Medicaid is a social program funded by the Federal Government. It was established in 1965 under the Presidency of Lyndon B Johnson. The program provides health coverage for the poor and disabled as long as their income falls below the federal poverty level. States are not required to participate in the program. If they do, the federal government will match a certain percentage of the state’s healthcare expenditures .
The federal government funds 50% to 80% of the cost to provide Medicaid based on a state’s per capita income . The federal government mandates that certain services are provided to particular Medicaid recipients. If the state decides that it wants to provide additional services other than those mandated, the federal government will match the cost. Up until 1995, recipients were having trouble finding a doctor who would accept Medicaid because of the low rates of pay. In 1995, Health Maintenance Organizations (HMOS) were contracted by Medicaid to provide care for needy families with children and pregnant women . Currently, all states participate in Medicaid.
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"States’ Rights versus Medicare".
The Issue of Federalism
The issue of states’ rights has been a point of contention since the founding of our nation. The Articles of Confederation were established by Congress in 1791, six years before the ratification of the US Constitution . The purpose of the Articles of Confederation was to make certain that “each state retains its sovereignty, freedom and independence, and every power jurisdiction, and right, which is not by this confederation expressly delegated to the United State in Congress assembled” . The 10th Amendment to the US Constitution sought to assure the Anti-Federalists that the state had control over its own polices. State law trumps federal law. The federal government and the state government have two different functions. In fact, the state can ignore a federal law .
Individual states are empowered to establish their own laws, including those involving healthcare. Medicaid provides a means where no one is denied access to quality medical care simply because they cannot afford to visit a doctor, or go to the hospital. Thousands of people who would have died of various diseases, but because of Medicaid, their lives are being saved because they have access to quality medical care .
Two Different Political Viewpoints
Healthcare is an issue where the two parties differ. The Republicans are against socialized medicine. The Democrats support socialized medicine because they believe that it gives everyone, regardless of the income level, the access to affordable health care. The Libertarian Party takes an extreme view on the limited role of government in society. They are basically anti-government, and want the private sector to be free to run its businesses the way they want, and that includes healthcare.
The big issues that politicians argue about Medicaid are state rights. Individual states create their own laws according to the needs of the constituency. Some states object when the federal government interferes with their rights. Sometimes the lines between the two are not clear. Liberal voters also support bigger government, decreased immigration standards, programs like Medicaid, Medicare, and aid for the needy. They consider themselves champions of the underprivileged and under-represented citizens in society.
Conservative voters are for less government involvement in business affairs, and believe in a free market economy. They feel that the government should not be involved in healthcare, that it should be left to the private sector to regulate insurance premiums. However, the states cannot afford to provide healthcare for everyone, and they end up taking money from the Federal government in order to help the needy.
With the Medicaid program, the states find themselves in a catch 22. They want to govern on their own without the intervention of the federal government, but they need the matching federal funds to provide adequate healthcare to the poor. Governors end up having to accept money from the federal government when they would rather not. This causes a major dispute when it comes to election time. Governors who run on a conservative agenda (less government spending and involvement in state affairs) have to be careful not to alienate the people who support Medicaid.
Medicaid is working. In fact, the expansion in Medicaid due the Affordable Care Act is providing people who did not qualify for Medicaid. With the new influx of federal funds, the states are able to provide health and human services to a broader range of constituents. Most governors have expanded their state’s Medicaid plan in order to receive matching funds from the federal government under the new Affordable Care Act passed by the Congress and signed into law by President Obama . There are still a few Governors that have refused to expand their state’s Medicaid program, like Texas governor Rick Perry to appeal to the extreme right wing of the Republican Party .
There is no need to continue to debate the Medicaid issue because it is a win-win situation for all involved. The 10th Amendment was created to prevent gross abuse of the federal government’s powers. The federal government is helping states by matching funds in order to assure that those who are struggling in poverty can get the medical attention they so desperately need. It is incomprehensible to both federalists and anti-federalists to deny citizens proper medical care. For that reason, all fifty states have Medicaid because it is a successful policy.
- Intellectual Takeout. (n.d.). 10th Amendment, Federalism, and States’ Rights. Retrieved January 26, 2015, from Intellectual Takeout: http://www.intellectualtakeout.org/library/law/10th-amendment-federalism-and-states-rights
- Kettl, D. (2011). Medicaid, Incentives and the Future of Federalism. Retrieved January 26, 2015, from Potomac Chronicle: http://www.governing.com/columns/potomac-chronicle/Medicaid-Future-Federalism.html
- LSNJ LAW. (n.d.). A Brief History and Overview of the Medicaid Program in New Jersey. Retrieved January 26, 2015, from LSNJ LAW: http://archive.lsnjlaw.org/english/healthcare/medicaid/medicaidhist/
- Miller, D. (2014). Medicaid Expansion Decisions: Federalism, Politics or Both? Retrieved January 26, 2015, from CAPITOL IDEAS: http://www.csg.org/pubs/capitolideas/2013_nov_dec/healthcare.aspx
- US Constitution Online. (n.d.). The Articles of Confederation. Retrieved January 26, 2015, from U.S. Constitution: http://www.usconstitution.net/articles.html
