Medicaid is a government program established in 1965 by the Lyndon Johnson administration. The program is partially funded by state governments and primarily managed by the state, though a significant portion of the funding is by the federal government. Individual states are not mandated to participate in the program—though all have since 1982. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid.
Medicaid is the largest source of funding for medical and health-related services for low income people in the United States, providing free health insurance to 85 million low-income and disabled people. About four in 10 children, almost half of adults in poverty, and 60% of nursing home residents have Medicaid. Coverage varies by state from 34% in New Mexico to about 11% in Utah.
The Republican budget resolution, passed by the House, plans to slash $2 trillion over a decade from the federal budget. Medicaid programs provide life-saving coverage for the most vulnerable individuals in the country. Currently, Medicaid is often states’ single greatest expenditure, and cuts by the federal government can create an enormous hole for state budgets. If funding is cut or reduced, the effect on public health in communities will be disastrous.
With the dependency on WHO and USAID, the health scenario globally is already in a very precarious situation. New epidemics can break out at any time and without timely intervention can easily become a pandemic. Travel accessibility between places in the globe has become so small an epidemic in one part of the world does not take much to travel. In 2014-16, the USA saw 11 Ebola infections, nine of which were sourced from West Africa.
Vaccine-preventable diseases
Childhood vaccine schedules include 15 different immunizations. Some vaccines protect against more than one disease. Some require more than one dose. The vaccines for children (VFC) program provides vaccines for children who parents and guardians may not be able to afford them. In 1989-91, a massive measles epidemic in the United States resulted in thousands of cases and hundreds of deaths. When the Center for Disease Control (CDC) investigated, they found more than half of the children infected had not received the vaccine. Vaccine cost was found to be a primary reason for children going unvaccinated.
In response, Congress passed a bill in 1993 creating the VFC program. Funding comes from the Office of Management and Budget (OMB) through Centers for Medicare and Medicaid (CMS) to CDC and then to the States. VFC provides vaccines against 19 different diseases and has prevented about 422 million illnesses and about 30 million hospitalizations. To maintain herd immunity, at least 95% of children should be fully vaccinated.
Post‑pandemic, there has been a general apathy towards immunizations. This has brought down the immunization uptake levels, and outbreaks of diseases like measles have already started. (A Texas measles outbreak had 150 confirmed cases and one death.) Organizations like WHO and UNICEF have prevented millions of childhood deaths. With general apathy and a negative view of vaccines, a public health catastrophe is imminent. Eradication of smallpox, and near eradication of polio and measles will be reversed with the reckless choices.
Maternal health
With about 45% of deliveries in the country covered by Medicaid, any prevention of funds will contribute to maternal deaths and associated illnesses. The maternal mortality rate in the United States for 2023 is 86 deaths per 100,000 live births according to the CDC. Our maternal mortality rates are very high compared to other developed nations, especially countries like Norway and New Zealand, who have numbers as low as less than two. The disparity in mortality is seen more in certain racial groups, with Black pregnant women three times more likely to die than white patients.
Nursing homes
Medicaid covers the care of about two-thirds of nursing home residents in the United States. So any reduction in funding for Medicaid will affect the elderly population more than any other group. Even now, Medicaid covers 82% of costs to provide services.
Unless a clear consensus is reached by authorities, our health systems will be stretched beyond imagination. In many cases, mistakes can be corrected after the fact, but in health, it’s too late. By the time the curtain comes down, many children will be harmed by being denied basic preventive care. Many mothers will be harmed by reducing their prenatal care. Access to nursing homes for thousands of disabled and aged will have moved on to the sunset.
When proven wrong, the wise man will correct himself, and the ignorant will keep arguing. I hope there will be no arguments on a bandaid medicaid. How many deaths will it take till he knows that too many people have died? The answer I hope is not blowing in the wind….
The above are the opinions of the author only.
Dr.Jacob Eapen MD.MPH is an elected Board of Director of Washington Hospital, Fremont. An alumnus of both U.C.Berkeley and Stanford University he has been an advocate of marginalized populations in his career.
