Preface
Acknowledgments
1. Background and History
The Historical Roots of Medicare and Medicaid
The 1965 Enactment of Medicare and Medicaid
Challenges for Implementation
State Medicaid Experimentation: A Departure from Freedom of Choice
Confronting Medicare Expenditures: The Prospective Payment System
Medicaid Reforms and Efforts to Control Costs
The Children's Health Insurance Program
Medicare's Prescription Drug Benefit: Part D
Medicare and Managed Care: Part C
Medicaid Expansion under the Affordable Care Act
Looking Back, Looking Forward
Sources
2. Problems, Controversies, and Solutions
Problem #1: Medicare's Spending Is High and Not Well Controlled
Addressing Medicare's Budget, Option 1: Protect the Status Quo
Addressing Medicare's Budget, Option 2: Adopt a Public Insurance Option
Addressing Medicare's Budget, Option 3: Adopt a Premium-Support Model
Problem #2: Building Medicare for All Would Pose Multiple Challenges
Problem #3: Medicare Advantage Is Not Generating the Expected Savings
Problem #4: Medicare Part D Is Not Getting Taxpayers the Best Value for Their Money
Problem #5: Low Medicaid Reimbursement Levels Limit Patient Choice and Medical Provider Participation
Problem #6: Medicaid Is Not a Sustainable Way to Cover Long-Term Nursing Home Care
Problem #7: The Medicaid Expansion under the ACA Has Been Uneven
Problem #8: Medicare Experiences a High Level of Improper Payments
Conclusion
Sources
3. Perspectives
My Journey on Medicaid
Aianna Zachary
Medicaid and the Family Medicine Practice
Adam Houghton, MD
A Nonprofit Clinic's Perspective on Medicare and Medicaid
Tory Lynch-Dahmm
Closing the Gap in Health Care Access
Amanda F. Hopkins, PhD, RN
Medicaid and Emergency Department Use
Mollie Ward, MDiv
Medicaid Expansion: Nationalized Politics Meets Intergovernmental Reform
Philip Rocco, PhD
Medicare from an Enrollee's Perspective
Ann C.
The Growing Privatization of Medicare
Andrew Scholnick
The American Health Care State
Robert Y. Shapiro, PhD
4. Profiles of People and Organizations
Introduction
The American Hospital Association
American Medical Association
Americans for Prosperity
America's Health Insurance Plans
Centers for Medicare and Medicaid Services
Healthcare-Now!
Kaiser Family Foundation
National Nurses United
Partnership for America's Health Care Future
Pharmaceutical Research and Manufacturers of America
Physicians for a National Health Program
Senator Bernie Sanders (b. September 8, 1941)
UnitedHealth Group, Inc.
U.S. Chamber of Commerce
Sources
5. Data and Documents
Data
Figure 5.1. Medicaid Enrollment by Year (1968â"2018)
Figure 5.2. Medicaid Spending by Year (1968â"2018)
Figure 5.3. Medicaid Enrollment by Age Group as a Percentage of Total (2017)
Figure 5.4. Medicare Enrollment by Year (1968â"2018)
Figure 5.5. Medicare Spending by Year (1968â"2018)
Figure 5.6. Medicare Advantage Enrollment (1999â"2019)
Figure 5.7. The Uninsured Rate (1997â"2018)
Figure 5.8. Enrollment in the Children's Health Insurance Program (1998â"2018)
Documents
President 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. Resources
Broad Overviews of the Medicare and Medicaid Programs
History
Policy Reform Failures
Changes under the Affordable Care Act
Prescription Drug Coverage
Consumer-Driven Health Care
Financing and Coverage Challenges
Recent Politics and Policy
Commentary on Proposals for a Public Option Government Insurance Program and Analyses of Medicare for All Proposals
7. Chronology
Glossary
Index
