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PERSPECTIVES: Combining Medicare and Medicaid into One Program

September 7th, 2018 | by Stephen Billias

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The status quo of government-sponsored health programs is beginning to fail. The government recently reported that Medicare will run out of money in less than 20 years unless drastic changes are made. But how can our health care system be altered to correct deficiencies and adjust to changing conditions, avoid a huge financial crisis in coming years, and make health care more affordable and secure for all Americans?

I believe that eliminating the distinction between Medicare and Medicaid, thereby combining them into one program, could be a viable solution.

Medicare and Medicaid are both government-sponsored programs that support Americans, but one – Medicaid – is aimed at lower-income individuals and families. Combining the two programs would remove the economic stigma associated with Medicaid. Then the Centers for Medicare & Medicaid Services (CMS) could stablish criteria within the joint system for providing care to all at a reasonable cost.

Existing health plan insurers could then make this new combined program a part of their offerings. Instead of Medicare Advantage plans, for example, health insurers would offer partially government-funded plans (like the exchanges) with some profit margin built in.

This would not be a single-payer model, nor “Medicare for All”— health insurers would still have a large role to play. There must be some blending of private and public health insurance, in a way that allows insurance companies to stay in business while ensuring that all Americans have access to reasonably affordable health care. The concept here would be to expand the pool of participants so that there are enough healthy younger people in the pool (some of those now enrolled in Medicaid) to offset the expenses incurred by older and more medically challenged participants (those enrolled in Medicare).

Obviously, these are big, bold ideas for huge changes that would fundamentally alter the Medicare/Medicaid landscape and transform the health care system in America. It would require immense political will to implement them, but the alternative is a current system that’s headed for collapse.


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