Cokie Roberts Answers Your Questions About Medicaid

DAVID GREENE, HOST:

The Republican health care bill died this week in the U.S. Senate. And one reason it collapsed was fear of deep cuts in Medicaid, the program that serves low-income Americans and children. The law that created Medicaid was passed back in 1965. And back then, lawmakers were already complaining about the high price tag for the program. It was going to cost $450 million more than was budgeted. And here's President Lyndon Johnson's response.

(SOUNDBITE OF ARCHIVED RECORDING)

LYNDON B. JOHNSON: Four-hundred million is not going to separate us friends when it's for health, when it's for sickness.

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D. GREENE: LBJ defending Medicaid back in 1965. Well, these days the cost has skyrocketed, and Medicaid remains highly controversial. We have been taking your questions about the program, and we're ready to put them to Cokie Roberts in our regular segment Ask Cokie. Cokie, good morning.

COKIE ROBERTS, BYLINE: Hi, David. Good to talk to you.

D. GREENE: Likewise. Let's cue up our first question here.

THOMAS GREENE: My name is Thomas Greene from Tallahassee, Fla. What percentage of Americans rely on Medicaid, especially in rural America?

D. GREENE: Well, Cokie, I like his last name, Thomas Greene.

ROBERTS: (Laughter).

D. GREENE: How do you answer his question?

ROBERTS: Well, the last numbers are for April, when 74.5 million people were enrolled in Medicaid and its extension, the children's health insurance program that's called CHIP. So that's about 23 percent of the population. And in rural areas, the number goes up a little bit to about 24 percent. But people in rural areas, David, are also so much more likely to be unemployed, less likely to have private insurance than those living in cities and suburbs. And that's one of the reasons that senators heard so much from some governors with large rural populations - governors opposing their bill.

D. GREENE: OK. Well, here's a question that we got on Twitter from Johnathan Grant. And you are really going to have to help me with this one.

ROBERTS: (Laughter).

D. GREENE: He said, I would like to hear more about EPSDT, the EPSDT benefit, and why it was added.

ROBERTS: That's a very sophisticated question...

D. GREENE: Yes.

ROBERTS: ...From Mr. Grant. And thanks to him, I now know the answer, which I would not have before the question. It stands for early and periodic screening, diagnostic and treatment. And it was added almost immediately, only two years after Medicaid was enacted. And it provides that people under the age of 21 can be screened for and treated for childhood health conditions before those conditions become serious or disabling. It was one of the very first steps moving Medicaid beyond being a program just for those on welfare. But in the last numbers I could find, David, fewer than 60 percent of those eligible for the program took advantage of it.

D. GREENE: Oh, that's interesting. But a reminder - this is a program that has evolved over its decades-long history. So here is a question, also on Twitter, from Shannon Flores about Medicaid and schools, Cokie. She asked, how many students, K-12, in the U.S. receive Medicaid assistance?

ROBERTS: Well, schools have played a huge role in getting Medicaid to kids. First, they are required by law to provide whatever medical services children with disabilities need to receive an education. Some also provide dental and vision screenings for eligible kids. Some add on monitoring of chronic conditions like asthma and diabetes. So they play a very big role in getting good health care to children.

D. GREENE: All right, Cokie. And we have audio here of our last question.

MICHAEL OLIVER: This is Michael Oliver from Portland, Ore. Why do beneficiaries struggle to find providers willing to accept Medicaid payment? Second question - why do Medicaid-funded services vary so wildly across states?

D. GREENE: OK, Cokie, not one, but two questions from...

ROBERTS: This sounds like a press conference. According to some...

D. GREENE: It does, doesn't it?

(LAUGHTER)

ROBERTS: ...Some surveys, close to a third of the doctors nationwide refused to see Medicaid patients. And that's because they say the pay is too low and the paperwork too high. But as Mr. Oliver suggests, there are big variations from state to state. The way it works is states administer the program under federal guidelines. But then they're free to put on whatever rules and agree to whatever compensation they want.

So it can go from a low of 40 percent in New Jersey to a high of 99 percent in Wyoming. So it's really a question of how much the politicians in the state value the program. And that's what we've seen play out here in the Capitol over the last few months as well. Governors in states that consider Medicaid invaluable made it clear to their senators they didn't support the health care bill.

D. GREENE: All right, commentator Cokie Roberts. And you can ask Cokie your questions about how politics and government work by emailing us at askcokie@npr.org. Or you can tweet us. Just use the hashtag, #AskCokie. Thanks as always, Cokie.

ROBERTS: Good to be with you, David. Transcript provided by NPR, Copyright NPR.