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February 17, 1989

A Health Policy Agenda Proposal for Including the Poor

JAMA. 1989;261(7):1044. doi:10.1001/jama.1989.03420070094038

Medicaid, the nation's major program to provide health care to low-income persons, is failing to meet the health care needs of the poor. Even though the number of poor persons without access to health insurance has grown over the past decade, 11 million persons with incomes below the federal poverty level were without any health insurance in 1988, and over 50% of the poor did not qualify for Medicaid.

Although a patchwork of charity care and publicly funded health provision systems is available to some individuals in some communities, this incomplete system does not ensure access to comprehensive and consistent care for all who need it. A 1986 survey discovered that 19 million Americans encountered difficulty in obtaining health care because of financial reasons, and an estimated 1 million persons were denied care because they were unable to afford it.

The failure of the program to provide comprehensive access for