Who gets Medicaid and who doesn't?

Who gets Medicaid and who doesn't? It's supposed to be a health care program for the poor. But over the years, the definition of poor has changed.

Tess Vigeland: The Congressional Budget Office has been crunching some numbers on the Affordable Healthcare Act. Today it said the recent Supreme Court ruling upholding the law, but changing its Medicaid requirements, will save the government around $84 billion over 11 years. It also noted that repealing the law would increase the deficit by more than $100 billion. We're going to be hearing a lot about Medicaid over the coming months, so we thought it would be a good time to look at the program -- what it is, and who uses it. From New Hampshire Public Radio, Dan Gorenstein has some answers.


Dan Gorenstein:Reporters love to write in a kind of shorthand. And when it comes to Medicaid, the preferred shortcut is, 'the health care program for the poor.'  

Genevieve Kenney: The fact is that's just not the case.

Genevieve Kenney is a health care economist with the Urban Institute.

Kenney: What I find troubling about that is many people assume job done.

The truth, say Kenney, is that Medicaid covers some poor people -- and that's the way it's always been. What makes Medicaid more confusing is that it's kept expanding. Like when it first started in 1965, it covered people with disabilities, low-income seniors, poor kids from broken homes and their caretakers. Fast forward to the '80s. All poor pregnant women and infants up to age 1 get coverage. Then beginning in the '90s, children up to 18 start getting added. Now, in 2012 -- if states decide to -- they can add the latest group of people to the Medicaid ranks.

Sarah Plourde: I walk in and the woman behind the counter very unceremoniously asks me three questions.

Sarah Plourde remembers when she applied for Medicaid.

Plourde: Are you pregnant? No. Do you have children? No. Are you disabled? And I say, no. So she just looked at me and said, we have nothing for you.

Like most people, Plourde had always thought of Medicaid as something for the disabled and the poor.

Plourde: I'm probably the poorest person I know. How can there be nothing for me?

Plourde is one of millions of Americans that policy wonks and, yes, reporters like to call...

Tape: Childless adults.

Parents of low-income kids and childless adults are next in line to receive Medicaid if states choose to expand the program under the new health care law. Historically, childless adults have been considered part of the 'undeserving poor,' people who are stable enough that they don't need help paying doctor's bills. Many of them are young, under 30. Six out of 10 work -- but make almost no money. To qualify for this Medicaid expansion, an individual can't make more than $15,000 a year. Making as little as she does, Plourde says she can't afford to find out what's causing all her migraines.

Plourde: I live with my father. I know he would try to help. But I wouldn't want him to have to shoulder that responsibility. Unless it would be a life or death situation, probably wouldn't seek treatment.

That attitude -- shying away from doctors until there's something urgent -- contributes to the ever-growing cost of health care. A number of governors are on record, saying that expanding Medicaid to people like Plourde is too expensive. As it is, the program eats up about 17 percent of every state's budget.

See how much your state will spend under expanded Medicaid. View an Interactive Map

But Genevieve Kenney at Urban says given that the feds will cover most of the new costs and states could cut elsewhere, some states could actually save money.

Kenney: It's hard for me to see states in large numbers walking away from the federal dollars to address this problem.

And that means if states go ahead and expand Medicaid, the next time I say 'Medicaid, the health care program for the poor,' I'll finally be right. I'm Dan...

Kenney: The one caveat... Gorenstein: Uh-oh. Kenney: The one caveat is that it will not cover immigrants who have been in the country less than five years, and it won't cover undocumented immigrants.

Aww, man. I thought I had it. I'm Dan Gorenstein for Marketplace.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

Comments

I agree to American Public Media's Terms and Conditions.
With Generous Support From...