Medicaid at 50
It is unlikely that the authors of the original Medicaid law ever imagined that the Medicaid program would come to occupy the integral place in our health care system that it does today. They could not have predicted that federal and state policymakers would look to the program again and again to cover the growing number of uninsured and underinsured Americans, or that it would become the nation’s de facto long-term care program for people with disabilities and senior citizens, or that it would be a major source of health care financing and innovation. Medicaid’s evolution has involved significant challenges stemming from many causes – its roots in welfare; its federal-state structure; spending pressures generated by economic recessions, legislated expansions, and health care cost inflation; and deep-running ideological conflicts. But by virtue of its federal-state design and its financing structure, Medicaid has been able to respond to diverse and changing societal needs over the course of 50 years. In its expansion to fill widening gaps in health coverage, its positive impact on access to care and community integration, and its role in improving care for people with complex needs, Medicaid is largely a story of adaptability and resiliency. While uncertainties are inevitable given ongoing Medicaid policy debates, demographic pressures, and factors in the health care system overall, Medicaid’s service and record as our nation’s health care safety net bode well for future generations of Americans as the Medicaid program begins its next 50 years.