The benefits of Medicaid

A major portion of benefits accredited to Obamacare actually was an expansion of a Great Society program known as Medicaid. In contrast with the Obamacare provision that ended up in the Supreme Court, Medicaid is a public program benefiting citizens and not insurance corporations. Here are some facts on how Medicaid has worked.

Center for Budget & Policy Priorities -  Medicaid's costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per- beneficiary costs under private employer coverage.

Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status.

Over the past 30 years, Medicaid costs per beneficiary have essentially tracked costs in the health care system as a whole, public and private. And over the past decade, costs per beneficiary grew much slower for Medicaid than for employer-sponsored insurance. Medicaid also is expected to grow no more rapidly through 2023 than spending per beneficiary for people with private insurance.

Moreover, the Congressional Budget Officenow projects that Medicaid spending between 2011 and 2020 will be $335 billion -- or 10.0 percent -- lower than it projected in August 2010, largely due to slower expected growth in per-beneficiary costs.

Medicaid gives states significant flexibility to design their own programs -- whom they cover, what benefits they provide, and how they deliver health care services.

The federal government sets minimum standards, including specifying certain categories of people that all states must cover and certain health coverage they must provide. Beyond that, states are free to set their own rules. For example, states have broad flexibility to decide which "optional" categories of low-income people to cover, and up to what income levels. As a result, Medicaid eligibility varies substantially from state to state.

Medicaid benefit packages vary significantly from state to state as well. States have flexibility to determine whether to cover services like dental and vision care for adults and can determine the amount, duration, and scope of the services they provide.

States also have flexibility over whether Medicaid delivers health care services through managed care, fee-for-service, or other types of delivery systems and how much to pay providers and plans that serve Medicaid beneficiaries.

Vermont implemented a program in 2011 that provides care coordination and case management services to Medicaid beneficiaries with one or more chronic conditions, such as asthma and diabetes. Within a year, ER use dropped 10 percent among program participants.

States like Missouri have also instituted innovative delivery system models in Medicaid, such as establishing "health homes" to coordinate care for certain categories of beneficiaries. Approved in 2011, Missouri's initiative targets beneficiaries with a mental illness and a chronic condition, such as asthma or diabetes. Health homes enrollees' blood pressure dropped by six points and LDL (bad cholesterol) fell by 10 percent over two years and one of the state's health homes saved the state $15.7 million in its first 18 months.

A landmark study of Oregon's Medicaid program found that, compared with similar people without coverage, people with Medicaid were 40 percent less likely to have suffered a decline in their health in the previous six months. They were also more likely to use preventive care (such as cholesterol screenings), to have a regular office or clinic where they could receive primary care, and to receive diagnosis of and treatment for depression and diabetes. In addition, research published in the New England Journal of Medicine reported that expansions of Medicaid coverage for low-income adults in Arizona, Maine, and New York reduced mortality by 6.1 percent.

Moreover, people with Medicaid in Oregon were 40 percent less likely than those without insurance to go into medical debt or leave other bills unpaid in order to cover medical expenses. In fact, the latest research from Oregon found that Medicaid coverage "nearly eliminated catastrophic out-of-pexpenditures."

Urban Institute researchers also have found that Medicaid provides beneficiaries with access to health care services that is comparable to -- but less costly than -- what they would receive through employer-sponsored insurance. If these beneficiaries were uninsured, they would be significantly less likely to have a usual source of care and more likely to forgo needed health care services.