Jul 18, 2019

Medicaid should be a bigger part of the "Medicare for All" debate

Illustration: Aïda Amer/Axios

The fact that “Medicare for All” would eliminate Medicaid hasn’t gotten nearly as much attention as its elimination of private insurance. But it’s a move that would largely eliminate states’ role in the health care system.

Why it matters: State Medicaid programs are leaders in experimenting with delivery and payment reforms, efforts to control drug costs, and addressing social causes of ill health, such as poverty and poor housing. All of those projects would still be important in a single-payer world.

How it works: Sen. Bernie Sanders’ bill would move most Americans into its new single-payer system, including people with private insurance but also virtually all of the 73 million people covered by Medicaid and the Children’s Health Insurance Program.

Winners: States would reap huge savings. Medicaid is the single largest item in most state budgets.

  • The effects on safety-net hospitals and clinics would vary, depending largely on how payment rates under the new plan compare to today’s Medicaid rates.
  • The uninsured in states that have not expanded Medicaid also would be big winners.

Yes, but: The change would all but eliminate states’ role in health care, where they have been leaders not just in providing coverage, but also driving efficiency and testing new models of care.

  • Those reforms — and the idea of states as laboratories of reform — would pretty much disappear, and the balance of federalism in health would fundamentally change.

The bottom line: For advocates of a single national plan, eliminating the patchwork of state Medicaid programs would be progress. For fans of a federal-state balance, it’s a big problem.

  • Either way, Medicaid is a large and generally popular program, and its future at least deserves a bigger role in the debate.

Go deeper

What Democrats are doing on health care

Illustration: Rebecca Zisser/Axios

As Democratic presidential candidates debate their ideal health care system, blue states are making incremental — yet significant — changes to the existing one.

Why it matters: In the states where they have power, Democrats are creating a blueprint for how the ACA could evolve under Democratic control in Washington.

Go deeperArrowJul 31, 2019

The health care debate Democrats aren't having

Candidates at the Democratic debate in Detroit. Photo: Justin Sullivan/Getty Images

Tuesday night's field of presidential candidates fought in 30-second soundbites over the merits of single payer Medicare for All versus a public option.

Yes, but: None of the candidates moved beyond sparring over insurance reforms to address the underlying reason why people are having so much trouble affording their health care, which is that health care services keep getting more expensive.

Go deeperArrowJul 31, 2019

Trump won't approve full federal funding for partial Medicaid expansion

President Trump and CMS administrator Seema Verma. Photo: Mark Wilson/Getty Images

The Trump administration made a very big decision over the weekend: It won't approve full federal funding for a partial Medicaid expansion.

Why it matters: The partial expansion had looked like a key weapon in red states' continued resistance to the ACA. Without it, Medicaid enrollment likely will keep growing.

Go deeperArrowJul 29, 2019