WASHINGTON — Medicaid embarks on a massive transformation Wednesday — from a safety-net program for the most vulnerable to a broad-based one that finds itself at the front lines of the continuing political and ideological battle over the Affordable Care Act.
Already the nation’s largest health-care program, Medicaid is being expanded and reshaped to cover a wider array of people.
On Wednesday, the 2 million people who have signed up for coverage under the new law will become eligible to receive it. About 3.9 million took steps to sign up for Medicaid, according to federal figures.
That remains a flashpoint as a proxy for the broader debate over the role and responsibilities of government. The program is open to anyone whose income falls below 138 percent of the poverty level.
“The big change is that it really is going to operate the way most people thought it did,” said Judy Solomon, a Medicaid expert at the Center on Budget and Policy Priorities, a think tank focused on policies affecting low- and moderate-income people.
The newly eligible come from many strata of society: homeless, former inmates, low-paid workers, recent college graduates, retirees not yet old enough for Medicare and people between jobs.
Because of its roots as a welfare program, Medicaid has long had an image problem. President Barack Obama and many Democratic lawmakers initially resisted the Medicaid expansion. But it turned out to be significantly less expensive than providing federal subsidies to lower-income people to buy private insurance through the state and federal exchanges.
The decision by many states to reject the Medicaid expansion has thwarted a basic goal of the law, which is to make health-care coverage universal and affordable.
“Well, 85 percent of the people who’ve signed up in Kentucky have signed up for Medicaid,” Sen. Mitch McConnell, R-Ky, said of the debate. “That’s free health care. If you want to give out free health care you’re going to have a lot of interest. Just like free anything else.”
