Medicaid is Critical to Homeland Security
Wait. What is Medicaid again? Medicaid is a joint federal-state insurance program that provides health coverage to the nation’s most economically disadvantaged populations including low-income families and their children, low-income people with disabilities, and low-income seniors. In 2015, Medicaid provided health care coverage to an estimated 81 million Americans.
Is that the same thing as Medicare? No. Medicare is a public insurance program for people aged 65 and older.
This sounds like Obamacare? Before the Affordable Care Act (Obamacare) went into effect on January 2014, over 41 million Americans were living their lives without health insurance. One of the main goals of the law was to improve access to health insurance, that is, to make sure as many people as possible would not just have health insurance but would have it at a more affordable cost. Although the ACA has been highly criticized for increasing the costs of some peoples’ health insurance (causes to be discussed in a future blog), the ACA has been successful in slowing down the overall rate at which health care costs grow while giving more people access to health insurance. In 2015, one year after the ACA went into effect, the uninsured rate among adults under age 65 years dropped by 37%. That means about 16 million people gained access to health insurance. The majority of people who gained access to health insurance fell into groups targeted by the ACA: adults and low-income individuals. The main way that low-income individuals got health insurance was through the expansion of state Medicaid programs.
Why is it so confusing? Medicaid is probably one of the most complicated, if not, THE MOST complicated health insurance program in the country. People who work with Medicaid programs will tell you, “if you’ve seen one Medicaid program, you’ve seen one Medicaid program.” Why? Well, all 50 states, DC and the territories have different Medicaid programs. Federal law requires all Medicaid programs to offer the same baseline set of health benefits, and then states have flexibility to provide additional benefits. The financing is also pretty complicated and varies in each state/territory. The main concept in one sentence is that the federal government pays a portion of each state’s Medicaid costs, and the state pays the remaining amount.
So WHY does Medicaid matter so much? Because the populations Medicaid serves are disproportionately affected by poverty, unemployment, and other socioeconomic factors that make it extremely difficult for these populations to obtain and pay for health care services, and those factors contribute greatly to the intensity of their health needs. These populations are typically in the greatest need, with the least amount of resources. Having access to health care influences overall physical, social, and mental well-being. It affects prevention of disease and disability, detection and treatment of health conditions, quality of life, preventable death, and life expectancy. Disparities in access to health services affect individuals and society, and insufficient access to health care has a significant impact on people being able to reach their full potential. Medicaid is a lifeline for the people it serves.
WHAT the hell does this have to do with Homeland Security? One of the challenges in homeland security is that there is not a single, unified definition guiding the field. Centered at each definition, though, is the concept of ensuring a nation that is safe, secure and resilient in the face of domestic and foreign threats. This fundamental concept is critical to understanding why health care coverage, such as Medicaid, is so essential to homeland security. Having a healthy, productive population is one of the most critical factors in building resiliency both at the individual level and at the community-level. Many characteristics affect individual resilience: health, age, gender, education level, cultural beliefs/traditions, and economic resources. Resilience is a function of an individual’s well-being, and well-being is dependent on physical, mental, emotional, and social functioning. Health care coverage through programs like Medicaid is essential to addressing physical, mental and emotional health of Americans.
It is important to note that only addressing health care will not improve resilience. It is a multi-pronged approach which includes addressing health and providing health care coverage, particularly for those populations that are underserved and most vulnerable, in addition to addressing economic stability, education attainment, and breaking down barriers to build multi-cultural understanding and acceptance that all contribute to building resiliency and creating healthy, and safe communities.
