Medicaid and the US Path to National Health Insurance

The U.S. has in place a working system that policy-makers could enlarge to achieve universal health coverage: Medicaid. A Medicaid expansion would be acceptable to business leaders, private insurers and other groups who have opposed health care expansion.

Medicaid is the most successful government health insurance program in U.S. history. Enrollment has doubled since the Reagan administration. This perspective analysis proposes using Medicaid to cover the uninsured. The author argues that Medicaid is a flexible program with bipartisan appeal. The essay describes structural features of Medicaid that make it adaptable to policy reform. The author acknowledges difficulties that might hinder a Medicaid expansion.

Key Findings:

  • A Medicaid expansion that includes an affordable buy-in, for those who do not automatically qualify, would lower costs for businesses.
  • Because states administer Medicaid within a federal structure, federal funds could finance increases in coverage at the state level.
  • States are already combining Medicaid buy-in programs with legal mandates for universal coverage.

Medicaid currently has around 60 million enrollees (25% of children in the U.S. use the program). This perspective analysis presents an argument for using a Medicaid expansion to achieve national health coverage.