Medicaid at 54: The Ongoing Fight for Health Rights

Medicaid at 54: The Ongoing Fight for Health Rights

On July 30, 1965, President Lyndon B. Johnson signed into law the Social Security Act Amendments. It established Medicaid, a health insurance program for low-income people, as well as Medicare, a health insurance program for older adults and people with disabilities. These programs were envisioned as providing access to health care for some of the most vulnerable communities in this country, and, for the better part of five decades, advocates have been working to protect and expand these programs.

This year, the National Health Law Program celebrates our own milestone – for 50 years we have been fighting to defend the health rights of low-income individuals and underserved communities across this nation. Our work is expansive and, as a team of expert lawyers and advocates, we draw from a large toolbox of laws to fight for greater health equity. Our toolbox includes the Civil Rights Act, the Americans with Disabilities Act, the Affordable Care Act, and an assortment of regulations, statutes, and court rulings that make up the body of health law in this country. But it is the provisions of the Medicaid statute that provide the crucial foundation for our work. Medicaid is baked into our DNA; it is the foundation on which generations of advocates have built a health care system that addresses the unique health care needs and challenges of low-income communities.

The National Health Law Program was founded by Ruth and Milton Roemer at the University of California, Los Angeles in 1969. It was created with a grant from the Office for Economic Opportunity (OEO). Our mandate as a legal “backup center” was to provide support and technical expertise to public interest attorneys and advocates as they worked to figure out how the newly enacted Medicaid Act would impact the lives and health of their low-income clients. In our earliest days, the work of the National Health Law Program was propelled by enthusiasm and grit more so than resources. Larry Silver, NHeLP’s first executive director, observed that “those first few weeks were lonely and frightening. I was the Program’s sole employee, and felt lost fighting the bureaucracy of the University for space, paper clips, and parking spaces!”

From our rag-tag beginning, our numbers have grown alongside our expertise. Our attorneys were some of the first to pore over the congressional records related to Medicaid’s passage and fundamentally understand the new legal protections afforded to low-income individuals under the law. They shared this understanding with public interest attorneys, free health clinics,  and others, with the goal of building a robust set of legal protections for individuals and families who had historically been left without access to quality health care. This expertise has inspired bright, dedicated people to join our organization and continues to drive our advocacy. Our work and the work of countless others has helped to evolve and expand Medicaid over the last half century.

Today, Medicaid is a vital lifeline for millions of individuals and families in communities across the United States. Nationally, one in five people access health care through Medicaid, and Medicaid covers almost half of all births in this country. Eighty-five percent of low-income children are covered by Medicaid, as are almost 50 percent of all children with complex medical needs, regardless of income. Medicaid provides home- and community-based care for millions of adults with disabilities and provides funding for over 60 percent of care in nursing homes.

Yet, despite the positive (and measurable) impact of Medicaid on the lives of millions, the program remains under attack. Attempts to overturn the Affordable Care Act in the courts threaten Medicaid expansion, while in Washington there is renewed talk of implementing block grants on Medicaid, which would force states to ration care. The National Health Law Program has taken the Trump administration to court, where we are actively fighting attempts to impose illegal work requirements and other barriers that would force millions of people off of Medicaid.

For 50 years, the National Health Law Program has defended the integrity of Medicaid by championing the rights of beneficiaries, enforcing the law through litigation, and advocating for federal and state policies that meet the needs of low-income individuals and families. We are proud of our role in the fight to expand health care in this country and know that the lessons we’ve learned over the last half century will inform our advocacy as we move into the next.


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