Medicaid is a government program established in 1965 by Lyndon Johnson administration.
The program is partially funded by state governments and primarily managed by the state, though a significant portion of the funding is by the federal government. Individual states are not mandated to participate in the program — all though all have since 1982. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 85 million low-income and disabled people. About 4 in 10 children have Medicaid, almost half of adults in poverty have Medicaid and 60% of nursing home residents have Medicaid. Medicaid coverage varies by state from 34% in New Mexico to about 11% in Utah.
With The House passing the Republican budget resolution, the goal is to slash $2 trillion
over a decade from the federal budget. Medicaid programs provide life-saving coverage for the most vulnerable individuals in the country. Currently, Medicaid is often the single most expenditure of the states, and cuts by the federal government can create an enormous hole for the state budgets. If the fundings are cut or reduced, the public health effect in the communities will be disastrous. With the dependency of WHO and USAID, the health scenario globally is already in a very precarious situation. Newer epidemics can breakout at any time and without timely intervention it can easily be a pandemic. Proximity between places in the globe has become so small an epidemic in one part of the world does not take much to travel. In 2014-16, 11 people in USA were affected with the deadly virus Ebola, of which 9 were sourced from West Africa.
Vaccine Preventable Diseases Childhood vaccine schedules includes 15 different immunizations. Some vaccines protect against more than one disease. Some require more than one dose. The vaccines for children (VFC) program provides vaccines for children who parents and guardians may not be able to afford them. In 1989-91, a massive measles epidemic in the United States resulted in thousands of measles and hundreds of deaths. When the Center for Disease Control (CDC) investigated they found more than half of the children infected had not received the vaccine.
Cost of the vaccine was found to be a primary reason for children going unvaccinated. In
response to this Congress passed a bill in 1993 creating the VFC program. The funding is
from the Office of Management and Budget (OMB) through Centers for Medicare and
Medicaid (CMS) to CDC and then to the States. VFC program provides vaccines against 19 different diseases and has prevented about 422 million illnesses and about 30 millio
hospitalizations. To maintain protection in a community at least 95% of the children should be fully vaccinated to obtain herd immunity. Since post pandemic, there has been a general apathy towards immunizations. This has brought down the immunization uptake levels and outbreaks have already started in diseases like measles. (Texas, a measles outbreak has already occurred with about 150 confirmed cases and one death). From a global level, with the help of World Health Organizations like WHO, UNICEF, the world has prevented millions of childhood deaths. So with the apathy of a general and negative approach to immunizations locally, a public health catastrophe is imminent if there are no success stories of vaccinations. Eradication of smallpox, and near eradication of polio and measles will be reversed with the reckless choices.
Maternal Health With about 45% of deliveries in the country being covered by Medicaid, any prevention of funds will adversely affect the maternal deaths and associated illnesses. Maternal mortality rate in the United States for 2023 is 86 deaths per 100,000 live births according to CDC. Our maternal mortality rates are very high compared to other developed nations, especially countries like Norway and New Zealand having numbers as low as less than 2. The disparity in mortality is seen more in certain racial groups with black pregnant women 3 times more likely to die than white patients.
Nursing Homes Medicaid covers the care of about two-thirds of nursing home residents in the United States.
So any reduction in funding for Medicaid will affect the elderly population more than any
group in numbers. Even now, Medicaid rates paid are 82% of costs to provide services.
Conclusion
In conclusion, Disparity in health care is one of the main factors in very low health indicators in many countries. In population health every member in the community has to be healthy for the population to be healthy. Medicaid is the only source of funding and life line for the millions of people who are covered by this program. Any reduction of funds will increase the disparity in health care in this population.Unless a clear consensus is reached by the authorities, our health systems and the health of people will be stretched beyond imagination. In many cases,mistakes could be corrected after the fact but in health, it is too late.By the time the curtain comes down, many children would have been affected by denying them the basic preventive care and well child visits. Many mothers would be affected by reducing their prenatal care and acess and thousands of disabled and aged in nursing home would have moved on to the sunset. When proven wrong, the wiseman will correct himself and the ignorant will keep arguing.I hope there will be no arguments on a bandaid medicaid. How many deaths will it take till he knows that too many people have died. The answer I hope is not blowing in the wind….
About the author
Dr.Jacob Eapen MD.MPH is an elected Board of Director of Washington Hospital, Fremont, CA. A alumini of both U.C.Berkeley and Stanford University he has been an advocate of the marginalized population in his career Executive Vice President of FOKANA International. President, Pravasi World Malayalee Council.
