Clinical Review & Education Special Communication Medicare and Medicaid at 50 Years Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers Drew Altman, PhD; William H. Frist, MD IMPORTANCE Medicare and Medicaid are the nation’s 2 largest public health insurance programs, serving the elderly, those with disabilities, and mostly lower-income populations. The 2 programs are the focus of often deep partisan disagreement. Medicare and Medicaid payment policies influence the health care system and Medicare and Medicaid spending influences federal and state budgets. Debate about Medicare and Medicaid policy sometimes influences elections. Author Audio Interview at jama.com Supplemental content at jama.com CME Quiz at jamanetworkcme.com and CME Questions page 402 OBJECTIVE To review the roles of Medicare and Medicaid in the health system and the challenges the 2 programs face from the perspectives of the general public and beneficiaries, health care professionals and health care institutions, and policy makers. EVIDENCE Analysis of publicly available data and private surveys of the public and beneficiaries. FINDINGS Together, Medicare and Medicaid serve 111 million beneficiaries and account for $1 trillion in total spending, generating 43% of hospital revenue and representing 39% of national health spending. The median income for Medicare beneficiaries is $23 500 and the median income for Medicaid beneficiaries is $15 000. Future issues confronting both programs include whether they will remain open-ended entitlements, the degree to which the programs may be privatized, the scope of their cost-sharing structures for beneficiaries, and the roles the programs will play in payment and delivery reform. CONCLUSIONS AND RELEVANCE As the number of beneficiaries and the amount of spending for both Medicare and Medicaid increase, these programs will remain a focus of national attention and policy debate. Beneficiaries, health care professionals, health care organizations, and policy makers often have different interests in Medicare and Medicaid, complicating efforts to make changes to these large programs. Corresponding Author: Drew Altman, PhD, 2400 Sand Hill Rd, Menlo Park, CA 94025 (
[email protected]). JAMA. 2015;314(4):384-395. doi:10.1001/jama.2015.7811 Corrected on July 30, 2015. A s the Affordable Care Act (ACA) marks its fifth anniversary, Medicare and Medicaid mark their 50th. Key milestones from enactment in 1965 to changes through 2012, including the expansion of eligibility and benefits, changes in the payment system, and stronger financial incentives to improve quality and efficiency, are shown in ACA Affordable Care Act Figure 1. The 2 programs are constant topics of policy and ACO accountable care organization political debate and, someFPL federal poverty level times, consternation among MCO managed care organization health care professionals and SGR Sustainable Growth Rate health care institutions. Despite the rhetoric that sometimes surrounds both programs, polling data show that Medicare and Medicaid are very popular with the American people and the health care system could not function without them. 384 Author Affiliations: Kaiser Family Foundation, Menlo Park, California (Altman, Frist). Dr Frist is the former US Senate majority leader. Together, Medicare and Medicaid provide health coverage to about 111 million people, or 1 in 3 Americans, including 10 million dual-eligible people covered by both programs (Table 11-10). That number is projected to reach 139 million people by 2025. Today, the programs constitute 39% of national health spending, account for 23% of the federal budget, and generat