01/28/2008 - In 1948, with less than half of the United States population benefiting from some level of health insurance, the nation’s two political parties were hotly debating the wisdom of establishing a national health insurance program.
Many of those lacking insurance then were the unemployed, the poor, the aged, the chronically ill and residents of rural areas of the country. For Philadelphians lacking the resources to pay for medical care, Philadelphia General Hospital filled a critical gap. From its origins as an almshouse in the 1730s until its closing in 1977, Philadelphia General was dedicated to the care of the city’s indigent residents. In 1948, the hospital admitted more than 25,000 patients, accounting for more than a half-million patient days, at a cost borne by city taxpayers.
Today millions of low-income Americans rely on Medicaid, a federal-state insurance program, to gain access to needed health care services. The program plays a key role in reducing the number of individuals who would otherwise be uninsured. In 2006, Pennsylvania’s Medicaid program, known as Medical Assistance, provided coverage to close to 15 percent of the state’s population, representing 1.9 million people. In Philadelphia alone, approximately 285,000 of Philadelphia’s children and families and 110,000 of its disabled residents were enrolled in Medicaid in 2005. The second-largest insurer in the state after the Blue Cross/Blue Shield affiliates, the program supports health services for low-income women and children, as well as individuals with disabilities, and it offers longterm- care coverage for those 65 and older. Approximately 68,000 providers across the state—physicians, hospitals, nursing homes and intermediatecare facilities, and other health and human service agencies—participate in the Medical Assistance program.
Despite its substantial scope, Medicaid’s role in the health care delivery system is not always fully understood or appreciated, even by key stakeholders. In part, this lack of understanding is a consequence of the program’s significant evolution since its establishment more than 40 years ago. Each state’s Medicaid program now has numerous eligibility categories, variations in covered services and complicated rules governing program administration. The result often is significant confusion about whom and what services the Medicaid program covers. In recent years, budgetary pressures related to increasing enrollment and federal cost-savings proposals are challenging Pennsylvania policy makers to take a close look at the program. These issues, combined with the increasing flexibility states now have to make significant changes in program design, underscore, as never before, the importance of a comprehensive understanding of Medicaid’s reach and impact.
To help stakeholders in Pennsylvania understand the facts about Medical Assistance, in 2006 Pew established the Pennsylvania Medicaid Policy Center. Other supporters from across the state include the Jewish Healthcare Foundation, the North Penn Community Health Foundation, the Brandywine Health Foundation, and the Pottstown Area Health and Wellness Foundation. The center’s mission is to serve as an independent, nonpartisan source of information and policy analysis regarding Medical Assistance and to highlight the role the program plays in Pennsylvania’s health care system and economy.
Pew’s support for the center is but one component of the Pew Fund for Health and Human Services in Philadelphia. This program also provides operating and project support to nonprofit organizations serving some of the most vulnerable residents in Philadelphia and four surrounding Pennsylvania counties—Bucks, Chester, Delaware and Montgomery. These individuals include poor children and families; adults who face multiple, complex issues related to substance abuse, homelessness or chronic mental and physical disabilities; and the frail elderly.
Currently, with Pew support, more than 100 organizations are helping 65,000 individuals and families on an annual basis. This assistance takes many forms, such as support that helps frail elderly reduce depression and social isolation, help for vulnerable adults who have low educational levels or inadequate work skills to maintain or obtain competitive employment, and the provision of tools for parents and other caregivers to prevent or reduce problem behaviors in young people.
Recognizing the importance of strong organizations in the delivery of high-quality services, the Pew Fund has helped its partner agencies strengthen their overall operations and management in a variety of important ways. With the assistance of the OMG Center for Collaborative Learning, the Pew Fund over the last year has provided capacity-building support to 15 local health and human service organizations to improve such key functions as financial management and analysis, internal communications and program assessment. As a result of these changes, agencies are able to operate with greater administrative efficiency and deliver services that are more effective and responsive to client needs.
The Pew Fund’s three components— providing support for needed services to address compelling needs, strengthening organizations, and influencing policy—work together to improve the quality of life for some of the Philadelphia region’s most disadvantaged citizens.
Frazierita D. Klasen
Deputy Director for Local Programs
Health and Human Services Policy