Medicaid State Public Health Insurance

Medicaid

State Public Health Insurance Programs

Medicaid is the United States

Millions of people in the United States today are uninsured, despite the fact that the U.S. government officially sponsors a program called Medicaid designed to help the poorest of poor Americans obtain healthcare. Theoretically, everyone whose income falls below a designated limit should be able to rely upon Medicaid for basic care. But given the realities of economic and political life in the U.S., this is not always the case. 16.3% of all individuals (about 44.3 million) had no insurance coverage in 1998 and that number has ballooned since the current recession (Jacobs & Rapoport 2002: 315). Individuals with incomes above the poverty threshold working multiple jobs that do not offer benefits to part-time workers often must rely upon emergency rooms for basic, primary care yet they are not technically eligible for Medicaid.

Part of the problem is inconsistency in terms of Medicaid funding and standards from state to state. Unlike Medicare, the program designed to provide healthcare coverage for senior citizens, Medicaid programs are run by the states and financed through state as well as through federal initiatives. States have been financially strapped because of the recent recession -- there is increased demand for social services, yet less income tax money is replenishing the state coffers. State-by-state funding is theoretically designed to allow states to tailor their aid to the needs of individual populations but has resulted in inconsistent policies and difficulties meeting the needs of the disparate populations Medicaid is designed to treat, including the elderly poor, children, mothers, and the disabled (Jacobs & Rapoport 2002: 323).

Medicaid's outreach has been expanding because of the increase in poor children without healthcare. Since 1990, the costs of the program have skyrocketed, as it has provided funding for families whose incomes are technically above the poverty line with uninsured children. There is also a persistent reluctance amongst physicians to serve Medicaid patients, because of low levels of reimbursement and a lack of timely reimbursement.

In Illinois, for example, the underfunded Medicaid program tallied up $1.5 billion in unpaid medical claims from 2005-2007 and there was a total of $80.6 million in unpaid interest owed to providers treating Medicaid patients between July 1999 and November 2007, despite the existence of an Illinois prompt-payment law. This interest is money that should not 'need' to have been spent, since money paid for interest does nothing to improve the quality of care for recipients. Another problem is a high rate of rejection of Medicaid claims and slow processing of rejection notices -- as much as 87 days in fiscal 2006, according to one recent study (Trapp 2008).

This high rate of rejection of claims has caused a correspondingly high rate of rejection of patients with serious health complaints, including children. A The New England Journal of Medicine study published in June of 2011 found that 66% of parents who mentioned they were part of the Medicaid-CHIP (Children's Health Insurance Program) were denied appointments from specialist physicians for complaints spanning from their children's diabetes, seizures, asthma, broken bones to depression, compared with 11% who said they were privately insured. For those whom the specialist agreed to see, the waiting time was on average 22 days longer (McArdle 2011). This results in less efficient care, given that all of the illnesses in the study were exacerbated rather than mitigated by long, untreated wait times.