As executive director of the National Health Law Program (NHeLP), I am an advocate for the health rights of individuals struggling to live on insufficient incomes and in underserved communities.
As I wrote here last month, Medicaid, a collective effort of the states and federal government to provide health care coverage to low-income individuals, is one of this country's greatest social safety nets. Nearly 70 million people receive their health care through Medicaid. Without it, our nation's inequalities would be even greater. Not surprising, conservative think tanks, such as the Hoover Institution, remain committed to terminating Medicaid and dumping enrollees into the private market because of their dogged belief in competition and unfettered markets. Earlier this month, the Hoover Institution's Scott W. Atlas took to the op-ed pages of The Wall Street Journal to trash Medicaid - an "inferior, low-value health system" -- and peddle more privatization, which is another way of saying that he would eliminate the essential features that make Medicaid effective in meeting the health needs of the population it is designed to serve.
Most of Atlas' piece was devoted to comparing what the presidential candidates have said about Medicaid, and trumpeting the Republican nominee's stances. But dubbing Medicaid "low-value," is a tired attack, and one far from what evidence tells us. For example, the Kaiser Family Foundation, reporting on findings from the Institute of Medicine (IOM) Committee on Consequences of Uninsurance, reveals that over and over again research shows that "people with Medicaid coverage fare much better than their uninsured counterparts on diverse measures of access to care, utilization, and unmet need. A large body of evidence shows that, compared to low-income uninsured children, children enrolled in Medicaid are significantly more likely to have a usual source of care (USOC) and to receive well-child care, and significantly less likely to have unmet or delayed needs for medical care, dental care, and prescription drugs due to costs."
Earlier this month Harvard researchers reported that, two years after Medicaid was expanded pursuant to the Affordable Care Act in Kentucky and Arkansas, low-income adults in both states "received more primary and preventive care, made fewer emergency departments visits, and reported higher quality of care and improved health compared with low-income adults in Texas," which has not expanded Medicaid. The Medicaid expansions in both states, the researchers found, "significantly increased access to primary care, improved affordability of medications, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Quality of care ratings improved significantly, as did the number of adults reporting excellent health."
And in states like California and Louisiana, where lawmakers have expanded Medicaid, scores are signing up for coverage. Californians are clamoring for that "low-value" health insurance. Since 2014, Kaiser Health News reported in August, nearly 5 million residents enrolled in that state's Medicaid program. Also this month, the Center on Budget and Policy Priorities issued a state-by-state examination of the economic impact of Medicaid and the Children's Health Insurance Program (CHIP), concluding that "in every state, programs assisting low-income Americans lift large numbers of people above the poverty line and provide health coverage to a large share of children."
Conservatives should note, moreover, that the benefits of providing health insurance to underserved communities go beyond collective goodwill; they help improve economies. As Families USA has reported, expanding Medicaid injects large numbers of federal dollars into the states, growing their economies in numerous ways -- increasing health care jobs and health care coverage gives residents money to pay for other goods and services, boosting states' economies broadly, and saving states because of declining uncompensated care costs. And a recent report from the U.S. Department of Health and Human Services showed an additional benefit of Medicaid expansion - it lowered the premiums for individuals purchasing insurance in the Marketplace by about 7 percent in those expansion states.
Much more can and should be done to help make all people healthier. Our country should not be a place where only the elite and privileged are able to thrive. So not only should all states expand Medicaid, the federal and state governments must ramp up support of social services for low income individuals and underserved communities. An August 17 report from the Robert Wood Johnson Foundation found that the states spending more on social services, such as supportive housing, nutritional support and case management and outreach programs had more healthy and productive populaces. Also, spending on social services, the report found, "could significantly offset health care costs nationally."
Touting tropes about Medicaid is lazy, misleading, and ultimately focused on protecting the powerful in this country. The truth , is that collective action to lift up our most vulnerable will make our republic a noble, and yes, a prosperous one for all.