Human Services: Medicare & Medicaid

Today, over 72 million ¹ people in the United States are enrolled in Medicaid, and 68 million ²  in Medicare. Medicare and Medicaid are ubiquitous aspects of modern society, but their importance and breadth of service are often undervalued and unrecognized.

Medicare and Medicaid were written into law by Lyndon B. Johnson as a part of the Social Security Amendments of 1965. Before this legislation, the 20th century saw many conflicting views on whether healthcare insurance should be a federal, state, or private matter. Earlier in the century, laborers were entitled to a form of disability insurance for lost wages. Still, as medical costs increased with technology and care practices, health insurance became a more pressing concern. Additionally, it became apparent that the country’s most vulnerable people- including the elderly, disabled, poor, and children- would require some form of assistance in paying for medical care. By not receiving this care, many people would suffer or die, ultimately reducing the country’s stability and productivity. After various iterations of healthcare initiatives, congress finally put forth the combination of state government, federal government, and private institutions that comprise what we know as Medicare and Medicaid ³.

Medicare and Medicaid are often conflated, but although managed by the same government agency, they are entirely different services. Medicare is primarily for people 65 years of age or older, as well as those with certain disabilities, and people pay into the Medicare fund throughout their working lives. It is fully funded and operated through the federal government and is essentially the same in every state. There are two primary parts to Medicare- Part A and Part B. Part A is considered hospital insurance and does not require additional consumer cost; it covers services like inpatient care, short-term nursing home stays, and hospice. Part B is considered medical insurance and generally requires the consumer to pay a monthly premium; it covers doctor’s appointments, outpatient care, preventative services, and some medical supplies. While Part B is optional, most people choose to include it. However, not all healthcare is covered by traditional Medicare – many people pay for additional plans from private insurance companies such as: Medigap, Medicare Advantage (often referred to as “Part C”), or Prescription Drug Plans (often referred to as “Part D”). Medicaid is for low-income individuals and families of any age. Unlike Medicare, Medicaid is administered and funded through a joint effort of state and federal governments, so there is some variation in services among states. Funded through tax dollars, Medicaid usually requires no monthly payments by the consumer, and covers a more extensive range of services than traditional Medicare. 

For our state’s most vulnerable populations, Medicare and Medicaid are often the only way to finance their health care. Close to three million Pennsylvanians are enrolled in Medicaid- almost half are children ¹. There are also nearly three million people in PA enrolled in Medicare ², with 17% of all Medicare users receiving additional benefits from Medicaid to fill in service gaps ⁴. In rural areas of Pennsylvania, 40% of all children and 20% of adults are provided coverage through Medicaid ⁵. Being no exceptions to this trend- Greene and Washington counties are home to significant populations relying on government-supplied health insurance. In Greene County, 8,921 community members are enrolled in Medicare ² and 9,619 in Medicaid (with some overlap between the services) ⁶. Washington County is home to 54,904 folks on Medicare ² and 44,204 on Medicaid ⁶. This means, according to government data, that 27% of all people in Greene and 21% of those in Washington utilize Medicaid services for healthcare ⁶. 

Along with essential doctor visits, hospital treatment, and preventative care, Medicaid provides additional services that maintain the health of those who use it. For example, Medicaid often funds mental health services, substance abuse treatment, home health care, long-term nursing home stays, and dental/vision coverage. In the United States, seven percent (with some estimates near 20%) of all people on Medicaid suffer from substance abuse disorder, and because of expanded government-supplied medical insurance, about 75% of this group of several million has received treatment to overcome their addictions ⁷.  Additionally, Medicaid funds programs that help the elderly live independently, provide transportation for medical appointments, enable foster children to have insurance up to 26 years of age, and even assist with weight loss or smoking abatement ⁸. 

Rural hospitals are particularly dependent on funding from Medicaid and Medicare. Over half of reimbursement costs rural hospitals receive are from Medicaid ⁹. Currently, 43% of rural hospitals in the state are operating at a loss (including UPMC Greene), and 12% are considered at risk of closing ¹⁰. Several rural hospitals in PA have been closed or repurposed in recent years due to a lack of resources. There are 16 designated critical access hospitals throughout Pennsylvania, which are essential in providing healthcare to the most rural populations. Critical Access hospitals receive Medicaid reimbursement at 101% of the treatment cost to help fund the general operations of the hospital. However, with the third highest rural population in the country, PA’s critical access hospital infrastructure is already considered insufficient. For example, the closest critical access hospital to most of the southwestern PA region is in Somerset County ¹¹. 

With the passage of the Affordable Care Act, many more United States citizens were able to gain access to health insurance than ever before. A fundamental aspect of this increase in coverage was through the Medicaid Expansion Program. Medicaid Expansion increased the income limit required to qualify for government-provided services. This was done to widen the net for people stuck between making too much money to be eligible for Medicaid but not enough to offset the ever-rising cost of healthcare. As of now, the government covers 90% of costs associated with medical care under the expansion, and states are only responsible for the remaining 10% ¹². Without this federal funding to supplement the state’s contribution, many who receive health insurance through the Affordable Care Act could suffer reduced services, or even a total loss of coverage. 

In addition to providing crucial medical care for a massive number of people in the United States, Medicare and Medicaid are also an effective tool for maintaining economic health. By increasing access to preventative care such as doctor appointments and prescription medication, the overall burden on hospitals for emergency care, surgery, and other invasive, expensive treatments is reduced. Government-provided health coverage is an investment in the youth of America- studies show that early access to medical care dramatically increases a child’s ability to receive proper education and become a productive member of the workforce ¹³. Further, Medicaid and Medicare vastly reduce the amount of medical debt people must take on for treatment. When unencumbered by debt, we give our most financially challenged neighbors a chance to participate in, and contribute to other vital sectors of the economy. Without Medicaid and Medicare, hospitals lose significant amounts of money through uncompensated fees that arise when the costs of medical care far exceed a person’s ability to pay for them fully. For example, common procedures utilized to treat cancer, strokes, and pulmonary disease can run a patient well over $100,000, which would leave most people in the country in a state of financial ruin, so the bill goes unpaid. Since the Medicaid Expansion Program, hospitals in Pennsylvania have seen a 28% reduction in uncompensated fees, ensuring fewer cuts to treatment they can offer patients ¹⁴. 

The rhetoric that people utilizing Medicaid or Medicare do not deserve the government-assisted health insurance they receive has long endured. Some feel it is unfair that they have to pay into funds to benefit those who, they believe, are not working their fair share, or have otherwise violated the socioeconomic contract we all share as citizens of the United States. However, these critiques may be misguided. Medicare recipients pay into Medicare for their entire working lives before claiming any benefit, and many (50% of users enroll in Medicare Advantage; 80% in additional prescription drug plans) continue to pay for insurance past 65 ². Further, the belief that people on Medicaid are benefiting from the labor of others while choosing not to work is simply false. Data shows that 64% of all people enrolled in Medicaid work, with most of this group working full-time ¹⁵. About 30% of the remaining recipients who are classified as not currently working cite three main reasons for their Medicaid enrollment: they are in school, disabled, or are primary caregivers. These are people who are trying to improve their situation, or are facing unfortunate circumstances through no fault of their own- circumstances many have faced, or will face at some point in their life. 

At the congressional level, there are current threats to Medicaid and Medicare coverage.  The Federal House has voted through a Reconciliation Bill, or a tax bill, that calls for potential cuts to Medicaid and Medicare up to 880$ billion ¹⁶. While the Senate still needs to pass, deny, or offer edits to this bill, a Continuing Resolution has been passed that will fund the federal government for the next year. While the Continuing Resolution technically maintains the same federal budget levels as 2024, it fails to include necessary funding for several new or expanded projects approved by Congress- some related to healthcare. Also contained in this Continuing Resolution is an order for agencies to report on their projected expenditures for 2025, which could indicate reductions in key health program workforce and services in the near future ¹⁷. 

To reiterate, Medicaid and Medicare play a vital role in the health of the country, the state, and even the communities in Greene and Washington Counties. If you would like more information on economic justice or democracy issues such as Medicaid/Medicare, or find out how you can get involved in advocacy, please reach out to Gavyn Marincheck, Community Organizer. Gavyn can be reached at gavyn@centerforcoalfieldjustice.org or by calling 412-229-7276.

1. October 2024 Medicaid & Chip Enrollment Data Highlights. Medicaid. (n.d.). https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html
2. Centers for Medicare & Medicaid Services Data. (n.d.). https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment
3. Berkowitz E. (2005). Medicare and Medicaid: the past as prologue. Health care financing review, 27(2), 11–23.
4. Peña, M. T., Mohamed, M., Alice Burns, Fuglesten Biniek, J., Ochieng, N., & Chidambaram, P. (2023b, January 31). A Profile of Medicare-Medicaid Enrollees (Dual Eligibles). KFF. https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/
5. Alker, J., Osorio, A., & Park, E. (2025, January 15). Medicaid’s Role in Small Towns and Rural Areas. Center For Children and Families. https://ccf.georgetown.edu/2025/01/15/medicaids-role-in-small-towns-and-rural-areas/
6. Data Dashboards & Reports. Commonwealth of Pennsylvania. (n.d.). https://www.pa.gov/agencies/dhs/resources/data-reports.html#accordion-f3ec9d1955-item-2bb29f02b2
7. Saunders, H., Euhus, R., Burns, A., & Rudowitz, R. (2024, March 28). SUD Treatment in Medicaid: Variation by Service Type, Demographics, States and Spending. KFF. https://www.kff.org/mental-health/issue-brief/sud-treatment-in-medicaid-variation-by-service-type-demographics-states-and-spending/
8. Your health benefits | PA enrollment services. Pennsylvania Enrollment Services. (n.d.). https://www.enrollnow.net/en/your-health-benefits
9. Rural Healthcare Payment and Reimbursement. Rural Health Information Hub. (n.d.). https://www.ruralhealthinfo.org/topics/healthcare-payment#:~:text=The%20American%20Hospital%20Association%27s%202019,Federally%20Qualified%20Health%20Center%20(FQHC)
10.National Rural Health Agency. (n.d.). State Rural Health Policy. Rural Health. https://www.ruralhealth.us/advocacy/state-rural-health-advocacy
11. Facts about Pennsylvania’s Critical Access Hospitals. The Hospital & Healthsystem Association of Pennsylvania. (n.d.). https://www.haponline.org/Resource-Center/resourceid/757
12. Park, E. (2025, February 24). Same Playbook: Major Medicaid Cuts Under Consideration for Budget Reconciliation Similar to Medicaid Cuts in Failed ACA Repeal Bills from 2017. Center For Children and Families. https://ccf.georgetown.edu/2025/02/24/same-playbook-major-medicaid-cuts-under-consideration-for-budget-reconciliation-similar-to-medicaid-cuts-in-failed-aca-repeal-bills-from-2017/
13.Chu, R. C., Peters, C., & Buchmueller, T. (2024, September). The Health and Economic Benefits of Expanding Eligibility. Health & Human Services. https://aspe.hhs.gov/sites/default/files/documents/effbde36dd9852a49d10e66e4a4ee333/medicaid-health-economic-benefits.pdf
14. How Medicaid Cares for Pennsylvanians. The Hospital & Healthsystem Association of Pennsylvania. (2025, March 6). https://www.haponline.org/Resource-Center?resourceid=64
15. Tolbert, J., Cervantes, S., Rudowitz, R., & Burns, A. (2025, February 4). Understanding the Intersection of Medicaid and Work: An update. KFF. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work-an-update/
16. Estep, S., Murphy, N., Ducas, A., & Gee, E. (2025, February 24). The Republican House Budget Resolution’s Potential $880 Billion in Medicaid Cuts by Congressional District. Center for American Progress. https://www.americanprogress.org/article/the-republican-house-budget-resolutions-potential-880-billion-in-medicaid-cuts-by-congressional-district/
17.Congress Passes Full-Year Continuing Resolution Bill, Maintaining Global Health Funding at Prior Year Levels. KFF. (2025, March 18). https://www.kff.org/global-health-policy/fact-sheet/congress-passes-full-year-continuing-resolution-bill-maintaining-global-health-funding-at-prior-year-levels/