Editorial: Medicaid’s mission is in jeopardy

Wednesday, Aug. 3, 2005 | 9:12 a.m.

A USA Today analysis published this week shows that the number of people covered by Medicaid grew from 34 million people in 1999 to 47 million people in 2004, a 72 percent increase in just five years. Medicaid is a health insurance program for low-income people whose costs are shared by the federal government and the states. Furthermore, the paper reported, 100 million people -- one out of every three people in the country -- are now receiving health coverage through the federal government, either through Medicaid, Medicare or employment in the military and other federal agencies.

Regarding Medicaid, it is disturbing that so many Americans now either can't afford private insurance or their employers don't offer coverage, forcing them to seek assistance from the government. Still, these Americans are fortunate that Medicaid exists, securing medical care for them. Medicaid was historically the health insurer for recipients of welfare, but as many of them entered the work force under President Clinton's welfare reform in the mid-1990s, it expanded to cover low-paid workers. In recent years it has also expanded to cover more children.

At the same time Medicaid is beginning to fill the void that has left millions of low-income Americans with no health insurance, however, the Bush administration is proposing huge cuts in the program. The president's budget for 2005-2006 proposes cuts of $60 billion over 10 years. And the administration this month commissioned a 28-member panel to recommend ways of cutting Medicaid by another $10 billion over five years. Many governors around the country are alarmed. They see cuts in the federal share of the program's cost forcing their own shares to increase, a development that would force them to cut budgets for education, public safety and other vital services. The result is that many states are slashing their shares of Medicaid funding.

In Nevada, under Gov. Kenny Guinn, that hasn't happened. Employees of some small businesses that do not offer health insurance can now receive a subsidy from Medicaid, so they can buy insurance on their own. Medicaid here has also grown to cover more pregnant women and to cover more major illnesses. At nearly $844 million, Medicaid is Nevada's third-largest program, behind the K-12 public schools and higher education. In 2000 the state had 49 Medicaid recipients for every 1,000 residents. Today the number is 79 per 1,000.

But the days of expanding Medicaid as the federal share of its cost decreases are not apt to continue, as states have demonstrated that they, too, will cut back. So the trend of more poor people being covered by health insurance may be an illusion. They may be covered, but for what? Without proper funding, the coverage will be scant indeed. If Medicaid is to continue providing low-income people with adequate health insurance, the federal government must not renege on its proper share of the cost.