Many years ago, as a fledgling social worker in New York City, one of us (JB) helped a single mom with a young son suffering from asthma get Medicaid coverage for her son. When I told her the news, she cried with relief. As young, privileged white guy, I was surprised by her reaction. I soon came to understand it.
For this mother, as for millions of other low-income people, Medicaid coverage means access to health coverage for a sick child or a family member with a chronic illness, or long-term care for an elderly parent. It means significantly improved financial well-being, and over the long term, better educational outcomes for kids covered by the program. It means having a regular doctor and getting care when you need it, with comparable access to care as private coverage.
Medicaid achieves these outcomes at a rate a spending growth that’s far below that of private insurance. Between 1987 and 2015, spending per beneficiary grew by about 4 percent per year for Medicaid, compared to about 7 percent for private coverage.
Nevertheless, conservatives often portray Medicaid as a dysfunctional failure, and the Trump administration is working hard to cut it. Last year, it tried do so by repealing the Affordable Care Act (ACA) and deeply cutting Medicaid. Now the administration is encouraging states to make it harder for people to qualify and harder for people to stay covered.
Slashing Medicaid would worsen low-income Americans’ access to care, health and financial security, as recent studies comparing outcomes for people and places with and without Medicaid show:
— The uninsured rate among the low-income adults eligible for the ACA’s Medicaid expansion fell by more than 20 percentage points more in Arkansas and Kentucky, which adopted the expansion, than in Texas, which didn’t. In Kentucky, the share of people with a personal doctor rose by about one-fourth, as did the share who got a checkup in the prior year.
— With greater access to care came better outcomes: The share of people who said they were in “excellent” health rose by 42 percent, and the share having trouble paying their medical bills dropped by 25 percent.
— Access to Medicaid coverage has long-run benefits for kids. For example, people eligible for Medicaid during childhood are likelier to attend and complete college; they also earn more as adults. Medicaid eligibility during early childhood reduced mortality rates for African American teenagers by 13 to 20 percent.
— Medicaid is particularly valuable to women, particularly women of color. Among women age 15 to 44, 31 percent of African American women and 27 percent of Hispanic women get coverage through Medicaid. The ACA’s Medicaid expansion has allowed many women to maintain continuous access to primary care and family planning services before and after pregnancy, and to avoid unintended pregnancy. When women have health coverage before becoming pregnant as well as between pregnancies, they are healthier during pregnancy, and their babies are more likely to be healthy at birth.
— Medicaid also helps women as they age, even when they become eligible for Medicare. Women live longer than men and are significantly more likely to need long-term care services through Medicaid.
Given these facts, it’s not surprising that Medicaid has wide public support. About three-quarters of Americans have a favorable view of the program — including 84 percent of Democrats and 61 percent of Republicans — and 67 percent say Medicaid is working well for most low-income people in their state. Only 12 percent of Americans support cutting federal Medicaid funding.
And yet, the Trump administration continues to attempt to undermine Medicaid, this time through state waivers adding work requirements to the program (such waivers do not require congressional approval). Their stated rationale is twofold: to incentivize beneficiaries to work in the paid labor market, and because, they claim, work promotes health.
Both rationales are wrong. Health coverage doesn’t pay for food, housing and anything other than coverage itself, so able-bodied beneficiaries must work, and, as we showed, most do. Second, the administration very likely has the causality backward: Coverage enables those with health conditions to get the treatment they need to participate in the workforce. By making it harder for them to maintain continuous coverage, many such current Medicaid beneficiaries will be less, not more, likely to work.
We observed something important and moving last year when Republicans tried to repeal the ACA: People stood up for Medicaid and insisted their representatives oppose massive cuts masquerading as “reform.” Americans saw the Republican war on Medicaid for what it was — an attack on an efficient, effective program.
Now, though, congressional Republicans claim they must cut Medicaid to help pay for their massive new tax cuts for the wealthy. If we want Medicaid to continue helping millions of Americans every day — enabling a single mother to get needed health care for her son, providing nursing home or chronic care for an elderly or sick family member without bankrupting the family, or providing a young woman with maternity care or family planning help — we must preserve Medicaid’s essential and highly valued benefits.
