Medicaid is typically thought of as the health insurance program for the poor. But when it was created in the 1960s, it was designed to cover only three low income groups: parents and children, older adults and individuals with disabilities. Single adults without a disability and without dependent children were left out. What this means in practice is that you can be homeless and have no regular income but as long as you do not meet the strict federal definition of disability and do not have any children under the age of eighteen, you cannot get access to Medicaid in many states. 47% of adults with incomes below 100% of the federal poverty level, or $10,830 a year for a single individual in 2009, are uninsured. more…

Few people outside of Washington have heard of Olympia Snowe, the senator from Maine. But on Tuesday, she became the most important person in healthcare reform. Her vote in the Senate Finance Committee gave the Obama Administration its first bipartisan victory on healthcare. more…

Writers of the open letter to America in defence of the NHS rebut clearly and concisely some of the more ludicrous charges leveled against our system of healthcare. It’s a debate that on the whole leaves me cold. The idea that wittingly a Government would allow a huge chunk of its population to go without proper healthcare is unfathomable to me. more…

It is a peculiar trait of American politics: long presidential speeches broadcast at prime time. Just as Bill Clinton did thirteen years ago, yesterday, for an hour, President Obama tried to convince the American people that they had more to gain from healthcare reform than they had to lose. After a summer in which the opponents of reform have dominated the debate and public support has waned, the president was under pressure to regain the upper hand. more…

I was out for dinner with a New Yorker friend of mine recently. She’s British, but she’d brought along an American friend and I happened to mention to him how much I was digging President Obama. Things deteriorated from there. “Obama is a socialist!” the heads of the rest of the table turned, as the conversation up until that point had been about interior furnishings. more…

I’m worried that in the highly charged atmosphere created by the extraordinary US debate on health care my published anxieties about the NHS might brand me as unpatriotic. Perhaps Fox News or some equally evil, right wing American media outlet will track down my words in the Journal of the Royal Society of Medicine and broadcast them. I will be obliged to go onto television in Britain and tearfully recant, rather like a hostage asking for release, saying that I’ve always adored the NHS and have no doubts that it is the best health care system in the world. more…

As disability and aging advocacy groups continue to wait for the publication of the UK Government’s social care green paper, advocates on the other side of the Atlantic have been celebrating Obama’s show of support for the inclusion of social care reform as part of healthcare reform. Social care, or long term care as it is called in the US, accounts for 36 percent or $110 billion (£68 billion) of the total costs of Medicaid, the public insurance programme for the poor and disabled. Medicaid is funded jointly by the federal government and by state governments and state leaders have long felt the weight of growing social care costs. But the issue had not reached the national debate until now. more…

An audible gasp went around Washington last week when the Congressional Budget Office (CBO) released its first estimate of the cost of healthcare reform: $1 trillion. The cost seemed all the more eye watering given that it would only cut the numbers of uninsured Americans by 16 million or around a third of the total uninsured population. more…

While Tom Daschle waits another week for his confirmation as the Secretary of Health and Human Services, health reform has got underway without him in the form of the stimulus bill. The bill that is currently working its way through Congress falls just short of $900 billion in tax cuts and spending. Principally, it is about kick starting the economy and healthcare has a major part to play in that. But within the 600 pages of the bill are also several provisions that have little to do with immediate economic recovery and more to do with longer term health reform goals. Overall, the stimulus bill includes an extra $120 billion for the Department of Health and Human Services.

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As with his presidential campaign, Barack Obama’s approach to health reform will leave little to chance. His strategy for enacting the first major coverage expansion in more than 40 years is starting to take shape. He is building public support for reform early in the hope that it will be enough to counter the opponents of healthcare reform when they eventually flex their muscles. more…