Economists might argue that the Great Recession is over, but Medicaid enrollment tells a much different story. According to HealthLeaders-InterStudy's latest census of health plans, 1.4 million Americans joined the Medicaid rolls from July 2010 to January of 2011.

To put that in perspective, Medicaid now has 57.5 million members, up from 54.3 million when healthcare reform became law a year ago. At that time, estimates held that the law's expansion of Medicaid (beginning in 2014) would add 16 million new lives to the total by 2019. But here we are in 2011 and we?re already up by 3.25 million people.

This is creating a budget panic for the nation's governors, and new paroxysms of handwringing over ?entitlements.? But once again, the healthcare industry?always quick to pluck the silver lining from every cloud?has figured out what our political leaders have not: Medicaid cannot be considered a marginal piece of the American healthcare system any more.

Sure, Medicaid was created to care for people on the margins ? uninsured kids, old people with no assets, welfare moms and the disabled. But when Medicaid is opened to all Americans below 133 percent of the poverty level, it will become the safety net for a lot of formerly middle class American families.

Healthcare companies--from giants UnitedHealth Group and WellPoint to specialists like Molina and Amerigroup--know this. While pharmaceutical companies know the price of playing in Medicaid is high rebates, they can?t ignore the potential growth in covered lives. The smartest of these firms are working with state Medicaid officials to make the program sustainable for taxpayers.

It's a mistake to marginalize Medicare or Medicaid simply as programs for the old and the poor. They were created because the rest of us don?t want people dying in the street and don?t want to have to take grandma in because the nursing home has kicked her out. They?re becoming mainstream concerns now because more Americans are living closer to the ?margins? than we?d like, and healthcare inflation is far outpacing the rise in workers? earnings and employers? ability to fund benefits.
 

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