By Sean Miskell
Last week, the House Energy and Commerce Committee held a hearing that provided an opportunity for lawmakers, administrators, and experts to acknowledge the foundational role that Medicaid plays as a source of coverage for millions of Americans and consider how the program will continue to evolve moving forward. Testimony from the Centers for Medicare & Medicaid Services (CMS), the Government Accountability Office (GAO), and the Medicaid and CHIP Payment and Access Commission (MACPAC), and all members of the committee reiterated that Medicaid has become a pillar of coverage alongside Medicare and private insurance, and the need to ensure that the program remains robust in the years to come.
While Medicaid has been a major federal and state program since its inceptions, the hearing highlighted how Medicaid has grown to cover over one in five Americans (72 million people in fiscal year 2013). A central element of this growth is the way in Medicaid has become a key source of coverage for children. As MACPAC notes in its testimony, the program covers almost half of all births in the country. As a result of expansions in the 1990s that expanded kid’s coverage in both Medicaid and the Children’s Health Insurance Program (CHIP), the uninsurance rate for children below the poverty level has declined from 22.4 percent in 1997 to 6.9 percent in 2014.
In her exchange with lawmakers on the committee, CMS’ Vikki Wachino highlighted the central role that Medicaid plays in covering children as well as the importance Affordable Care Act’s Medicaid expansion. In addition to serving as both a crucial source of coverage for uninsured, low-income adults, Medicaid expansion has a welcome mat effect that communicates a clear message to those who qualify for Medicaid but are not enrolled that they are eligible. Wachino also pointed to research that underscores how Medicaid is a sound investment through the long-term educational and economic effects that Medicaid coverage has on children, an issue that we will highlight in a paper later this month.
As witnesses and lawmakers spoke to Medicaid’s important role as a source of coverage, there was much focus on how Medicaid can continue to improve and how to control costs so that Medicaid remains sustainable. Along these lines, congressional representatives and panelists reiterated the importance of increased transparency and better data to help lawmakers and administrators ensure that funds are used in a manner that is consistent with Medicaid goals, a point that was central to our own Joan Alker’s recent testimony before the same committee. In addition to other initiatives designed to move the program towards a value-based payment system, the hearing underscored the importance of the proposed managed care regulations that seek to address and improve a way in which care is provided to a growing number of beneficiaries.
Of course, lawmakers disagree on how Medicaid ought to evolve moving forward, but committee members were unanimous in acknowledging Medicaid’s importance and the need to ensure that the program is sustainable in order to continue to serve as a source of coverage. For example, MACPAC’s testimony underscores the unique role that Medicaid plays as a pillar of coverage alongside other sources, as it serves a population who might otherwise not have access to insurance, is a source of revenue for safety-net providers, provides long-term care for the nation’s elderly, and wraps around other sources of coverage such as employer-sponsored insurance. Further, MACPAC reminds us that the challenge of financial sustainability is not unique to Medicaid. Indeed, Medicaid’s projected 4 percent annual growth rate of four percent is similar to Medicare and lower than that of private insurance.
You’ll see a lot more about Medicaid s we move closer to the program’s fiftieth birthday later this month, but last week’s hearing and testimony provide a great summary of how Medicaid has and will continue to evolve to remain a pillar of health coverage for millions of Americans.
