Medicaid at 57: Opportunities for the Future of Health Care

Medicaid at 57: Opportunities for the Future of Health Care

*Co-written with Anna Muthalaly | Communications Intern and Public Policy major at Duke University

This week marks the 57th anniversary of the Medicaid program, which provides health care coverage for over 75 million people in the United States. Although little attention was paid to Medicaid when it was passed in 1965, it is a program that has stood the test of time and now offers our best opportunity to address the profound disparities in coverage, access to services and health outcomes that our country wears as its badge of shame.

Medicaid is not perfect – racism was baked into the program from the onset,  and, even before Dobbs, Medicaid only covered abortions in the case of rape, incest, or a danger to the life of the mother. Nonetheless, the Medicaid program has given millions of people access to health care and has the ability to provide coverage for millions more through Medicaid expansion. At the National Health Law Program, we believe in the promise of Medicaid as a powerful tool to advance toward our goal of health equity, mobilizing the diverse web of systems, communities and organizations that makes health possible.

Earlier this year, NHeLP’s Legal Director, Jane Perkins, and North Carolina Managing Attorney, Sarah Somers, published an article in the Journal of Health and Life Sciences Law,The Ongoing Racial Paradox of the Medicaid Program,” exploring the complex role race has played in Medicaid. They note that almost 2.4 million uninsured black, indigenous, and people of color (BIPOC) would become eligible for coverage if policy makers deployed Medicaid to its full potential and expanded in the current non-expansion states. Increased access to care would help to address health disparities.  In addition, Medicaid provides opportunities for innovation, such as coordination of health care services with needed social services, and better data collection to enable us to understand and address health inequities.  Medicaid has stood the test of time because, little by little, we have unleashed the potential built into the Medicaid program.  There is more untapped potential that we can and should use in our pursuit of health equity, where everyone has access to quality health care, people are able to achieve their own highest attainable standard of health, and each person has all they need to flourish and thrive.

As we celebrate Medicaid’s anniversary this year, we are doubling down in our efforts to protect and advance access to quality and affordable health care for all. In addition to  the harsh realities we are all grappling with in the wake of the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, we face an additional threat to health rights this year, as the Court has also agreed to hear the case of Health and Hospital Corporation of Marion County, Indiana v. Talevski. In this case, use of Section 1983 of the Civil Rights Act to bring actions against states that are not fulfilling their obligations under  Medicaid, is under challenge. A negative ruling in Talevski would threaten the ability of individuals to enforce the promises of Medicaid, a key tool that NHeLP has used to great effect over the last 50 years, ensuring that those promises are realities for the low-income people the statute was designed to protect.. We are hoping for the best, but prepared for the worst. Regardless of what the Supreme Court decides, we are ready to keep fighting to enforce Medicaid in every state and protect the health rights of the people who need us most. 

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