# How much does Medicaid cost the feds? **URL:** \ **Category:** Factual Questions\ **Created:** [March 18, 2017, 6:09pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495 "2017-03-18T18:09:24Z")\ **Posts on this page:** 17\ **Page:** 1
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [March 18, 2017, 6:09pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/1 "2017-03-18T18:09:24Z")
In [http://www.electoral-vote.com/evp2017/Pres/Maps/Mar18.html#item-2](http://www.electoral-vote.com/evp2017/Pres/Maps/Mar18.html#item-2), end of the first paragraph claims that Medicaid costs the government over a half trillion a year. Can this be true? That would make it comparable to the defense budget, wouldn’t it? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [March 18, 2017, 6:33pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/2 "2017-03-18T18:33:06Z")
Governments (federal, state, local, etc) make up about 60% of all medical spending in the US, which is about 1.8 trillion out of a 3 trillion total. so that isn’t surprising. The federal government spends about 1 trillion a year on health (mostly medicaid and medicare, but also CHIP, NIH, VA, etc) > **[Total Medicaid Spending](https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)** > > Visit the post for more. I believe medicaid is a 50/50 program where the state pays half and the federal gov pays half (although that doesn’t include the ACA, which is 90% federal). Total government spending (state + federal) on medicaid is around $500 billion, federal share of that is around ~$350 billion. Finding the exact figures aren’t easy, one site may be tens of billions different from another. So my figures aren’t exact, but they are roughly correct. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [March 18, 2017, 8:23pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/3 "2017-03-18T20:23:44Z")
> [@Wesley\_Clark](#): > > I believe medicaid is a 50/50 program where the state pays half and the federal gov pays half (although that doesn’t include the ACA, which is 90% federal). Not quite. The feds pay at least half in every state. The percentage depends on the number of poor people in the state. ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [March 19, 2017, 10:56am UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/4 "2017-03-19T10:56:27Z")
> [@Hari\_Seldon](#): > > In [ElectoralVote](http://www.electoral-vote.com/evp2017/Pres/Maps/Mar18.html#item-2), end of the first paragraph claims that Medicaid costs the government over a half trillion a year. Can this be true? That would make it comparable to the defense budget, wouldn’t it? The defense budget included the cost of Tricare, the medical program for active duty military & their dependents. (Though they are mostly young 7 in shape, so medical costs are low. Except that they are prime reproductive age, and pregnancy/birth are very expensive medical cars.) There is also the cost of veterans medical care – that is much more expensive because they are many more of them, and they are much older & in poorer health. But I don’t think that is in the military budget. Also, there is a cost to NOT paying for medical care for poor people. They then end up getting medical care via the emergency room, which is much more expensive and less successful. A certain number don’t get needed medical care, or get it in time, and then die. Which often costs our society in terms of lost productivity & work hours. (But going into that too much will probably move this thread toward GD territory.) ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [March 19, 2017, 11:05am UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/5 "2017-03-19T11:05:19Z")
> [@t-bonham@scc.net](#): > > Also, there is a cost to NOT paying for medical care for poor people. > They then end up getting medical care via the emergency room, which is much more expensive and less successful. There are costs, but giving more people insurance actually _increases_ ER visits. It moves some people out of the ER, but even more people come in because they can now afford the bill. (This isn’t bad, but it’s not necessarily cheaper.) ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [March 19, 2017, 1:35pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/6 "2017-03-19T13:35:02Z")
Medicaid is a specific program and the replies above don’t really address the question. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [March 19, 2017, 1:56pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/7 "2017-03-19T13:56:03Z")
Medicaid is indeed over half a trillion a year, which is roughly equal to the defense budgets with war costs excluded, or about $550 billion in 2015. Medicare is larger, and slightly more than the military budget with war costs included, or roughly $650 billion in 2015. > **[NHE Fact Sheet | CMS](https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet)** > > Quick summary of NHE Facts ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [March 19, 2017, 2:02pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/8 "2017-03-19T14:02:19Z")
> [@Hari\_Seldon](#): > > Medicaid is a specific program and the replies above don’t really address the question. Wesley Clark’s numbers are close. Somewhere in the mid 300 billions. ---
**Author:** ![OldGuy](https://avatars.discourse-cdn.com/v4/letter/o/3bc359/32.png) [@OldGuy](https://boards.straightdope.com/u/OldGuy)\ **Post date:** [March 19, 2017, 3:30pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/9 "2017-03-19T15:30:49Z")
> [@Ravenman](#): > > which is roughly equal to the defense budgets with war costs excluded, or about $550 billion in 2015. This is an interesting comparison. The defense budget excluding war costs. How does it compare to Medicaid excluding say the costs of surgical procedures? ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [March 19, 2017, 4:32pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/10 "2017-03-19T16:32:40Z")
Note that about a third of Medicaid goes to long term care (nursing homes). Only a small percent of the formerly middle class elderly can afford much time at all in nursing homes. [There is this conservative vision that Medicaid is mostly paying for drug addicts, immoral single women pumping out kids…] There is also the question of cost shifting. When poor people go to hospitals and don’t pay it doesn’t mean hospital staff don’t get paid. Instead most of the costs are shifted to the people who can pay–and the federal government is one of them. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [March 19, 2017, 5:48pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/11 "2017-03-19T17:48:41Z")
> [@OldGuy](#): > > This is an interesting comparison. The defense budget excluding war costs. How does it compare to Medicaid excluding say the costs of surgical procedures? The military budget is annually requested in two parts: the much larger part which is called the “base budget,” which is the bulk of defense spending, and the other part is called “overseas contingency operations,” which is basically a separate pot of money that, in theory, if peace broke out next year in Afghanistan, Syria, etc. would in theory go away nearly immediately. Medicaid does not present its budget in terms of “here’s everything we do except this important thing” and “here’s the budget for this important thing.” DOD does, which is why I made the comparison. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [March 19, 2017, 8:23pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/12 "2017-03-19T20:23:05Z")
Lots of good data at the link given above: [https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html](https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html) The downloadable tables actually do break down Medicare/Medicaid spending into expenditure type, but surgery is not called out (hospital care and physician and clinical services are broken out). One takeaway is that total government expenditures (federal, state, and local) are about 45% of total national health expenditures. And the total per capital national health expenditure is almost $10,000 (for comparison, Canada’s is $6,299 - cite: [Health spending | CIHI](https://www.cihi.ca/en/health-spending)). ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [March 19, 2017, 9:52pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/13 "2017-03-19T21:52:57Z")
Here is another informative [article](http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub) from Physicians for a National Health Program. It shows that 2013 per-capita tax funded government healthcare expenditures (no private, employer funds - or out of pocket) are higher than all the “socialized” universal coverage costs in Sweden, Canada and the U.K. Taxes pay for about two-thirds of all US healthcare expenses - private & employer payments cover the rest. but of course, all that money still leaves people without healthcare. > [@](#): > > Estimated total U.S. health spending for 2013 was $9,267 per capita, with government’s share being $5,960. Indeed, government health spending in the United States exceeded total health spending (government plus private) in every other country except Switzerland. > > The finding that Americans pay the world’s highest health-related taxes conflicts with popular perceptions that the U.S. health care financing system is predominantly private, write Drs. David U. Himmelstein and Steffie Woolhandler, the authors of the study. Himmelstein and Woolhandler are professors at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. > > Direct government payments for such programs as Medicare, Medicaid and the Veterans Administration accounted for 47.8 percent of overall health spending. The analysis also identified two commonly overlooked tax-funded health expenditures – government outlays for public employees’ private health insurance coverage ($188 billion, or 6.4 percent of total spending) and tax subsidies to health care ($294.9 billion, or 10.1 percent of the total). Together, these public expenditures put the U.S. in first place for health care taxes. ---
**Author:** ![OldGuy](https://avatars.discourse-cdn.com/v4/letter/o/3bc359/32.png) [@OldGuy](https://boards.straightdope.com/u/OldGuy)\ **Post date:** [March 20, 2017, 12:54am UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/14 "2017-03-20T00:54:15Z")
> [@Ravenman](#): > > The military budget is annually requested in two parts: the much larger part which is called the “base budget,” which is the bulk of defense spending, and the other part is called “overseas contingency operations,” which is basically a separate pot of money that, in theory, if peace broke out next year in Afghanistan, Syria, etc. would in theory go away nearly immediately. > > Medicaid does not present its budget in terms of “here’s everything we do except this important thing” and “here’s the budget for this important thing.” DOD does, which is why I made the comparison. Ahh so it’s more like the comparison of welfare costs. How much are they in normal times. Let’s separately account for the welfare costs of dealing with a recession. If it disappeared (and I have much more confidence in recessions disappearing), those costs would in theory go away. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [March 20, 2017, 1:21am UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/15 "2017-03-20T01:21:25Z")
> [@OldGuy](#): > > Ahh so it’s more like the comparison of welfare costs. How much are they in normal times. Let’s separately account for the welfare costs of dealing with a recession. If it disappeared (and I have much more confidence in recessions disappearing), those costs would in theory go away. It’s more than that, actually. The overseas contingency operations budget of the military is more than a temporary increase like you describe, it is separated. Imagine if you went on a business trip and you got a single per diem check for $300: $220 for your hotel, $50 for meals, and a $30 bump for being in a high cost city. That’s the idea you’re talking about for welfare costs. But what if you got two different checks from different banks, one for $270 in “normal” costs, and a large check from another bank for the extraordinary costs. That’s what I’m talking about for the defense budget. ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [March 20, 2017, 2:47pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/16 "2017-03-20T14:47:03Z")
My ignorance fought. The most interesting fact that emerged is that the government spends more to give spotty care than every country other than Switzerland pays for universal care. It might be of interest to know that 47% of Quebec’s budget goes for medical care. And they also get a few billion a year from the federal government. Medicare in Canada (outside of Saskatchewan that started earlier and, in fact, became the model) started in 1971 when medical expenses were relativity modest and modern life-saving care (let me just mention heart bypass operations, even leaving aside heart transplants) was just getting started. As costs grew so did expenses and the governments just had to budget for it since the population just wasn’t going to abandon it. Just to give one example, in early February I was seeing flashes in my left eye when I moved my head suddenly. Also an increase in floaters. I went to the emergency room where I was examined within maybe an hour for at least a half hour, including an ultrasound scan and then sent to the ophthalmology department where I was examined by a doctor (actually a resident) for over an hour, including a second ultrasound (“I just don’t trust those people in emergency”) which still showed nothing and then given an appointment to see the big chief, which I did last week. Total cost to me: 0. Obviously someone paid, but I pay in taxes. Including a sales tax of 15% and something like a 50% marginal tax rate to the two governments. Glad I am in a position to pay these taxes. (In case you are interested, the diagnosis by everyone was separation of the vitreous humour from the back of the lens–nothing to worry about. Retina was fine.) ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [March 20, 2017, 3:32pm UTC](https://boards.straightdope.com/t/how-much-does-medicaid-cost-the-feds/782495/17 "2017-03-20T15:32:08Z")
> [@Hari\_Seldon](#): > > Obviously someone paid, but I pay in taxes. Including a sales tax of 15% and something like a 50% marginal tax rate to the two governments. Glad I am in a position to pay these taxes. Taxes here are not that different. I live in a state with no in one tax but when employed, my federal taxes were close to 40% for income and payroll taxes and another 9.1% state sales tax. Easy to go over 50% in a state like California.