WASHINGTON (AP) — It may not equal Social Security and Medicare
as a “third rail” program that politicians touch at their own
risk, yet Medicaid seems to have gotten stronger after the
Republican failure to pass health care legislation.
Reviled by conservatives, the 1960s Great Society program started
out as health insurance for families on welfare and disabled
But the link to welfare was broken long ago, and the
federal-state program has grown to cover about 1 in 5 Americans,
ranging from newborns to Alzheimer’s patients in nursing homes,
and even young adults trying to shake addiction. Although
Medicaid still serves low-income people, middle-class workers are
more likely to personally know someone who’s covered.
Increased participation — and acceptance — means any new GOP
attempt to address problems with the Affordable Care Act would be
unlikely to achieve deep Medicaid cuts.
“This was an important moment to show that people do understand
and appreciate what Medicaid does,” said Matt Salo, executive
director of the National Association of Medicaid Directors, a
nonpartisan group that represents state officials. “The more
people understand what Medicaid is and what it does for them, the
less interested they are in seeing it undermined.”
With Republicans in control of the White House, both chambers of
Congress, and 34 out of 50 governorships, it would have been hard
to imagine a more politically advantageous alignment for a
conservative overhaul of Medicaid.
President Barack Obama’s Affordable Care Act expanded Medicaid to
cover more low-income adults, many of them working jobs without
health insurance. Thirty-one states have accepted the ACA’s
expansion, covering about 11 million people.
The GOP bills would have phased out funding for Obama’s
expansion, and also placed a limit on future federal spending for
the entire program — a step now seen as overreach. Spending caps
in the House and Senate bills translated to deep cuts that
And GOP governors who had expanded the program couldn’t swallow
the idea of denying coverage to hundreds of thousands of
constituents. Some went public with their opposition, while
others quietly warned their congressional delegations about dire
Medicaid “is not yet at the Medicare and Social Security level
because it isn’t framed as something that you contribute to
during your working years and you get it later as a commitment,”
said Diane Rowland of the nonpartisan Kaiser Family Foundation.
“But I think there is a recognition that for all its flaws…it’s
really the nation’s health care safety net.”
An AP-NORC poll taken last month found the public overwhelmingly
opposed to GOP Medicaid cuts, by 62-22.
“You just can’t do this to people who are in situations that they
didn’t put themselves in,” said Sara Hayden of Half Moon Bay,
California. Unable to work as a data journalist due to
complications of rheumatoid arthritis, she was able to get health
insurance when her state expanded Medicaid.
Hayden estimates that one of the medications she takes would cost
about $16,000 a month if she were uninsured. She pays nothing
with Medi-Cal, as the Medicaid program is known in California.
“If they are going to repeal and replace, then I am dead in the
water,” she said.
Brian Kline of Quakertown, Pennsylvania, works as a customer
service representative, and got coverage after his state expanded
Medicaid in 2015. Early last year he was diagnosed with colon
cancer. After treatment that Medicaid paid for, his last CT scan
“You just wonder if the Republican bill had passed…what would
have happened to me?” said Kline. “Would I have had access to my
doctors and the tests to make sure my cancer didn’t come back?
I’m not sure what the answer to that question would have been.”
Many Republicans view Obama’s Medicaid expansion as promoting
wasteful spending, because the federal government pays no less
than 90 percent of the cost of care, a higher matching rate than
Washington provides for the rest of the program.
“That is not a good recipe for encouraging states to implement
better, lower-cost models of care,” said Mark McClellan, who
oversaw Medicare and Medicaid under former President George W.
Nonetheless, the debate showed Congress can’t just elbow its way
to a Medicaid overhaul.
“You are going to have to be gentle and thoughtful, working in a
bipartisan way to see what ideas will reach across the aisle,”
said Republican economist Gail Wilensky, also a former Medicare
and Medicaid administrator.
The push for Medicaid changes will now shift to the states. Some
on the political right are seeking federal approval for work
requirements and drug testing. From the left, activists in the 19
states that have not yet expanded their programs are
contemplating revived campaigns.
An area that could find bipartisan support is health promotion,
since Medicaid beneficiaries tend to have higher rates of smoking
and other harmful lifestyle factors.
Katherine Hempstead, who directs health insurance research for
the nonpartisan Robert Wood Johnson Foundation says Medicaid has
come out a “winner” — for now.
“I imagine these challenges to Medicaid will rise again,” she
added. “But I think its supporters will also rise again.”