Medicaid as Health Insurance: A Blog Post Series

About 60 million people are currently enrolled in Medicaid, making it the largest single provider of health insurance in the United States. Since its inception in 1965, Medicaid has evolved from an adjunct benefit for people receiving cash assistance to a key component of the Affordable Care Act’s coverage expansions. As the role of Medicaid expands under the reform law and the program becomes an increasing focus of debate at federal and state levels, it is more important than ever for policy makers and the public to understand Medicaid’s place in the U.S. health insurance system. Without a clearly defined role, the program’s ability to function as a strategic purchaser, provide effective coverage, achieve a more coordinated system of coverage, and improve care, will be compromised. Challenges to Medicaid as a health insurer have surfaced in the coverage restrictions of some state Medicaid expansion proposals, as well as federal Medicaid reform proposals. With the 50th anniversary of Medicaid as backdrop, this project will develop a series of five blog posts on the evolution of Medicaid from a public assistance program to a large health insurer, lay out a conceptual framework for Medicaid as a health insurer, and explore Medicaid’s role in the coverage goals of the ACA. This work will inform federal and state policymakers about the current and future role of Medicaid as they consider opportunities for reform and state proposals for Medicaid expansion.