigid government programs typically fail to adapt in a timely way to address the unique needs of a very diverse population.
This Thursday, the Heritage Foundation is hosting its annual antipoverty forum, where a broad cross-section of researchers, policy leaders, expert practitioners, communicators and philanthropists will gather to explore better ways to serve the poor, including providing better health care options. With regard to health care, we will discuss ways to ensure better access to care, more effectively target the needs of the poor and ways to integrate more patient-centered care into the existing programs.
There are many people on all sides of the political spectrum who care for the poor. Now is not the time to surrender to the status quo but to explore better options.