“It was a generation ago that Harry Truman said, and I quote him: ‘Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.’ … The need for this action is plain; and it is so clear indeed that we marvel not simply at the passage of this bill, but what we marvel at is that it took so many years to pass it.”
President Lyndon B. Johnson said this 52 years ago on July 30, 1965, as he signed the bipartisan legislation that established the federal Medicaid Program and thanked former President Harry S. Truman and the many members of Congress from both parties who had laid the groundwork and worked tirelessly over many years to make the Medicaid program and its protections reality. For more than a half-century, Medicaid has been a shining example of the good and essential support government can provide those most in need across all ages. Over the years we have been striving to live up to the promise of ensuring all children and young people a chance to reach healthy adulthood — laboriously and successfully expanding coverage to more children thousands by thousands, millions by millions, state by state.
Today nearly everyone in America has a family member, neighbor, coworker or classmate who has benefited from Medicaid’s critical protections. Medicaid offers health coverage to 80 million people. With the help of the Children’s Health Insurance Program (CHIP) and the Affordable Care Act 95 percent of all children today have health coverage. So all of us have millions of reasons to celebrate Medicaid’s birthday. And on this day particularly, we can celebrate, at least for now, a rejection of the cruel, relentless and frantic effort to end Medicaid as we know it that threatens tens of millions of children and families terrified by an uncertain future and the loss of life giving care.
Why are so many people across our country standing up to protect Medicaid? Because Medicaid is a lean, efficient and essential safety net program that allows millions to be healthy and productive members of society. Medicaid is the largest health insurer for our nation’s children, providing affordable, comprehensive health coverage to almost 37 million low-income children. Forty-three percent of all Medicaid enrollees are children; Medicaid serves 40 percent of children with special health care needs. It also covers more than 40 percent of all births in the United States and serves millions of low-income pregnant women, children, adults with disabilities, and the elderly. Medicaid helps two of three seniors in nursing homes.
Medicaid is a foundational part of our nation’s health insurance system for children and vulnerable adults.
• Today all states provide Medicaid coverage to children under 19 with family incomes under 138 percent of the federal poverty level ($33,534 for a family of four in 2016). Some states cover children up to 21 or with higher incomes.
• Medicaid is a valuable source of preventive services helping children get the well-child visits and screenings they need to support healthy development and prevent expensive health complications later.
• Medicaid is a lifeline for children with disabilities and their families. For some families struggling to provide the time and financial resources needed to care for disabled children, Medicaid is often the only viable source of financing for their extensive and expensive health care. Medicaid also supplements private coverage to allow children access to specialized medical equipment and devices such as hearing aids and wheelchairs. It also allows children and adults with serious disabilities to be treated at home and in their own communities rather than being sent off to more costly institutional settings.
• Medicaid is especially important for children of color who are twice as likely as white children to be poor.
• The Affordable Care Act’s expansion of Medicaid to 11 million low-income adults, including parents, enabled them to receive services and treatment. Evidence shows children are more likely to have health coverage when their parents are also covered.
• Without Medicaid’s strong protections, coverage guarantee, and comprehensive, age-appropriate health and mental health coverage, many children would go uninsured or underinsured, increasing short and long term costs for states and local communities and jeopardizing children’s academic performance and futures.
Medicaid guarantees coverage to millions of Medicaid-eligible children, seniors, and people with disabilities.
• Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit guarantees children a full range of comprehensive primary and preventive care and access to all medically necessary health and mental health services.
• Medicaid guarantees health coverage to all eligible applicants without waiting lists or enrollment caps.
• Medicaid expands as needs grow and more who are eligible require assistance.
Medicaid is a smart investment.
• By investing in child wellbeing now, our nation and economy will recoup benefits later. Research comparing children eligible for Medicaid during childhood to their non-eligible peers found Medicaid eligible children were more likely to attend college, make greater contributions as adult taxpayers, and live longer than those without coverage.
• Medicaid is far more efficient and cost effective than private insurance for children with administrative costs about half those of private insurance coverage. Over the past decade, Medicaid costs per enrollee have grown more slowly than premiums for employer sponsored coverage or overall national health expenditures.
• Medicaid funding also offers critical support to hospitals and helps prevent increases in uncompensated care and declines in their operating margins which can force some of them to close, seriously impacting their local economies.
Changes to Medicaid’s structure, including caps and cuts, would hurt other essential child-serving systems vulnerable children need, including:
• Education. Since child health impacts educational attainment, any structural changes to Medicaid would compromise returns on other major investments in children’s education from Early Head Start to college. Medicaid not only helps ensure our nation’s most disadvantaged children are healthy and learning in school, but reimburses schools for services delivered to Medicaid-enrolled children. Schools currently receive about $4 billion in Medicaid reimbursement each year. These dollars help support the work of health professionals and other specialized instructional support personnel, including school nurses, psychologists and speech-language pathologists. They also underwrite specialized equipment and assistive technology for disabled students and support vision and hearing screening for low income children.
• Child Welfare. Medicaid for children and parents helps address needs that can otherwise result in children coming to the attention of the child welfare system. It helps treat children in foster care most of whom have experienced trauma in their lives; provides continuing support for children who move from foster care to guardianship with relatives; assures children with special needs who are adopted from foster care permanent families; and continues specialized treatment for some children who transition from foster care without permanent families and face special challenges.
We have been asking a question for months: Will our president and congressional leaders ultimately choose to preserve Medicaid as we know it and reject structural changes and cuts that undermine its critical protections, hard-earned coverage and resulting health gains for children and other vulnerable populations made over more than 50 years? Or will we see a generation of harsh callous congressional and presidential leadership that rejects Medicaid’s promise and ends critical protections for tens of millions of Americans?
Thank God there is some good news from the U.S. Senate that very early Friday morning voted to preserve Medicaid as we know it, at least for now, and to reject the so-called Health Care Freedom Act of 2017 by a 51 to 49 vote. While we must be diligent and watch for proposed deep cuts and other attacks on Medicaid as Congress considers the 2018 Budget Resolution, tax reform and other reform initiatives, we all should give special thanks to those who worked so hard to make the case in their own states and communities to protect Medicaid and other critical pieces of the Affordable Care Act. We know Medicaid works and on its birthday celebrate its more than 50 years of success. And we must continue to reject any actions and any leaders who threaten the health and futures of the tens of millions of our children and vulnerable adults.
Marian Wright Edelman is president of the Children’s Defense Fund.