The Road Ahead: Medicaid & Medicare

Written by: Christopher Plein, Ph.D.  West Virginia University

Recently, I made a community presentation to social workers, education specialists, healthcare prevention workers and other helping professionals in my home state of West Virginia.  Among those in attendance were professionals working with veterans, some of whom are long retired and others more recently separated from military service.

The meeting helped my thoughts turn again to how closely military families are tied to the “civilian world.”  I introduced the group to the work that we do in the OneOp emphasizing the common bonds that we all share in helping families. We talked about recent trends in Medicare and Medicaid and possible future developments for these two keystones of the American health system.

Active duty military families may find that family and loved ones are eligible for these programs due to health conditions, age or economic need.  Those facing retirement and separation from the military also need to consider the road ahead and how Medicaid and Medicare may figure into their plans.

Most know that Medicare is a federal health insurance program primarily for those over 65 years of age.  It also serves those with specific diseases and disabilities.  Medicaid operates as a state-federal partnership providing health insurance for lower income populations as well as those with special health conditions and disabilities.   As we have noted in previous blogs and webinars, these programs are a complex yet vital part of our healthcare infrastructure.

For well over a decade, both programs have changed due to various federal legislative and regulatory reforms.  The best known of these is the Affordable Care Act of 2010 which made some revisions to Medicare but most importantly allowed for Medicaid expansion to newly eligible populations of low income adults.

Along with demographic changes in our population (many of us are getting older), policy changes are resulting in more and more Americans being covered by either Medicaid or Medicare. Currently, 33 percent of the U.S. population is covered by one or the other helping to bring our overall uninsured rate down to 9 percent.

Utilizing helpful data from the Kaiser Family Foundation and comparing these to data on active duty military populations in the states, we offer a quick glimpse of trends in the tables and charts below.

As noted in a previous blog, almost half (49 percent) of all active duty military are based in just five states:  California, Virginia, Texas, North Carolina, and Georgia.  The table below is from that blog that and relies on data from Defense Manpower Data Center (MDDC).  We’ll call these states the “Big Five.”

Source: Understanding Military Assignment Dynamics in the U.S.: A Look at the Data & Some Questions to Ponder (Plein, 2018).

Medicaid & Medicare Enrollment

Now let’s take a look at Medicaid and Medicare enrollment trends in these states.  What we find is an interesting and varied portrait of what is happening.  In California, for example, 36 percent of the population is covered by either Medicaid or Medicare.  To date, California is the only state among the “Big Five” to implement an expanded Medicaid program.  By expanding Medicaid coverage to previously ineligible groups, enrollment numbers have increased.  As the data suggest, this helps to reduce overall uninsured rates.

Source: Health Insurance Coverage of the Total Population, Henry J. Kaiser Family Foundation, 2016

Both Virginia and Texas lag behind the national average for Medicaid and Medicare coverage.  However, the picture in Virginia may change soon as it has recently passed legislation to expand Medicaid.

Because Medicaid and Medicare can figure so prominently in providing assistance to family members, it is worth considering the status of these programs when making location and caregiving decisions.  While Medicare coverage provisions are uniform across the United States, Medicaid varies widely from state to state.

One trend that we can anticipate is that more states, even in traditionally “red” regions, will decide to expand Medicaid in order to help lower income adults.  In the 2018 mid-term elections, three states, Idaho, Nebraska, and Utah all approved ballot measures to expand Medicaid eligibility to new low income groups.

More broadly, there is growing interest in expanding Medicare coverage to new populations. This would be a real game changer — especially for those who have difficulty accessing care due to health conditions or age. There are active discussions and legislative proposals now being considered to allow those nearing retirement age (say between the ages of 55 and 64) and those with serious health conditions to “buy-in” to Medicare at a reduced premium or to be entitled to the program.  Excellent and accessible analysis and reporting on these developments can be found online through the Kaiser Family Foundation.

In the months to come, we should anticipate further conversations about Medicaid and Medicare as platforms for healthcare coverage and access.  New Medicaid expansion efforts in states will no doubt inspire others, but will also have their own share of growing pains and difficulties.  As for Medicare, we can anticipate that both sides of the aisle will give active consideration to ideas on how this program can help those in need.

Note: The research assistance of Lonnie Long, MPA student and OneOp Military Caregiving special needs graduate assistant in preparing this blog is appreciated.