Last time we looked at Medicare, that gives health coverage to people who are 65 years and older. Now we're going to look at Medicaid, the government program that gives health coverage to people who are poor. Medicaid passed at the same time was predominantly targeted to the poor people. Today, about half of the people would get Medicaid, our children, another quarter our pregnant women and parents of the children and a quarter our elderly and disabled. Poor elderly people in Medicaid pays for those provisions that Medicare doesn't cover. It turns out while a quarter of the people are elderly and disabled, they actually use almost two-thirds of all the Medicaid dollars. The Medicaid dollars predominantly don't flow to children and adults, but to the disabled and elderly. Despite being a program to pay for healthcare for poor, it turns out that there are certain groups which are very largely excluded from Medicaid. Working parents, only some of them get covered on Medicaid even if they're poor. Turns out that if you're a childless adult and destitute, you are not eligible for Medicaid. You are left out of the health care system if you have no children and you aren't poor. It's important to contrast Medicare and Medicaid. While they were part at the same time, they are very different programs. In Medicare, once you turn 65, you get the program. You don't have to file papers, there are no complex eligibility requirements. In addition, it's exclusively a federal program. The same rules apply throughout the United States for everyone on the program. On the other hand, Medicaid is a very different arrangement. It's conditional, you have to prove you're eligible. Not everyone who's poor is eligible. Second, it's a joint federal-state program in two senses. It's funded jointly between the federal government and the state. Federal government pays on average 57% of the cost, it pays more for poor states and less to richer state and states pick up the rest. It's also a joint federal and state administrative program. The federal government sets minimum eligibility criteria, minimum criteria for what needs to be covered, and then the states make the final eligibility determination, and what's covered, and how it's administered. In addition to Medicare and Medicaid, the federal government has a program called CHIP, Children's Health Insurance Program. After President Clinton's healthcare reform plan was defeated, he teamed up with Senator Kennedy and passed CHIP in 1997. It was meant to fill in a gap, provide coverage for children who were ineligible for Medicaid, cover those children that were uninsured. Again, like Medicaid states set the eligibility criteria, like Medicaid, its a joint federal- state finance program. Today about 6 million children get CHIP and it costs about $13 billion. One of the consequences of our complex system is that White and Asian children tend to be insured through private healthcare insurance. Whereas minority, Hispanic and Black children, are predominantly covered by public programs, Medicaid and CHIP. In addition to Medicaid and Medicare, there are a number of other large public programs. For example,Veterans Affairs covers veterans. There are about 150 veteran hospitals in the country. There are about 800 veteran outpatient facilities. This is a program which the federal government both owns the hospitals, employs the doctors. It is true socialized medicine. And it cost about $53 billion per year. The Defense Department has strike year which provides services to about 9 million active military personnel, retirees and their dependents. There is the Indian health service which provides services to the native American populations. And there are a few other programs around, between the private insurance market covering employees and individuals who bribe private insurance. The Public Health Insurance Programs, Medicare and Medicaid, veterans programs and others. We have a very complex way of funding health insurance. That is matched by a complex way of providing coverage between doctors, hospitals, pharmacies, home health care agencies, and others.
