- escalating poverty especially among families with children;
- population demographics and an aging society;
- the widespread erosion of employer coverage, particularly for lower income workers;
- infant mortality and child development;
- major advances in life-saving technology; and
- public health crises both natural and manmade.
Over a half century, federal and state policymakers alike have turned to Medicaid because its flexible structure repeatedly has offered the ability to nimbly respond to social problems as they emerge—for example, ramping up relatively quickly in the face of immediate need, such as a recession, and then scaling back. When the Zika crisis hit, states turned to Medicaid to immediately fund the intensive outreach and case management needed to help identify women and families at risk. Medicaid accounts for nearly half of all births, covers over one-third of all children, and accounts for nearly half of all long-term care spending. The program has enabled children with severe disabilities to attend school and adults with severe disabilities to work.
Thus, how to change Medicaid’s growth trajectory without weakening its unique and indispensable qualities represents perhaps the most significant of all U.S. health policy challenges. The rest of the nation’s intensely market-driven system, as well as Medicare, rests on Medicaid’s features and capabilities.