Commentary Health Systems

The Life-or-Death Factor We Must Keep in Mind About Medicaid

Dawn Godbolt

Put simply, in 2017, there are racial differences in access to health insurance and, consequently, vast differences in morbidity and mortality.

With all the talk about appeals, repeals, expansion, dismantling, restructuring, per-capita caps, and block grants when it comes to health insurance, it is increasingly important to keep one life-or-death factor in mind: Medicaid provides coverage for the country’s most financially vulnerable individuals. And these people disproportionately happen to be people of color.

Put simply, in 2017, there are racial differences in access to health insurance and, consequently, vast differences in morbidity and mortality. Black and brown people in the United States fare far worse than white people across health measures when it comes to diabetes, hypertension, and cancer mortality, just to name a few examples. Many of these conditions are due to lack of access to preventive care. As the debate in Washington continues to rage over a proposed replacement for the Affordable Care Act (ACA) beyond President Donald Trump’s “100 Days” mark, we should keep in mind who benefits and how.

Medicaid is a public service that has proven results, and dismantling or restructuring it ineffectively would harm a large portion of Americans. Following the implementation of the ACA, which included Medicaid expansion, nearly a quarter of people in the United States are now covered by Medicaid and its subsidiary program, the Children’s Health Program (CHIP). Medicaid covers 60 percent of children with disabilities, 30 percent of adults with disabilities, and one in five Medicare recipients. Additionally, Medicaid expansion saw the number of uninsured Americans drop to an all-time low, from roughly 46 million uninsured people in the United States down to 29 million. Medicaid also allowed people who fall within 133 percent of the federal poverty line to be eligible for coverage.

The effect of Medicaid is especially notable on reproductive health care. Almost a third of Black and brown women who are of reproductive age are enrolled in Medicaid, meaning they rely on it for services including cancer screenings, sexually transmitted infection testing and treatment, and prenatal care if necessary. Half of all births are now covered by Medicaid. In other words, all these women are classified as “financially vulnerable,” but do not have access to private coverage.

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Reducing health disparities through policy is practical since fewer sick people means a healthier community. Currently, the United States is failing at that in many respects. For example, the World Health Organization uses infant mortality to determine a country’s general well-being. In the United States, infant mortality for Black children is twice that of white ones. That statistic is chilling, but when we place it in historical context, we find that disparity was actually lessened due to Medicaid’s implementation. Just a few years past Medicaid expansion, many studies also point to an increase in access to care, an increase in diagnoses of chronic conditions, and an increase in treatment provided to adults in need of care.

Even with Medicaid expansion, however, 2.5 million adults fall into the “coverage gap.” These people make too much money to qualify for Medicaid, but not enough to purchase private insurance, work for employers who do not provide health benefits, do not work enough hours to qualify for employer-sponsored benefits, or live in states where Medicaid did not expand.

So while the gains made in access to care through Medicaid are noteworthy, it’s important to note that while people of color are disproportionately more likely to use Medicaid, they also remain less likely to have access to care. Latino people and Native Americans are at greatest risk of being uninsured; Black people are also disproportionately at risk of not being covered, in part due to being concentrated in Southern states that chose not to expand Medicaid.

Expanding Medicaid further, then, could ensure that people who fall into the coverage gap have access to care.

The future of our country depends on the next generation. There will be no “making America great again” without healthy people able to reach their full potential. In some societies, the cost of social support is considered to be the cost of social reproduction, which means in order for the country to have a new generation of people to engage in economic production, you must provide basic social safety nets.

Although attempts to repeal the ACA have failed so far, Medicaid is always vulnerable, with many conservatives calling for restructuring that would see a vast reduction in the amount of money states can dedicate to the program. House Majority Leader Paul Ryan recently told reporters he’s been “dreaming” about cutting Medicaid funding since “drinking out of kegs.”

Many Republicans like Ryan argue that Medicaid expansion was a “bait and switch” policy that will leave states struggling with the cost of expansion. The evidence says otherwise: In Colorado, for example, more than 30,000 jobs were created due to expansion alone; similar reports on job expansion have also come from Michigan.

Conservatives also argue that the quality of Medicaid care is subpar to that of private insurers, but until the social determinants of health like residential segregation, quality of education, and discrimination in hiring practices can be addressed, Medicaid and CHIP, which currently insure almost a quarter of all Americans, should be commended rather than condemned. As these programs are expanded, the powers that be should also work to improve them.

Progressive pushback against efforts to eliminate Medicaid has some support right now from Democratic and Republican constituents expressing anxiety about health-care coverage at town halls and their representatives’ offices. In response, many Republicans have simply stopped holding town hall meetings.

In order to promote equity in health outcomes, policymakers should stop the posturing and seriously consider further expansion of Medicaid. An evaluation of Medicaid implementation demonstrates that disparities can be reduced through an efficient and relatively simple policy adjustment. Further expansion of the effective program is the path to successful health outcomes for all.

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