Low-income adults (those with incomes below 200 percent of poverty, or $33,200 for a family of three in 2007) account for just over half of the non-elderly uninsured in the United States. This brief reviews the health coverage of non-elderly low-income adults and discusses the implications for national health reform efforts of broadening coverage for this population by filling gaps in Medicaid eligibility.

Low-income adults are more than twice as likely to be uninsured as low-income children. Many low-income adults have significant health needs, and yet lack access to employer-sponsored coverage and cannot afford or access private coverage in the individual market.

Although Medicaid covers some low-income adults, parent eligibility levels are below poverty in 34 states and childless adults are excluded from the program under federal rules. Eliminating the categorical exclusion of childless adults, increasing income eligibility levels and enhancing the federal financing available to support coverage for adults could enable Medicaid to cover more of the low-income uninsured and help establish a strong floor of coverage upon which additional expansion efforts could build.

Summary (.pdf)

Policy Brief (.pdf)

This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates.

The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children.

Report (.pdf)

This policy brief examines the structure and experience of Community Care of North Carolina, an enhanced medical home model of care that North Carolina began implementing in 1998 as part of its Medicaid program.

Evaluations of the initiative, which includes a heavy emphasis on care coordination, disease and care management and quality improvement, suggest that it has resulted in both improved care and cost savings.

The program provides important lessons for broader health reform efforts and demonstrates Medicaid’s ability to incorporate quality improvement strategies that enhance its ability to provide coordinated, cost effective care to low-income individuals with significant health needs.

Summary (.pdf)

Policy Brief (.pdf)

These related research papers examine the policy opportunities for expanding Medicaid to cover more low-income and high-need people in ways that would enable the program to serve as a platform for larger national health reform efforts.

As congressional leaders work on proposals for universal coverage, some policymakers have suggested that strengthening Medicaid’s coverage of the poorest Americans and those with special health needs could provide a base for broader health reform efforts to expand coverage, control costs and improve quality. How many of the uninsured should be covered through public programs and how many through private insurance is an issue of debate in the designing of health reform legislation.

The new resources include:

Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

The Coverage and Cost Impacts of Expanding Medicaid

Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility

Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid

The Kaiser Family Foundation released the papers May 12 at a public briefing on Medicaid as a Platform for Broader Health Reform. An archived webcast is available.

Podcast

Transcript (.pdf)

Incorporating data from the 2009 Medicare Trustees’ Report, this chartpack examine the fiscal challenges facing the Medicare program as well as the public’s views on confronting them.

Chartpack (.pdf)

Medicaid is the health insurance safety net for nearly 60 million of the nation’s poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate.

This paper, based on years of research and analysis from the Kaiser Commission on Medicaid and the Uninsured, summarizes the problems that low-income individuals face in today’s health care system and explores policy opportunities to expand the Medicaid program to cover more of this population as a base for broader health reform efforts.

Many leading health reform proposals rely on a combination of public and private approaches to expand coverage, control costs and improve quality, with shared responsibilities across employees, employers, consumers and the insurance markets. Medicaid can provide a strong foundation that can help assure the success of broader reform efforts by maintaining coverage for the poor and sick while providing a vehicle to reach low-income adults with affordable coverage.

Health Reform: State Financing and Medicaid

Executive Summary (.pdf)

Paper (.pdf)

This report is based on a survey of Americans on the U.S. role in global health and was designed and analyzed by public opinion researchers at the Kaiser Family Foundation. It was conducted January 26 through March 8, 2009 (before the international outbreak of the H1N1 influenza A virus), among a nationally representative random sample of 2,554 adults ages 18 and older. Telephone interviews conducted by landline (N=1,951) and cell phone (N=603, including 214 who had no landline telephone) were carried out in English and Spanish. The survey includes oversamples of African American and Latino respondents as well as respondents ages 18 – 29. Results for all groups have been weighted to reflect their actual distribution in the nation. The margin of sampling error for the overall survey is plus or minus 3 percentage points. Most questions reported here were asked of a random half-sample of respondents and have a margin of sampling error of plus or minus 4 percentage points. For results based on subgroups, the margin of sampling error may be higher. Portions of this survey (questions about the domestic HIV epidemic) have been previously released.

Report (.pdf)

Data Note

On March 30, 2009, the Centers for Medicare & Medicaid Services issued the 2010 “call letter,” which functions as a request for proposals to private health insurers and organizations that want to sponsor Medicare Advantage Plans or Medicare Prescription Drug Plans.

This issue brief reviews the call letter — the first issued by the Obama Administration — and examines the implications for beneficiaries of some of the proposed changes, including its emphasis on accountability of health plan sponsors, promoting informed choices for beneficiaries, and providing protections for beneficiaries.

The brief was prepared for the Foundation by the Center for Medicare Advocacy.

Issue Brief (.pdf)

Two-thirds of the public supports maintaining (39%) or increasing (26%) U.S. government funding to improve health in developing countries, while fewer than a quarter (23%) say the government is spending too much on global health, according to this survey of the American people’s attitudes towards U.S. global health and development assistance. Levels of support are similar for spending to fight HIV/AIDS in developing countries, although the public’s sense of urgency about the HIV/AIDS epidemic around the world has declined. However, perhaps not surprisingly given the current recession, the vast majority (71%) of Americans say that given today’s serious economic problems the U.S. can’t afford to spend more on global health right now.

The survey of Americans on the U.S. role in global health was designed and analyzed by public opinion researchers at the Kaiser Family Foundation. It was conducted January 26 through March 8, 2009 (before the international outbreak of the H1N1 influenza A virus), among a nationally representative random sample of 2,554 adults ages 18 and older. Telephone interviews conducted by landline (N=1,951) and cell phone (N=603, including 214 who had no landline telephone) were carried out in English and Spanish. The survey includes oversamples of African American and Latino respondents as well as respondents ages 18– 29. Results for all groups have been weighted to reflect their actual distribution in the nation. The margin of sampling error for the overall survey is plus or minus 3 percentage points. Most questions reported here were asked of a random half-sample of respondents and have a margin of sampling error of plus or minus 4 percentage points. For results based on subgroups, the margin of sampling error may be higher.

News Release

Survey

Data Note