Congress may be proposing to vastly expand Medicaid as a main vehicle for reducing the number of uninsured in America, but this (like many of the proposed ideas) could have serious ramifications for families.

The state and federal health insurance program doesn’t cover just poor people. As Heritage senior health fellow Dennis Smith explains:

Federal law requires states to cover certain populations (including parents of children on Medicaid at old welfare eligibility levels), allows states to cover additional “optional” populations (including parents of children on Medicaid with higher family income levels), and refuses to pay for other populations (childless, non-disabled adults).

The idea of expanding Medicaid to more of these childless and non-disabled adults ignores the reality that people move on and off of Medicaid, which means their physicians may not be the same. Families would be better served by remaining in some form of private coverage, Smith continues:

Treating individuals differently based on income level will also result in the creation of new inequities among and even within families.

To break that down, say a family with an income that’s 125 percent above the federal poverty level has a child (let’s call her Sue) who is eligible for state’s Child Health Insurance Program (CHIP), while the parents are in Medicaid. Under one of the Senate health reform bills, little Sue can access private health plans through a Gateway because she’s on CHIP, but her parents can’t because they’re on Medicaid.

That’s going to mean real differences in the physicians Sue can see as opposed to her parents, since doctors are increasingly not taking on Medicaid patients rates because of the low reimbursement rates. This could impact a lot of low-income families, because CHIP starts at 100 percent of the federal poverty line.

Keep in mind, Congress is considering the massive expansion of a program that’s not known for its efficiency or smooth operations. This week, New York state and New York city officials agreed to pay back the federal government more than half a billion dollars for improper Medicaid claims for speech therapy and other services dating to the early 1990s.

Audits by the Department of Health and Human Services, spurred by lawsuits from a speech therapist, found that city and state programs financing speech therapy and other programs for disabled children had “substantial potential for fraud, reporting that a vast majority of the claims submitted did not meet federal requirements, and that in many cases there was no evidence that the services had actually been provided,” the NY Times reports.

Rather than put more people on a government health program, “Congress could achieve more coverage and save money by transitioning those on Medicaid into private insurance,” Smith said in his paper. See how Congress could achieve that by visiting