ABSTRACT
This chapter examines the link between health care of the poor and social insurance through an assessment of the Medicare and Medicaid models. The impact of Medicaid, as the primary insurer for the nonelderly poor, and of Medicare, as the insurer of the elderly, on the health of the poor and access to care provides valuable lessons for national health care reform. Medicaid’s enactment, the financing and provision of health care to the poor was a meager combination of charity care and reliance on public hospitals and clinics coupled with limited public welfare-based assistance. Medicaid was enacted in 1965 as companion legislation to the Medicare program to provide grants to states for medical assistance to the poor welfare population and the medically indigent who met the welfare categories. Medicaid has achieved significant advances in health care of the poor but has fallen short of realizing equity of access between the poor and non-poor.
