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Can Washington Make Medicare and Medicaid Work Better Together?

Tradeoffs Podcast
| Published March 14, 2024


On Thursday, a bipartisan group of six U.S. Senators unveiled a bill aimed at helping millions of Americans trapped in a special kind of health insurance hell. These people, who are among the country’s sickest and poorest patients, are covered by two government health insurance programs — Medicare and Medicaid — yet still struggle to get the care they need.

Right now, to access vital services, most of the 12 million ‘duals’ are forced to deal with two different insurance plans and decipher two sets of confusing, sometimes conflicting rules. Medicare covers more urgent medical needs like surgeries while Medicaid pays for longer-term services like regular home visits from an aide. This bill aims to remove the patient from the middle of that maze.

The legislation mandates states to offer people at least one single, seamless insurance plan option that manages all of their medical, behavioral and long-term care — combining the Medicaid and Medicare sides of their benefits. Lawmakers hope the move makes care better and more cost-effective.

Industry groups, consumer advocates and academic experts applaud the bill’s authors for lighting a federal fire under states to solve this annual half-a-trillion-dollar problem. However, many question if it would achieve the bill sponsors’ twin goals of saving taxpayer money and improving patient health. 

The legislation is silent on many key technical details like how much health insurance plans would be paid to run these new seamless plans or how plan quality would be measured, they point out.

“We have the opportunity to be transformational and to hold health plans accountable,” said Amber Christ, managing director of health advocacy for the nonprofit Justice in Aging. “I don’t see this legislation really moving the needle.”

Featured Staff

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