The changing future of Medicare and Medicaid at 50
With Medicare and Medicaid turning 50 this month, research suggests overall public support for the programs is strong but somewhat split along party lines.
A recent survey from the Kaiser Family Foundation finds that 77% consider Medicare to be "very important" and 63% consider Medicaid to be. The report adds that today, the programs cover a combined 111 million Americans and are projected to cost $1,035 billion this year.
What's changing lately, experts note, is the impact of these government programs on the health insurance and healthcare industries at large—notably through the growth of Medicare Advantage and through the expansion of Medicaid to millions more low-income adults.
However, the programs have never been static. As the KFF report notes, "Over the past five decades, both programs have adapted to a changing healthcare landscape" in terms of scope, roles, and operations—often as a result of debate by both policymakers and the public.
Given their positions as government programs, it's unsurprising that the KFF survey found evidence of partisan divisions on Medicare and Medicaid.
According to the results, "about seven in ten Republicans and independents and about nine in ten Democrats say the Medicare program is very important," the survey finds.
Support goes up among those ages 65 and up—a group in which virtually everyone is covered by Medicare. In that group, 85% of Republicans, 89% of independents and 92% of Democrats say the program is very important.
Thoughts on Medicaid are more varied, with 78% of Democrats, 62% of Independents and 47% of Republicans calling it very important.
One constant: change
Medicare has always been evolving and continues to do so, suggests Mark Norrell, a lecturer at Indiana University School of Public and Environmental Affairs.
He notes that since its inception, every administration has made changes to Medicare's payment methodology in an effort to make patients and providers more cost-conscious, while also protecting quality of care.
"Since Congress passed Medicare half a century ago, the program now seems to understand its market power—and obligation—in protecting the health of 55 million senior citizens under its trust," Norrell says. He adds that seniors generally report satisfaction with their Medicare coverage and that any efforts to curtail benefits or to increase their cost sharing result in loud objection.
However, "Eventually the Medicare program and CMS would like to encourage more senior citizens to shift over from traditional Medicare to Medicare Advantage," Norrell says, "so CMS is setting up rules to encourage senior citizens to do that, and allowing private insurers to compete more for those customers."
Indeed, the influences in the competitive world include mergers fueled at least in part by anticipated growth of Medicare Advantage compared to employer-based plans. "That market is stagnant," Norrell says, while Medicare Advantage is viewed as the major growth opportunity. "They're betting that Medicare Advantage is going to be the wave of the future."
Challenges for the future
The shift to pay for performance, with its additional burdens on providers to document quality outcomes, is what Norrell sees as the next major hurdle for Medicare.
Tying in to that is the public's greatest concern: the future financial viability of Medicare. The KFF finds most people would like to see federal spending on the programs increase or stay the same, and in order to do so, 68% say changes need to be made to the Medicare program to keep it sustainable for the future.
Notably, just over half of the overall public (51%) say they would support reducing Medicare payments to private insurance companies that provide Medicare benefits.
While the public will generally call for federal spending to be maintained or increased and for the government to keep the status quo rather than restructure the programs, "policymakers must grapple with competing priorities and visions for the nation's healthcare system that can sometimes be at odds with the public’s preferences," the KFF report concludes.