As Republicans take over the House of Representatives this month, focusing on fixing Medicaid, the giant of the U.S. health system, should be at the top of their agenda. While creating Medicare in 1965, Congress added a small funding source of less than $1 billion to help states with medical services for poor and disabled Americans. Since then, Medicaid has grown to account for nearly $800 billion in federal and state expenditures and covering more than one in four Americans. House Republicans should restore Medicaid to its original form as a safety net reserved only for the neediest.
First, the federal government’s three-year public-health emergency must end immediately. During this period, states have been prohibited from conducting routine eligibility reviews, which has resulted in Medicaid caseloads’ growing by over 30 percent. Many of the current recipients are likely ineligible and have employer coverage. Simultaneously, managed-care organizations’ profits have soared because they are paid a monthly fee for each recipient, regardless of whether the recipient uses their services. Many state governments already face labor shortages, and redeterminations for current Medicaid recipients may take states a year or longer to complete.