Health insurance Medicaid

D15. Do you currently have any type of health insurance coverage, including Medicare or Medicaid (DO NOT READ LIST) ... 

Medicaid A federal and state partnership to provide health insurance to the needy (or those with low income and assets) that has become the only source of prescription drugs for many. 

The U.S. is unique among advanced nations in that it has resisted the implementation of a system of imiversal health care and instead has gradually built a system in which employers are the primary sponsors of health care coverage for the majority of the population. Medicare and Medicaid cover the elderly, disabled, and very poor. According to data from the U.S. Census Bureau, a small proportion of people, less than 7% of the population under 65 years of age, purchase health insurance on their own. In 2002, the remaining 41 million persons were uninsured. The uninsured represent 14.6% of the total population, 16.5% of the population under 65 years. Those with adequate resources pay out of their pockets for health care. The others go without care, delay care, or seek health services from a fragile and incomplete system of charity care and safety-net providers. 

President John F. Kermedy made Medicare a major election issue in 1960, but it was not unhl Lyndon Johnson achieved a landslide victory, accompanied by Democrahc control of Congress, thaf another defining step was taken in the history of health insurance coverage. In 1965, Congress amended the Social Security Act to implement Medicare for the elderly and Medicaid to help states pay for health services for their very low-income parents and children. 

Many persons report more than one type of coverage. For example. Medicare beneficiaries often have supplemental retiree health benefits as well as Medicare, and a disabled child might be covered under both a parent s employer-sponsored coverage and Medicaid. The following sections discuss each of the major types of health insurance coverage. 

Medicaid covers over 40 million people in the U.S. and accounts for more than 15% of nafional health care spending. Medicaid is the largest health insurance program in the U.S. in terms of fhe number of enrollees. In 1998, Medicaid paid for one third of all birfhs, half of nursing home care, and fhe healfh care for 25% of children under fhe age of five. 

Kaiser Commission on Medicaid and the Uninsured (2002b). Health Insurance Coverage in America 2000 Data Update. Washington, D.C. The Henry J. Kaiser Family Foundation. 

Private employers, the federal government, and state and local governments invest significant financial resources in health care purchasing expenditures. In 1995, private employers contributed 183.8 billion to private health insurance premiums, whereas the federal government spent 11.3 billion on private health insurance premiums, and state and local government spent 47.1 billion. " In 1995, more than 83% of the insured population was covered by private insurance, whereas about 31% was enrolled in a public program, such as Medicare or Medicaid. 

The health care lexicon includes two new terms to reflect these problems underinsured and uninsured. The underinsured may include the working poor, those individuals who have jobs and may be covered by a very limited, if any, health insurance program by their employers. They are likely low wage earners and those receiving incomes at, or slightly above, the poverty level. Typically, they do not qualify for Medicaid entitlements, do not have employer-paid health insurance benefits, and cannot afford (or choose not to purchase) third-party coverage for payment of health care services. 

Department of Health and Human Services, Centers for Medicare Medicaid Services, The Health Insurance Portabfiity and Accountability Act of 1996 (HIPAA) http //www.cms.hhs.gov/hipaa (accessed August 19, 2004). 

CMS requires a budget of 325.4 billion to provide these and other services. Among CMS other responsibilities is administration of the Children s Health Insurance Program. The Children s Health Insurance Program provides reduced or no-cost health coverage for more than 2 million children under the age of 19 whose families earn too much to be eligible for Medicaid but do not earn enough to afford private insurance. 

Health Insurance Portability and Accountability Act (HIPAA) http //www.hcfa.gov/medicaid/hipaa/adminsim/ privacy.htm, accessed June 24, 2002. 

Qualifications for the VFC program are as stated here. Each state s children s health insurance qualifications are unique but can be found at their web site. ° Children through 18 years of age qualify to receive federally purchased vaccines under the VFC program if they are medicaid-enrolled, uninsured, or Native Amer-icans/Native Alaskans. Children who have insurance that does not cover immunizations also qualify to receive VFC vaccine at federally qualified health centers and rural health clinics. In addition, states may use their funds to purchase vaccines for additional groups of children. Contact the immunization program in your state for more information. 

By contrast, the delivery of most medical care in the United States is now need-based—bureaucratic-statist, paid, partly or entirely, by Medicare, Medicaid, or so-called private health insurance. Access to, and reimbursement for, medical services is premised on the assumptions that its proper distribution is the duty of the state or other third party HMOs should approve and in-... 

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