07/31/2015 06:49 pm ET Updated Jul 31, 2016

Reflections on the Anniversary of Medicare

Andrii Kondiuk / Alamy

The 50th anniversary of the enactment of Medicare and Medicaid on July 30 celebrates programs that have made an incredible difference in the lives of millions, particularly women. While the programs share a birthday, they are different in important ways that make Medicare far more stable and secure than Medicaid. Both deserve our hearty birthday wishes, but Medicaid needs our help too, if the millions who need it are to get the health care all Americans deserve. A special priority is the adoption by all states of the expanded coverage available under the Affordable Care Act.

Medicaid expansion was designed to cover millions of low-income individuals who were previously excluded from benefits. The expansion is almost entirely covered by new federal funds, but due to a Supreme Court ruling, states are free to turn the money down. At least 20 states chose not to accept the new federal money, leaving millions uninsured. Those still excluded will continue to suffer the dire consequences of not having insurance. They will be unable to afford access to routine care or care for chronic conditions. They will turn up in emergency rooms for costly acute care that could have been avoided if they could afford a doctor. And thousands will die earlier than those who do have the security and peace of mind of health care coverage.

Even with expansion stymied for now, one cannot overstate the degree to which Medicaid has become a bulwark of our national health system and a lifesaver for millions, especially women, young and old. After 50 years, Medicaid has evolved to provide health care to more than 67 million low-income people in the US, including low-income seniors, people with disabilities, children, and some adults who meet its income criteria. Women, particularly women of color, are more likely to experience poverty and need the health care coverage that today only Medicaid can provide them. And Medicaid, begun to help young mothers, is now just as important to women in retirement as it is to women in their child-bearing years.

The statistics are eye-opening. Medicaid pays the childbirth expenses for 40 percent of all babies born in the US, including 60 days of post-partum care for eligible mothers. (States can adopt criteria to extend coverage to more pregnant women and most do so.) Medicaid is critical to helping low-income women access family planning care -- it provides three-quarters of all publicly funded family planning services in the US.

For older women (and men) Medicaid is the primary payer for long term care, covering 61 percent of all spending on such care nationwide. Nearly 70 percent of elderly recipients are women, including those who may have once been middle class but who have outlived their retirement savings (Medicare does not pay such expenses). Medicaid not only covers nursing home care, but pays for personal care that can keep older women in their homes longer. Medicaid also provides support to safety-net hospitals and health centers.

Medicaid has incorporated many changes over the decades and its provisions can be difficult to comprehend. Even without expansion, many thousands eligible for Medicaid are not enrolled. Medicaid is run and partly funded by the states, which share its expense with the federal government. While the federal government sets minimum standards, each state provides different benefits. Some states are more generous and incorporate more categories of recipients than others. Unfortunately legal immigrants paying the same taxes as everyone else are not now eligible for coverage until five years of US residence.

Other issues plague Medicaid's promise to close the gaps in our national health care system. Many states have set reimbursement rates for doctors and other providers far below the prevailing Medicare and private insurance rates. The low rate of reimbursement limits the number of doctors and others willing to take Medicaid patients. Already a serious problem making it hard for recipients to find a doctor, a lack of providers promises to become worse as more people are enrolled. Payments to doctors and hospitals must be raised to ensure that all patients are of equal value to providers. The complexities of determining eligibility in each state and wide disparities between states in benefits and scope of coverage continue to be problematic.

The purpose of Medicare, Medicaid, and the Affordable Care Act taken together is to ensure that as a nation, we at long last have a viable national health care system. Our birthday wish on the anniversary of the government programs that launched us on the journey to universal care is that we strengthen our commitment to ensure every US resident has the coverage she or he needs. As grown-ups, we know that fulfilling that wish means more than blowing out candles. It means more hard work to make our wish come true.