Government Funded Health Insurance And Medical Malpractice

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The United States is one of the few countries in the developed world that does not provide universal healthcare and continues to rely on private insurance companies to pay for the medical needs of its residents. However, there are a small handful of government programs that are meant to bridge the financial gap between people in need of care and their medical providers. Among these government programs are Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Each one targets specific people in need, financially subsidizing their care so that they can get the medical attention they might not otherwise have been able to pay for.

Even though these government programs pay for medical care, it does not mean that the healthcare provider can give medical care that is substandard. Doctors, surgeons, and other medical professionals are still required to uphold their normal standard of care. If they fail to do so, they could be liable for medical malpractice, regardless of whether they are paid with government-funded health insurance.


Medicare aims to help senior citizens, aged 65 and over, who have contributed to the program during their working lives through a payroll tax payment of 2.9% of their annual wages, half of which is imposed on the employer. In addition to senior citizens, Medicare also helps younger people who have certain types of disabilities, e.g., end-stage renal disease. In all, there are an estimated 55 million people in the U.S. who benefit from Medicare, including 46 million seniors. On average, Medicare covers approximately half of the medical costs of those covered.

Some may think that because they only pay half of their medical expenses while the government provides the remaining half, they should not expect medical care on par with patients who cover 100% of their medical expenses. This logic is faulty. If the doctor that you visited misdiagnosed your ailment or the surgeon made a mistake that exacerbated your injuries, you should be compensated in a medical malpractice suit. Government-funded health insurance does not bar you from filing a medical malpractice lawsuit. It does, however, sometimes mean that you must complete additional paperwork throughout the process.


While Medicare covers primarily senior citizens in the U.S., Medicaid was created to cover people of all ages, so long as they either do not have the resources to attain medical insurance on their own in the private marketplace or fall into other categories of persons who need crucial medical attention. These other categories include pregnant women, seniors with a low income, or low-income parents of children who are eligible for Medicaid.

For people who do not have the means to pay for private medical insurance, their eligibility depends on the state of their residence. One of the provisions of the Affordable Care Act (ACA), also known as Obamacare, expanded the reach of Medicaid to include more people. Though some states did not, Pennsylvania, Maryland, and the District of Columbia have all allowed the Medicaid expansion that the ACA implemented. Pennsylvania residents can be covered by Medicaid if they are at or below 133% of the federal poverty line, while Maryland residents can be if at or below 138%, and District of Columbia residents can by up to 200% of the poverty line.

In all, Medicaid is estimated to be the health insurance provider for 72.5 million Americans.

With so many patients relying on Medicaid for their healthcare, it should come as no surprise that they suffer from medical malpractice on a nearly daily basis. Just because their healthcare is federally funded does not mean that they do not have a case against the doctor, surgeon, or other healthcare provider that hurt them. It does, however, mean that the state can try recouping costs of medical expenses that it has already paid from any medical malpractice award that you win in a case.

Children’s Health Insurance Program

Finally, there is the Children’s Health Insurance Program (CHIP), which aims to provide young people with health insurance so they can get the medical attention they need and deserve to live full and rewarding lives, but who live in families that do not have a low enough income to qualify for coverage under Medicaid. Individual states have more leeway to change the precise details of how CHIP works, though. For example, Pennsylvania’s CHIP program is available for families whose income is more than 133% of the federal poverty line, while eligibility for Maryland’s CHIP program depends on the child’s age and the District of Columbia’s CHIP eligibility depends on how many people are in the household.

Regardless, if a doctor or other medical professional makes a mistake or performs a medical procedure negligently, either of which causes a child to get hurt, CHIP does not prevent a person from enforcing legal rights to compensation in a medical malpractice lawsuit. This is especially important for children who have been hurt by malpractice because they are more likely to suffer long-term debilitations that hinder their ability to develop and live normal lives.

Medical Malpractice Attorneys at Gilman & Bedigian

The U.S. government takes the health of its citizens seriously, as shown by the amount of money that it spends to ensure that elderly, children and low-income people have access to the healthcare. Receiving government-funded healthcare in whole or in part does not negate a patient’s right to seek compensation if injury results from negligent care.

If you or someone you love has been hurt in a medical malpractice situation, reach out to the medical malpractice attorneys at Gilman & Bedigian by calling us at (800) 529-6162 or by contacting us online to schedule a free consultation.

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