Coverage for Low Income Americans

Let’s assume for a moment that both Democrats and Republicans want to see Americans covered by health insurance.  Then how do you make that work for those who can least afford to pay for the coverage?  Income tax credits or low income subsidies only go so far. What we need is a plan that provides coverage at little or no cost for those who are on the edge, financially.

What if we were to craft a plan of coverage for those between 100% and 300% of federal poverty that they could easily obtain, at little or no premium cost for them? The plan would provide coverage but would require some level of cost sharing when services are accessed, so that unnecessary utilization is discouraged.  A plan like this could be funded with a combination of federal and state dollars, but the administration of the actual plan would be the responsibility of the states, with some federal oversight.

Well this exists now, under what is called “Medicaid”.  The problem is that the recent Medicaid expansion is costing the federal government too much, and fears exist that this cost will increase substantially over the next ten years, which threatens major increases in the national debt.

The solution is in crafting creative approaches to reforming the current Medicaid program, not attempting to create something new.  If the reference to “Medicaid” is too politically charged, then a new name should be created for this reformed program.

Medicaid is certainly not perfect: its reimbursement for primary care providers is too low which discourages them taking new patients, which results in unnecessary emergency room care; the types of benefits are structured in silos based upon categorical eligibility; the level and types of case or disease management is largely ineffective (varies by state); etc. But these shortfalls are known, and can be fixed.

Let’s focus on how to improve the current program, and control its cost, without discarding it.