This paper examines the structural differences between Medicare and Medicaid, two federally administered health coverage programs serving distinct populations in the United States. It traces key reforms introduced under the Affordable Care Act and analyzes how the 2020 presidential campaigns of Donald Trump and Joe Biden diverged in their approaches to both programs, particularly in the context of the COVID-19 pandemic. The paper also evaluates health disparities, proposed expansions of coverage for vulnerable groups, and the politicization of pandemic-era healthcare policy. A concluding section applies these findings to a nursing field placement focused on hypertension management.
The paper uses comparative policy analysis to juxtapose two health programs and two presidential platforms simultaneously, using the COVID-19 pandemic as a stress-test lens. This technique reveals how external crises expose underlying philosophical differences between political positions, particularly around eligibility criteria and government's role in ensuring healthcare access.
The paper opens with a definitional grid comparing Medicare and Medicaid side by side, then narrates historical change through the ACA, moves into a political comparison of the 2020 campaigns, provides a broader evaluative analysis, and closes with a personal field placement application. This progression from description to history to politics to reflection is characteristic of undergraduate health policy writing.
Medicare and Medicaid are two types of health coverage granted to people aged 65 and above or to those with a low socioeconomic status (Cotton et al., 2016; Allen et al., 2021). They are administered by the same federal government but differ in important ways. This paper analyzes how both the 2020 presidential campaigns and their candidates positioned themselves on these two health insurance plans, and how COVID-19 influenced the politicization of both programs.
The following grid describes the basic coverage distinctions between Medicaid and Medicare (Center for Medicare and Medicaid Services, 2018).
Medicare is intended to provide services for people aged 65 or above, disabled individuals, or those suffering from end-stage renal disease (ESRD).
Part A — Hospital Insurance: Covers inpatient hospitals, skilled nursing facilities, hospice care, and certain home health services. Medicaid may be used as a last resort in these cases, paying after Medicare as the primary payer.
Part B — Medical Insurance: Covers services provided by specialist physicians, outpatient care, durable medical equipment, and specific preventive services. If an individual has Medicare coverage and qualifies for Part B benefits, they may be automatically enrolled in the Medicare Savings Program (MSP), with Medicaid paying the premium (Medicare Interactive, n.d.-a).
Part C — Medicare Advantage (MA): Private insurance companies approved by Medicare provide all Part A and Part B services, along with coverage for substance abuse treatment and additional benefits.
Part D — Prescription Drug Benefit: Drug insurance plans provided by private Medicare-approved companies covering prescription medications.
Medicaid is intended to provide services for individuals in low-income segments, pregnant women, and children.
Part A equivalent: Medicaid may serve as a secondary payer for inpatient and nursing facility services when Medicare has already paid its share.
Part B equivalent: As noted above, Medicaid may cover the premium for those enrolled in the Medicare Savings Program.
Part C equivalent: Functions similarly to the Part B arrangement for dual-eligible enrollees.
Part D equivalent: Medicaid covers some drugs not included in Medicare Part D — for example, medications related to anorexia, weight management, fertility, and cold and cough relief (Medicare Interactive, n.d.-b).
The comparison above highlights key differences between the two medical coverage programs in the United States. Because the focus of each plan differs — Medicare serving the aging population, disabled individuals, and ESRD patients, while Medicaid targets low-income populations, pregnant women, and children — their coverage structures are complementary rather than redundant. Most medical insurance facilities flow through Medicare's Parts A, B, C, and D; Medicaid steps in to cover gaps or serves as a payer of last resort.
After the President signed the Affordable Care Act in 2010, the ACA worked to reduce the uninsured rate from 16 percent down to 9 percent by 2016 (Rapfogel, Gee & Calsyn, 2020). In 2014, Medicaid expansion was introduced to allow private coverage as well. Together, the ACA and Medicaid insured more people than previously targeted, without discrimination based on income level, race, or age, and including both children and elderly individuals.
Low-income people gained significantly improved access to healthcare services that had previously been at record-low levels of availability, including mental health treatment, outpatient visits, cancer care, and substance abuse services. These gains translated into tangible benefits: access to a personal doctor, regular follow-up care, and reduced rates of re-hospitalization (Kino & Kwachi, 2018; Griffith, Evans & Bor, 2017; Brown et al., 2021). Access to prescription drugs expanded for low-income individuals, the disabled, and the elderly, and taxes on certain medications were reduced, helping to lower mortality rates among less-privileged populations. Eligibility criteria also became less restrictive, allowing previously ineligible individuals to enroll.
For Medicare specifically, many of the ACA changes mirrored those made for Medicaid-eligible populations. The coverage gap in Part D was narrowed (Rapfogel, Gee & Calsyn, 2020), prescription drugs became more accessible to a broader population, and elderly patients no longer faced the full out-of-pocket cost of most medications.
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