An Empirical Perspective on Medicaid as Social Insurance

Abstract

This paper is a contribution to the symposium entitled Scalpel to Gavel: Exploring the Modern State of Health Law. This essay quantifies and explores the central role Medicaid now plays in our health insurance system. For its first forty-nine years, Medicaid covered less than half of the nation’s poor. Today, one in five Americans have Medicaid coverage during the course of a year, and that number soon will increase to one in four given the insurance expansions enacted through the Patient Protection and Affordable Care Act. Medicaid now effectively functions as social insurance for many of its enrollees. In this essay, we begin to explore how Medicaid, after the ACA, metamorphoses from exclusion and limitations in access and benefits to a form of social insurance that implicates theories of social justice. The social justice aspect of universality provides an important lens for understanding the numbers, both in terms of the states that are expanding and the states that so far are opting out. States that refuse to expand their Medicaid programs are denying millions of Americans the benefit of a precious legal entitlement. It is essential that states understand the power — and the potential — of this evolving social program and its newfound status as a vehicle of social insurance.

Keywords: Medicaid, ACA, health reform, PPACA, Obamacare, working poor, universal, universality