State control over Medicaid has brought us great disparities in eligibility, availability of services, and provider payments. The need of poor Americans for health care and their inability to pay for it do not vary depending on state of residence, as their Medicaid coverage does.37 While geographic disparities in the Medicare program are considered to be a major policy problem, they are inevitable in Medicaid as it is currently structured.38
The Tenuous Nature Of The Medicaid Entitlement
Before 1965, federal assistance to the states for the provision of health care was provided through two grant programs. The first program was established in 1950 and provided federal matching funds for state payments to medical providers on behalf of individuals receiving public assistance payments. In 1960, the Kerr-Mills Act created a new program called "Medical Assistance for the Aged." This means-tested grant program provided federal funds to states that chose to cover the "medically needy" aged who were defined as elderly individuals with incomes above levels needed to qualify for public assistance but in need of assistance for medical expenses
Medicaid
Now it does seem to me that Chairman Ryan's budget does seem to borrow from the Kerr-Mills Bill but he does seem to forget that by block granting states such as the Kerr Mills bill did, that your health care for the most part under that system depended on two factors, one is your income, and two what state you lived in. It deos appear to move us not forward but rather back to a time when Seniors, disabled, Vets, etc were one of the most under-insured portions of our population. While we can all agree that there are many things that can be reformed, tearing down a program like Medicare is not one of them. It would make a lot more sense to had the Chairman proposed a budget that rather than completely gutted Medicare, perhaps means tested it for those individuals that are ABLE to afford their own insurance or perhaps are covered under a retirement program, or Tri-Care, etc. further the Chariman could have proposed letting new enrolee's into the system i.e. those just entering into the work for the choice NOT to make contributions and thus opting out of it. However, going back to a time when "private insurerers" were responsible for the health and well being of our Seniors, Vets, disabled, etc. is not the way to accomplish a balanced budget, espcially when you lack the courage to look at ALL area's of the budget. (Defense, Taxes, subsidies, your own salary and staffing costs, etc. )
