The following excerpt is from an op-ed that first appeared in The Hill on May 9th, 2024.

To appreciate one of the great snafus of American health care, consider the plight of people who are poor, elderly — often with a disability — and insured by both Medicare and Medicaid.   

One might think having two insurers must be better than one. But these two programs were never meant to work together. Rather than cooperating, the programs follow rules that create incentives for each partner to shift costs to the other, while patients are stuck in the middle, without the care they need.  

For dually eligible Americans, bureaucratic nightmares are their daily realities.  

These accounts are emblematic of the problems that plague the nearly 13 million dually eligible individuals with disabilities or are old enough to qualify for Medicare and poor enough to get Medicaid. Nearly all make less than $20,000 a year. They are arguably sicker than any other group enrolled in Medicare or Medicaid, with lifespans that are a decade shorter than other patients. And they cost the government a cool half a trillion dollars a year — a sum greater than any other group and one that will surely rise as the country ages. 

Read the entire op-ed here.


Rachel M. Werner

Rachel M. Werner, MD, PhD

Executive Director of the Leonard Davis Institute; Robert D. Eilers Professor of Health Care Management and Economics, Wharton School; Professor of Medicine, Perelman School of Medicine

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