Medicare and Medicaid

Greg M. Shaw, PhD, is professor of political science at Illinois Wesleyan University in Bloomington, Illinois, USA.

• PrefaceAcknowledgments1. Background and HistoryThe Historical Roots of Medicare and MedicaidThe 1965 Enactment of Medicare and MedicaidChallenges for ImplementationState Medicaid Experimentation: A Departure from Freedom of ChoiceConfronting Medicare Expenditures: The Prospective Payment SystemMedicaid Reforms and Efforts to Control CostsThe Children's Health Insurance ProgramMedicare's Prescription Drug Benefit: Part DMedicare and Managed Care: Part CMedicaid Expansion under the Affordable Care ActLooking Back, Looking ForwardSources2. Problems, Controversies, and SolutionsProblem #1: Medicare's Spending Is High and Not Well ControlledAddressing Medicare's Budget, Option 1: Protect the Status QuoAddressing Medicare's Budget, Option 2: Adopt a Public Insurance OptionAddressing Medicare's Budget, Option 3: Adopt a Premium-Support ModelProblem #2: Building Medicare for All Would Pose Multiple ChallengesProblem #3: Medicare Advantage Is Not Generating the Expected SavingsProblem #4: Medicare Part D Is Not Getting Taxpayers the Best Value for Their MoneyProblem #5: Low Medicaid Reimbursement Levels Limit Patient Choice and Medical Provider ParticipationProblem #6: Medicaid Is Not a Sustainable Way to Cover Long-Term Nursing Home CareProblem #7: The Medicaid Expansion under the ACA Has Been UnevenProblem #8: Medicare Experiences a High Level of Improper PaymentsConclusionSources3. PerspectivesMy Journey on MedicaidAianna ZacharyMedicaid and the Family Medicine PracticeAdam Houghton, MDA Nonprofit Clinic's Perspective on Medicare and MedicaidTory Lynch-DahmmClosing the Gap in Health Care AccessAmanda F. Hopkins, PhD, RNMedicaid and Emergency Department UseMollie Ward, MDivMedicaid Expansion: Nationalized Politics Meets Intergovernmental ReformPhilip Rocco, PhDMedicare from an Enrollee's PerspectiveAnn C.The Growing Privatization of MedicareAndrew ScholnickThe American Health Care StateRobert Y. Shapiro, PhD4. Profiles of People and OrganizationsIntroductionThe American Hospital AssociationAmerican Medical AssociationAmericans for ProsperityAmerica's Health Insurance PlansCenters for Medicare and Medicaid ServicesHealthcare-Now!Kaiser Family FoundationNational Nurses UnitedPartnership for America's Health Care FuturePharmaceutical Research and Manufacturers of AmericaPhysicians for a National Health ProgramSenator Bernie Sanders (b. September 8, 1941)UnitedHealth Group, Inc.U.S. Chamber of CommerceSources5. Data and DocumentsDataFigure 5.1. Medicaid Enrollment by Year (1968–2018)Figure 5.2. Medicaid Spending by Year (1968–2018)Figure 5.3. Medicaid Enrollment by Age Group as a Percentage of Total (2017)Figure 5.4. Medicare Enrollment by Year (1968–2018)Figure 5.5. Medicare Spending by Year (1968–2018)Figure 5.6. Medicare Advantage Enrollment (1999–2019)Figure 5.7. The Uninsured Rate (1997–2018)Figure 5.8. Enrollment in the Children's Health Insurance Program (1998–2018)DocumentsPresident Lyndon Johnson's Remarks upon Signing Medicare and Medicaid into Law (1965)President Barack Obama's Remarks upon Signing the Patient Protection and Affordable Care Act into Law (2010)U.S. Senator Lamar Alexander on the Proposed Expansion of Medicaid (2009)U.S. Supreme Court Ruling in National Federation of Independent Businesses, et al. v. Kathleen Sebelius Secretary of Health and Human Services,et al. (2012)Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds (2019)National Health Expenditure Fact Sheet (2019)GAO Report on the Medicare Advantage Plan Finder (2019)6. ResourcesBroad Overviews of the Medicare and Medicaid ProgramsHistoryPolicy Reform FailuresChanges under the Affordable Care ActPrescription Drug CoverageConsumer-Driven Health CareFinancing and Coverage ChallengesRecent Politics and PolicyCommentary on Proposals for a Public Option Government Insurance Program and Analyses of Medicare for All Proposals7. ChronologyGlossaryIndex