What Makes Medicaid, Medicaid? — Affordability

Executive Summary

The foundation of accessible health care is affordability. High premiums prevent people from getting insurance, increase uncompensated care in hospitals and emergency departments, and contribute to medical bankruptcies. People facing high cost-sharing often delay or avoid necessary medical care, even when they know it could lead to worse outcomes and more expensive treatments in the future. Individuals with low incomes may face impossible choices between essential needs like medicine or food, personal care services or rent.

Congress created Medicaid, the nation’s largest health insurance program, specifically to meet the needs of low-income individuals. The program includes robust affordability protections to keep out-of-pocket expenses low and encourage the use of the most cost-effective services because affordability is fundamental to access to health care.

In this paper, Senior Policy Analyst David Machledt explains why cost sharing can discourage low-income individuals from seeking health care coverage, and the importance of Medicaid’s protections against run away cost sharing mechanisms.

For additional information about unique and important aspects of the Medicaid program, check out our entire What Makes Medicaid, Medicaid? series. And for a high-level overview of this paper, see our Highlights: What Makes Medicaid, Medicaid? – Affordability factsheet.

This paper was originally published in 2017 and an archival copy can be found here.

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