Is Medicaid welfare?

This is a question that’s stirred some debate recently.  Republicans have always considered Medicaid—a means-tested public benefit that’s received based on income guidelines, much like TANF or food stamps—to be welfare.  Democrats lately have been contending that it’s not, especially within the context of the Medicaid expansion debate.   

So, what do others have to say?

It’s telling that Pennsylvania, a state whose decision to expand Medicaid under the ACA is being touted by Maine Democrats, places its Medicaid program within the state’s “Department of Public Welfare.”  The Department’s home page lists “Medical Assistance” (the name for Pennsylvania’s Medicaid program) right next to Cash Assistance and Food Stamps when directing visitors to apply for benefits.

Idaho’s Medicaid program similarly falls under that state’s Department of Health and Welfare.

In Nevada, the Division of Welfare and Supportive Services determines eligibility for the Medicaid program.

Most states administer their Medicaid program under the same cabinet-level department as the rest of their welfare programs, such as cash assistance, food stamps, and rent subsidies.  If it’s really health insurance—as Democrats claim—and not welfare, wouldn’t Medicaid be administered by the states’ departments or bureaus of insurance?

The University of Pennsylvania’s School of Social Work considers Medicaid to be welfare, classifying it as non-cash assistance right next to Food Stamps and rent subsidies.

Even the American Association of Retired Persons (AARP) considers Medicaid to be welfare.  

Merriam-Webster Dictionary defines welfare, in part: “a government program for poor or unemployed people that helps pay for their food, housing, medical costs, etc. [emphasis added].”

The Portland Press Herald, citing this definition, has concurred that Medicaid is, indeed, welfare.

Historically, Medicaid has always been cognizable as a welfare program, being signed into law originally as a part of President Lyndon Johnson’s “Great Society” initiative and factoring largely into the 1996 federal welfare reform law.  In fact, prior to the national welfare reform, Medicaid coverage used to be automatically extended to those who receive cash welfare benefits.

As a means-tested public benefit that’s granted based on income guidelines, it has much more in common with Food Stamps and TANF than it does with Medicare or Unemployment Insurance, which are granted by virtue of age or employment, not means. 

So why does this all matter?  Is it just a semantic argument or are there real policy implications for how we conceive of Medicaid? 

Of course, Medicaid, like many other public benefits, is of vital importance for the truly needy in our society.  Many children and elderly and disabled Mainers rely on this program.  Republicans put an emphasis on fiscal conservatism in part because we want our social safety net to be sustainable.  

But a growing number of Mainers and Americans believe that it’s not just the truly needy who are reaping the benefits of welfare.  The safety net is becoming a hammock for some, and our most vulnerable neighbors are slipping through the netting.  The safety net works when it holds only those who need it most.  However, when distributed to one-third of the state, as Democrats are proposing with Medicaid, welfare creates disincentives to work and crowds out scarce funding for those whom it was originally intended to serve. 

Furthermore, expanding medical welfare again would wreak fiscal havoc on Maine’s budget.  Past expansions left us with a $500 million hospital debt that we only just paid off thanks to Governor LePage’s persistence, and Medicaid-induced budget shortfalls continue to plague Maine taxpayers year after year.  Maine’s Medicaid program has doubled as a share of our state budget in just 15 years and now ranks as the third-largest in the nation.

There are alternatives.  Maine Republicans have implemented reforms that are bringing down the cost of health insurance.  Also, most of the people Democrats are proposing to cover with welfare expansion are soon eligible to buy federally-subsidized private health insurance for as little as $5 per week at no cost to the state.   

People’s frustration with welfare spending and overuse means that Democrats can’t sell another expansion of medical welfare unless they cast it as “free health care.” 

So yes, it’s natural for Democrats to resist the term “welfare” as a descriptor of Medicaid.  They don’t want to be the party of expanding welfare. 

But that’s what it is, and that’s what they are. 

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Comments

JOHN PAINTER's picture

Medicaid and Medicare are

Medicaid and Medicare are both forms of social welfare in the same way Social Security is. Medicare and Medicaid are (1965) amendments to the Social Security Act of 1935.

Personally a debate on definition of the term is not helpful. For me the real question is have these government programs been successful in improving and stabilizing public health, and to an extent, our economy.

Prior to the the Social Security Act there were large numbers of Americans who experienced severe poverty in old age, and while I while I have my moments of nostalgia thinking life must have been much simpler in the 19th Century, to a large extent the Social Security Act and it's offspring Medicare and Medicaid have vastly improved the health and well being of Americans and added a stability in the economy we did not experience previously.

Social Security and Medicare and Medicaid have changed quite a bit over the decades (e.g. originally women and minorities were excluded from Social Security), and I think they need to continue to evolve to meet the new challenges we face. Personally I'm partial to a revised form of Friedman's "negative income tax" as way to overhaul Social Security, and Medicare and Medicaid and cut out much unnecessary bureaucracy. Though that's another issue.

Being familiar with healthcare history in the US, I'm much more concerned that we do not have a public debate on the current healthcare oligopolies threat to affordable healthcare. To bring that debate home, it's utterly bizarre in a capitalist economy, that hospitals do not publish their charge masters. We can compel McDonalds to publish how much fat and sodium is in their burgers, but we really have no idea what we're being charged for our health.

It's like going VIP and they say they won't tell you what the parts and labor costs for a repair until after they're done.

Personally, I want to know if I'm going to be charged .20 or $11 for a vitamin E pill just as much as I want to know if I'm going to be charged $2 or $20 for a sparkplug. That for something as fundamental to the American spirit as life and liberty that healthcare oligopolies are tolerated when they tell us what we can or can not know is unacceptable to me.

CAROLYN LIBBEY's picture

I know I will get

I know I will get name-calling in response to this, but Medicare and Medicaid are different programs, and believe me, not many retirees are receiving generous medical benefits from the government.

MARK GRAVEL's picture

Medicaid is 100% welfare by

Medicaid is 100% welfare by definition:

Consider an average-wage two-earner couple together earning $89,000 a year. Upon retiring in 2011, they would have paid $114,000 in Medicare payroll taxes during their careers. But they can expect to receive medical services – including prescriptions and hospital care – worth $355,000, or about three times what they put in. [...]

Moreover, those who collect more than they pay in medicare benefits also receive a form of welfare.

It's 100% welfare folks, no matter how much you say it is not....

Jeff Wilkins's picture

Medicaid vs. Medicare

Of course Medicaid is a form of welfare. By definition, it's qualified for based on income.

Medicare however, is a age requirement benefit similar to social security. In theory, you pay into these programs during your lifetime and the benefits are there when you retire.

More information:
http://www.medicare.gov/Pubs/pdf/11306.pdf

Carol Durgin's picture

Is Medicaid welfare?

I tend to agree with Tina Hutchinson. The system is way out of whack. The hospitals are ripping people off. On the other hand, I guess we are helping cover the cost of those that can't pay. I feel that the cost increase and service decline that
Doreen Sheive speaks of will be par for the course if the Obama health care passes. There are many folks that need medicaid but there are also those who take advantage.

Claudette Therriault's picture

Health Care

Carol, The Obama Health Care bill passed two years ago. The argument in DC is whether to defund it or not.

Medicaid is a safety net for the most vulnerable populations of our country. And, yes. there are those on it who cheat. But, for every cheater, there are so many more who need the program that won't get it if the state does not accept expanded Medicaid.

It does not matter what it's called. Why is Congress wasting time arguing on what to call the program? As an elderly person, I don't personally feel that I'm on "welfare." Most of us worked their whole lives and paid our taxes, volunteered and still do, and basically paid our dues to society.

MARK GRAVEL's picture

Medicaid is undoubtedly

Medicaid is undoubtedly welfare. Moreover, the average citizen withdraws more than 2x in medicaid benefits than they paid into the system - that overpayment is too welfare.

Claudette Therriault's picture

Not when you've worked and

Not when you've worked and paid income taxes for over 50 years!

MARK GRAVEL's picture

Readers, this is a classic

Readers, this is a classic demonstration of American's entitlement mentality. I lived, therefore I am entitled. Come on, get real.

Little do they know that America's tax system is pay as you go, meaning that taxes I pay today, fund the government today, not to fund government off as some future date.

Claudette Therriault's picture

During these 50 years that i

During these 50 years that i worked, I paid taxes so that other needy folks could get the help they need. I never thought that my husband would die a few years ago and I would find myself needing help. It's not something you plan on. That's reality! So today, younger folks are working and paying taxes so that I can get the help i need.

Someday your comments will come back and bite you in the butt. You may just find yourself in a situation where you need help!!!

MARK GRAVEL's picture

First, my condolences for

First, my condolences for your loss.

That said, there are a plethora of statistics indicating that you would outlive your spouse, so why where you not prepared?

Claudette Therriault's picture

Mark, you are an insensitive

Mark, you are an insensitive moron and I can only hope that someday Karma bites you in the ass and you are in need of WELFARE.

MARK GRAVEL's picture

There is one takeaway readers

There is one takeaway readers can pull from this discussion.

DO NOT depend on the government to comprise part or all of your retirement. Yes, we all pay taxes, but those who assume they will have government benefits available when they retire are setting themselves up for hardship. One just has to look at government spending, unfunded liabilities, and the growing national debt to know the current modus operandi is not sustainable. Things WILL change, and they will not be for the better.

Save and plan like there will be no government assistance in your golden years. DO NOT depend on the government.

MARK GRAVEL's picture

First, I did not question

First, I did not question your need.

I asked a ostensible, but tough, question. I have two statistics that all women need to know:

1. You spouse is like to die before you - please prepare a little at time over you life.
2. You have a 50% probability that you will divorce your spouse - please be sufficient prior to getting married.

Planning now can smooth the bumps that we all experience in life.

Lastly, if one person learns from this discussion, the awkwardness this discussion presents is well worth it. Sometimes growing and learning means confronting uncomfortable topics.

DONALD FERLAND's picture

Mark I have bitten my tongue

Mark I have bitten my tongue many times while reading your posts. Do you know Claudette? Do you know her situation? Do you know that she worked for a non profit agency helping others in need (that's right ...in NEED)? Do you know personally how much she may have prepared for the day when her husband may die before her? Well let me tell you something...I DO know Claudette personally and I knew her husband. She prepared as much as anyone could for the future. But we all know that things happen that can take all that away in a split second. Her and her husband worked all their lives and now when she should be able to enjoy her children and grandchildren the most she is worried about how to pay for her medication. Even though she is retired, she still volunteers her time to help others as a way to stay active, not just for personal reasons but because that is the way she is. Claudette taught me alot about how to prepare for my future and how to deal with the bumps in the road that I have faced. She has given me a shoulder to cry on and someone to celebrate milestones with. For you to be so heartless and cruel is uncalled for. Just because your life may not have the same struggles that others may have does NOT give you the right to get on your high horse and be such an ass to others. Claudette....I apologize for not being as tactful as you have taught me to be but this guy is living with his head so much higher than reality that I couldn't take it anymore. Karma WILL definitely bite him in the ass one day and I hope that when that day comes there are people there to say Mark we will NOT help you even though you worked and paid taxes. You know it is funny because I actually feel sorry for him....

MARK GRAVEL's picture

My intention was not to

My intention was not to personally attack Claudette, but to trigger a discusion on how to prepare for the unexpected.

Perhaps a discussion on what Claudette did to prepare, such as I did XYZ, and I'm still having diffuclty making ends meet would be educational for all readers. A discussion of that form would allow other readers to introspect into their own lives and preparadness for the furture.

"For you to be so heartless and cruel is uncalled for." You are welcome to interpret my question, "what did you do to prepare?", as you see fit. I merely presented the opporuntiy for Claudette to discuss what she did to prepare, what worked, what did not work.

Lastly, I don't take your emotional reponse in a bad way. That is just you and your opinion, and I welcome all opinions whether they are fact-based or not.

DONALD FERLAND's picture

IF that was your intention

IF that was your intention then you should have stated that. Instead you come across as being a cold, heartless person. Discussion is all well and good but there comes a time when you need to put your brain in gear before opening your mouth or in this case typing the words. Stuff happens no matter how well you prepare for the future that can change everything. You plan for your future and pay all your bills, work all your life, pay taxes, pay your mortgage then your house burns down and your insurance finds some way to not pay what it will cost to rebuild....did you not plan for the future....unexpected things happen constantly. When that happens you should be able to expect programs out there to be able to help you...not make you wonder if you have to choose between medication or food, housing, or heat.....stop and think what you want to say before you type and hurt someone more then they have already been hurt. Do you think it is easy for some people to ask for help? What would you do if you were in their shoes? Tact goes further than any argument you can give.

MARK GRAVEL's picture

Why beat around the bush?

Why beat around the bush? Just ask the question!

"you have to choose between medication or food, housing, or heat....."

There are viable alternatives that no one talks about, like finding a roommate in a similar situation so you can at least share housing and heating expenses. Why suffer and carp about the situation? There are tangible actions one can take.

DONALD FERLAND's picture

I am so glad you have ALL the

I am so glad you have ALL the answers....NOT....you have no clue what anyone's situation is and yet you can solve everyone's problems....you are so full of yourself that it isn't funny. Just an FYI ...Claudette does have a roommate to split expenses with and yet she still has to make some very tough decisions. Claudette and many others like her should be able to rely on the government programs to help them after all their years of work...in most cases long before preparing for the future was even considered a feasibility. But again...you come across as a cold heartless person who thinks they know all when in fact you haven't a clue. I wish I could be there when reality bites you in the butt.

MARK GRAVEL's picture

Seems like Claudette does

Seems like Claudette does have a roommate, so I'm right on that one. That was a tangable suggestion.

Is Claudette purchasing internet services? If yes, services is not cheap.

"...others like her should be able to rely on the government programs to help them after all their years of work"

Doesn't sound like that is working that well according to you and Claudette. So what do you do about it other than complain? What actions do you take to fix the situation? There are always alternatives?

Let's discuss details and possible solutions then? Hiding behind your personal attacks will not get you solutions.

MARK GRAVEL's picture

P.S. Perhaps there is a bit

P.S.

Perhaps there is a bit of RC (Reluctance to Change) in play.

DONALD FERLAND's picture

And perhaps there is a bit of

And perhaps there is a bit of "full of yourself" in play. You have an issue with people who are lazy receiving assistance. You have an issue with elderly and disabled having assistance. Maybe it is you who has issues that need to be looked at. What the rest of us are doing is fighting for what is right for our elderly and disabled. The programs are in place to protect those that are the neediest. While we all agree that the lazy should not be having things handed to them, most of us also agree that we need to protect the elderly and disabled. Maybe it's your reluctance to let programs work for those that they are intended to help that is the issue. The only thing you have accomplished, in my opinion, is to show what a cold heartless person you are....oh and you have made my day in giving me a way to vent frustrations out on someone who is soooooo deserving...instead of those that don't deserve to feel my anger.

MARK GRAVEL's picture

As long as we keep talking in

As long as we keep talking in non-quantifiable terms, there is no hope in discussing possible solutions. What we say cannot be measured.

Over the years, I have observed how people react to adversity. Their responses falls, more or less, into three broad categories:

1. Adversity triggers call to action and changes are made to overcome.
2. Adversity triggers call for sympathy and whining, but no changes are made to overcome.
3. Adversity triggers an individual to freeze in fear. They cannot react even to whine.

Claudette Therriault's picture

Well Tina, now I have an

Well Tina, now I have an explanation for M G's views on welfare. His Sun Journal profile says he is from Roseville. That's the attitude you have when you look at the world through "Rose" colored glasses...no one is deserving of welfare.... for every problem. there is a solution, and everybody is happy all the time...

MARK GRAVEL's picture

P.S. Life is a struggle, one

P.S. Life is a struggle, one only has the right to pursue happiness, there is no guarantee one will find it.

DONALD FERLAND's picture

the right to pursue

the right to pursue happiness???? is that in our Bill of Rights? Can you quote your source on that? Gee I wish some people would just get a clue.....I am not talking in quantifiable terms....I am talking that it is our responsibility as human beings (although there is some question on just how human some people are) to take care of our elderly and disabled. The elderly have (in most cases) worked all their lives and paid into a system with the belief that the system would be there to help them in their old age. The disabled have not asked to be in the position they are in (in most cases) and deserve to have a system of assistance to help them have a decent quality of life. When we fail our elderly and our disabled then we fail as human beings and if we fail our elderly and disabled all we can hope for is our children will find a way to not fail us when we grow old. With that said, if you take a look at the next generation we should all be shaking in our boots because I do not see them stepping up to the plate when the time comes (with a few exceptions). And since it has already been determined by our illustrious governor that our schools are failing our children we can only expect everything to get worse then it already is. It is time to stand up, put on our big boy and big girl panties, put on our hip boots and do the work that we all need to do and to do that we need to take care of our elderly and disabled. As far as whining...I don't whine...I get mad and then I figure out a way to get things done. The one thing I don't do is think I have ALL the answers for EVERYONE'S situation.

MARK GRAVEL's picture

“worked all their lives and

“worked all their lives and paid into a system with the belief that the system would be there to help them in their old age.”

Isn’t that the crux of the problem? Since when did we expect the government to take care of all our needs? Social Security was only supposed to be supplemental. That implies it supplements individual savings. If someone works for 50 years and has zero savings, well, Houston we have a problem.

Moreover, the gap between what government says and does is as wide as the Grand Canyon.

I really feel sorry for those who beleive in what governemnt says.

I'm tiring of this circular discussion, so feel free to keep yelling at me. I'm going to go do something productive.

Cheers,

America's Mr. Right

MARK GRAVEL's picture

That is a good one -

That is a good one - Roseville...

I never said there should be no welfare. That statement is a manifestation of your emotional state.

By the way, glad I can help with your anger management. Better to yell at me than your family members.

The amount of welfare government doles out is not likely to change significantly. If that does not cover the bills, bowing to Washington DC with arms extended, palms up is not likely to get you more.

What other choices does one have? Continue to whine or take action?

Jeff Wilkins's picture

Medicaid vs. Medicare

Medicaid and Medicare are two different programs. Medicare is designed to assist the elderly.

Claudette Therriault's picture

Really?? I have news for

Really?? I have news for you. Low income elderly can't afford to pay for their medication on Medicare alone. That's why so many elderly are on MaineCare as well.

Jeff Wilkins's picture

Doesn't matter

I understand that, but that doesn't change the fact that they are separate programs with separate objectives.

Jeff Wilkins's picture

Whoops

Whoops, not separate objectives, separate funding.

Doreen Sheive's picture

I see no real purpose in arguing whether Medicaid is welfare or

The point is that Medicaid is absolute necessity for our poor (including our elderly who have worked hard all of their lives raising their families and participating in our communities). And, quite frankly, the insurance program that the Republicans put forth has been very detrimental to the people living in our rural communities -- costs have increased and services have declined.

DONALD FERLAND's picture

And maybe we should all be

And maybe we should all be looking at the out of control billing done by hospitals and doctors. Maybe we should be telling them that $12 for vitamin B12 is too expensive and needs to be a lower cost. Maybe we should be telling them that $500 to go from St. Mary's to D'Youville (which is across the road for those that don't know) by ambulance in unrealistic. Maybe we should be reeling in those costs before taking away from our elderly and disabled.

MARK GRAVEL's picture

The only why to stop crazy

The only why to stop crazy billing practices is to put healthcare spending directly in the hands of consumer. Anytime there is a third party paying the bill, insurance or government, then there will be unscrupulous billing practices. Only the consumer has their best interest in mind and the power to stop paying $12 for Vitamin B12.

If you don't believe me, just look at the inflation curve of cosmetic surgery vs. primary healthcare. The former is paid directly by the consumer and the inflation rate of cosmetic surgery is less than CPI - go figure.

RONALD RIML's picture

Healthcare is a Basic Human Right, not 'Welfare'

That Republicans fail to recognize it as such is an indicator of their moral bankruptcy.

MARK GRAVEL's picture

Yep, just as the readers

Yep, just as the readers thought, no sources to back up your claim.

Healthcare is not a right.

MARK GRAVEL's picture

Oops, I forget to cite my

Oops, I forget to cite my reference: http://www.law.cornell.edu/constitution/billofrights

The bill of rights, no where do I see healthcare listed. Where is your source Ronald?

MARK GRAVEL's picture

Throw out all the name

Throw out all the name calling you want there Ron...nald. Healthcare is not a human right. Show me in the US bill of rights where is says the right to free healthcare, or any healthcare for that matter.

Moral bankruptcy is using deadly force to talk others money to give out healthcare. I never joined your communist family, so off.

MARK GRAVEL's picture

Correction

talk --> take

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