Medicaid at 60: Advocates warn that cuts could negatively affect all of us

At a time for celebration, it's a time of crisis. Medicaid's future might be in jeopardy? AI generated image

Medicaid is marking its 60^th anniversary this year. But, what could be a time of celebration for this nation’s largest public health insurance program has turned instead into a time of reduced health coverage for millions of Americans.

Health advocates, physicians, and policy leaders warn that Medicaid is facing the steepest federal rollbacks in its history. While Medicaid currently provides health coverage to more than 75 million people with low incomes and disabilities, a newly passed federal bill will have devastating effects by leaving many millions, who are currently covered, without any health insurance at all.

Speaking to more than 50 journalists at a press briefing hosted by American Community Media, a nonprofit news and communications agency, Dr. Ilan Shapiro Strygler said that Medicaid is not just insurance—it’s a lifeline.

Dr. Strygler is the chief health correspondent and medical affairs officer at AltaMed Health Services, located in Southern California. He expressed the fear that a lack of health insurance, and even reductions in insurance, will bring about less visits for primary care and more ER visits, adding to longer waiting time and more health complications. Without insurance and adequate funds, people will not be taking the medications necessary to control health issues like diabetes and high blood pressure. 

More ER visits and less primary care visits will lead to higher costs, which will have negative impacts on rural hospital and community clinics, especially.

Currently, KFF, formerly known as the Kaiser Family Foundation, stated in a brief outlining the impact of federal budget cuts on rural areas:

“The Congressional Budget Office (CBO) estimates that the enacted reconciliation package  would reduce federal Medicaid spending by an estimated $911 billion over ten years, and result in 10 million more uninsured people nationwide. Senators from both parties have raised concerns about potential impacts on rural hospitals and other providers, particularly given the ongoing trend of rural hospital closures.”

Dr. Strygler predicted that these impacts will lead health care facilities to have less physicians, less nurses and less healthcare for all of us.

Such a domino effect will bring an increase in chronic diseases nationwide making all of us vulnerable, especially, during times when influenza and colds are more prevalent.

A coordinated attack

Cary Sanders added to the concerns that Strygler expressed. Sanders is the senior policy director for the California Pan-Ethnic Health Network, which has offices in the Bay Area and in Sacramento. She highlighted the fact that Medicaid was established “60 years ago as a civil rights era program to ensure that the government provided basic health care to poor people.”

Since Medicaid was passed during the same time that the Voting Rights Act and the Civil Rights bills were passed, Sanders believes that the current administration’s attack on both Medicaid and on our civil rights is intention.

“This is not a coincidence,” she said, “as much as Medi Cal or Medicaid is a health care program, it's also an anti poverty program, and it's foundational to our ability to advance health and racial equity.”

An attack on California and immigrant communities

Some states like California are trying to close health care gaps and should be praised. For Sanders, California is one of these states, since it expanded the Affordable Care Act, expanded health care to all Californians, brought down premium costs, zeroed out copays for the lowest income Californians and codified stronger consumer protections into law so that insurers can’t consider things like pre-existing conditions.

The ”big beautiful budget bill” that the U.S. Congress passed is an attack on states, like California, since it restricts access to the ACA for immigrant communities, including those lawfully here as Violence Against Women Act recipients, refugees and asylees. The federal bill also “imposes work reporting requirements that target low wage workers, largely people of color, with onerous paperwork requirements that will knock them off of coverage and as well as by offering states to not take up the ACA expansion,” Sanders said.

National Alarm

Anthony Wright, who heads Families USA in Washington, DC, estimated that as many as 17 million people will lose their health coverage under the bill and maternity wards, nursing homes and community clinics will be particularly hard hit, leaving a sicker risk pool of people throughout the country. This growing sick population will lead “the state government, …to have to make some tough choices about what it cuts, whether it cuts people, whether it cuts benefits or whether it cuts rates to providers.”

Getting better care and better coverage

Wright said that we need to do three things: First, we need to make people accountable for their vote on the bill, since it will result in rising premiums, people losing coverage, services being scaled back or closed.

Second, “There needs to be continued federal advocacy, with all of us letting our Congressional representatives know that we don’t want to see our health premiums increase, since current premiums could increase by “hundreds if not thousands of dollars…”

Third, we also need to put forward a vision for a better, improved system for all, … a system that is affordable, … accessible, and … administratively simple ….”

Reasons for hope

On the positive side, Sanders said that the changes made by the “monstrosity of the bill” that was passed, will not happen right away and we have time to educate the public on its drastic negative effects with the opportunity and the hope to change it.

While it is true that the predicted budget cuts to Medicaid and SNAP won’t be effective until after the 2026 midterm elections, there is no room for complacency.

The advocacy needs to start immediately, if it hasn’t started already, since some health care systems develop budgets several years ahead. This means that the planning for some closures in rural areas might already have begun.

Wright urged that everyone, interested in preserving Medicaid from the planned cuts, organize, show that they care about having health care and be willing to defend it. He said that there should be financial mechanisms in place at the local, state and federal levels that provide broader and better tax policies. “We're not giving tax breaks to welcome in corporations” Wright said, “but we're, you know, funding the programs that help everybody, including the wealthy…[and] everybody else as well.”

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