Like a lot of social programs that rely, at least in part, on state funding, Medicaid is somewhat oddly designed. It's easy to fund when the economy is good and state tax revenues are high. But that's when it's least needed. It's very hard to fund, however, when the economy is bad and state tax revenues drop. But that's when enrollment spikes. So when Medicaid is most needed, it is most expensive, and states are least able to afford it. And, as The New York Times reports, that's the situation we're in right now.That's why the federal role is important, and why it's crucial that the stimulus contain quick funding to expand and sustain Medicaid. But it's also time we changed the program pretty significantly. The popular perception is that Medicaid is health care for the poor. It is not. It covers some poor people, and some pregnant people, and some young people, and some disable people, and some other people. Oh, and who fits in those groups varies from state to state. Quoth the Centers for Medicaid and Medicare Services: "Medicaid does not provide medical assistance for all poor persons... [or] even for very poor persons, unless they are in one of the designated eligibility groups."For instance, 18 states, including DC, provide comprehensive coverage to working parents in families with income at 100 percent of the federal poverty line or higher. 33 don't. Change any of those variables -- say you're a married working adult with no children -- and the number shifts again. And the variations among states are huge. Alabama cuts off unemployed parents at 25 percent of the federal poverty line. 25 percent. If you're a working parent making more than $366 a month, you're too rich for Medicaid in Alabama. In Arizona, the threshold is 200 percent of the poverty line -- $2,933 a month.As you can imagine, this makes Medicaid a bitch to sign up for, and humiliating to boot. There are asset tests and a thousand categories and a million forms. And now we're in a deep and likely enduring recession. So, enough. This is an excellent time to reform and simplify Medicaid. Open it up to all individuals and families making beneath 250 percent of the federal poverty line. Increase the reimbursement rate to doctors slightly (stimulating!). Make it a primarily federal program, with states able to use state money to expand categories or add services. Fund it with federal stimulus money. The spending will pump cash into the economy and fill an acute need. People think we have a program that provides health insurance to the poor. We don't. It's long past time to fix that.Update: And by the way, MSNBC, posts like this demonstrate exactly why the 10 P.M. Ezra Klein Hour will get tremendous ratings. Jay Leno's got nothing on ending categorical eligibility in Medicaid. TOWARDS A BETTER MEDICAID.
Like a lot of social programs that rely, at least in part, on state funding, Medicaid is somewhat oddly designed. It's easy to fund when the economy is good and state tax revenues are high. But that's when it's least needed. It's very hard to fund, however, when the economy is bad and state tax revenues drop. But that's when enrollment spikes. So when Medicaid is most needed, it is most expensive, and states are least able to afford it. And, as The New York Times reports, that's the situation we're in right now.That's why the federal role is important, and why it's crucial that the stimulus contain quick funding to expand and sustain Medicaid. But it's also time we changed the program pretty significantly. The popular perception is that Medicaid is health care for the poor. It is not. It covers some poor people, and some pregnant people, and some young people, and some disable people, and some other people. Oh, and who fits in those groups varies from state to state. Quoth the Centers for Medicaid and Medicare Services: "Medicaid does not provide medical assistance for all poor persons... [or] even for very poor persons, unless they are in one of the designated eligibility groups."For instance, 18 states, including DC, provide comprehensive coverage to working parents in families with income at 100 percent of the federal poverty line or higher. 33 don't. Change any of those variables -- say you're a married working adult with no children -- and the number shifts again. And the variations among states are huge. Alabama cuts off unemployed parents at 25 percent of the federal poverty line. 25 percent. If you're a working parent making more than $366 a month, you're too rich for Medicaid in Alabama. In Arizona, the threshold is 200 percent of the poverty line -- $2,933 a month.As you can imagine, this makes Medicaid a bitch to sign up for, and humiliating to boot. There are asset tests and a thousand categories and a million forms. And now we're in a deep and likely enduring recession. So, enough. This is an excellent time to reform and simplify Medicaid. Open it up to all individuals and families making beneath 250 percent of the federal poverty line. Increase the reimbursement rate to doctors slightly (stimulating!). Make it a primarily federal program, with states able to use state money to expand categories or add services. Fund it with federal stimulus money. The spending will pump cash into the economy and fill an acute need. People think we have a program that provides health insurance to the poor. We don't. It's long past time to fix that.Update: And by the way, MSNBC, posts like this demonstrate exactly why the 10 P.M. Ezra Klein Hour will get tremendous ratings. Jay Leno's got nothing on ending categorical eligibility in Medicaid. 
