Noah Jackson, guest writer

Human dignity was Lyndon B. Johnson’s goal when he signed Medicaid into law in 1965. He believed that the wealthiest country in the world should be able to provide healthcare for those who cannot afford it. Little did he know how complicated Medicaid would become.

There are 43.1 million people in poverty in America. Without government-funded healthcare, those with little or no income could not receive the care they need. Most of us know people who are on Medicaid, and recognize it as an essential safety net to a flourishing society.

Still, very few people talk about Medicaid, much less understand how it works or how much it costs. Medicaid is health insurance originally designed to cover people in poverty, disabled people and pregnant mothers. It is a dual federal and state-run program intended to provide healthcare to those who cannot otherwise afford it. In 2015, Medicaid cost $545 billion, or roughly $4,500 per income tax payer.

A majority of recipients are children in single-parent homes. If the money spent on Medicaid was simply used to buy private insurance for every family in poverty in America, the current budget would be able to purchase premium plans and the government would be left with billions in surplus; this is even taking into account the rising health insurance costs.

Yet as Ronald Reagan said: “A government bureau is the nearest thing to eternal life,” and because of the strength of bureaucracy, we can bet that Medicaid is here to stay.

Today, Medicaid covers far more people than just those in poverty. It is the largest health provider in the nation with over 68 million people enrolled, 21 percent of the population.

There is no question that Medicaid is an absolutely necessary program. Yet the above statistic begs the question: Do one in five Americans need to be covered by Medicaid?

The official poverty rate according to the U.S. Census Bureau is 13.5 percent, meaning a third of Medicaid recipients are above the poverty line. While it is wonderful in theory to have as many people receiving free care as possible, expanding eligibility to those above the poverty line is damaging the quality of care received by those who truly need it.

Medicaid has caused many problems. The government has been unable to pay the bills that they owe to medical providers, with a repayment rate of 90 percent, according to the American Hospital Association. In some cases the underpayment is much worse.

Dr. Stephan Zerlang, said that the clinic he works for in Greeley, Colo. only receives 48 percent of the money owed to them by Medicaid. This has forced the clinic to cover costs by cutting the time each patient gets with the doctor, and by also inflating the amount the clinic charges per visit.

The problem is worse in hospitals because many states provide services with no copay to those on Medicaid. A copay is a portion of the medical bill paid by the insured individual. The theory behind Medicaid not having a copay is that those who qualify for Medicaid cannot afford the copay. However, entitlements without personal responsibility attached to them reward people for remaining in poverty and foster complacency.

Dr. Zerlang explained that a visit to the ER that would cost anyone with private insurance between $100-$300, costs Medicaid recipients a maximum of $3. This causes emergency rooms to be flooded with Medicaid beneficiaries who come on a regular basis for often trivial needs.

According to one study done by The Atlantic, the average emergency room visit costs $2,168. This means that millions of ER visits for non-emergencies end up costing billions of dollars.

Luckily there is a simple solution to this problem: attach a copay to ER and clinic visits to encourage people to only go to the doctor and ER when necessary. This is what almost all American citizens who pay for their health care have to do already. This would be the first step in promoting personal responsibility for those receiving Medicaid.

While this one step of adding copays will save our government billions of dollars, it is only the first step in a long list of needed Medicaid reforms. My hope is that we as a population start paying attention to these issues because our government is borrowing trillions of dollars in order to pay for programs like Medicaid, and we are going to be the generation paying for it.