As I write this essay, our national leaders just concluded contentious negotiations related to raising the debt ceiling. There was high anxiety in all quarters because both parties agreed that deep cuts must be made in government spending. Even previously protected programs were “on the table,” such as Social Security, Medicare and, especially, Medicaid.
Medicaid—a collaboration between federal and state governments to provide health insurance coverage for the poor and disabled—has grown so much and become so costly for state governments that it is under attack. Medicaid now covers about 67 million people in the U.S., more than one-fifth of our population.
Serious, though disparate, efforts are already under way to “reform” Medicaid. Many Democrats see Medicaid as part of the solution to addressing the problem of the 49 million of our fellow citizens who are uninsured. The Patient Protection and Affordable Care Act, if implemented according to schedule, will add as many as 17 million more Americans to the Medicaid rolls by 2021.