<P> Medicare Part D provides a private insurance option to allow Medicare beneficiaries to purchase subsidized coverage for the costs of prescription drugs . It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and went into effect on January 1, 2006 . </P> <P> Medicaid was instituted for the very poor in 1965 . Since enrollees must pass a means test, Medicaid is a social welfare or social protection program rather than a social insurance program . Despite its establishment, the percentage of US residents who lack any form of health insurance has increased since 1994 . It has been reported that the number of physicians accepting Medicaid has decreased in recent years because of lower reimbursement rates . </P> <P> The Affordable Care Act dramatically expanded Medicaid . The program will now cover everyone with incomes under 133% of the federal poverty level who does not qualify for Medicare, provided this expansion of coverage has been accepted by the state where the person resides . Meanwhile, Medicaid benefits must be the same as the essential benefit in the newly created state exchanges . The federal government will fully fund the expansion of Medicaid initially, with some of the financial responsibility gradually devolving back to the states by 2020 . </P> <P> In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States . </P>

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