Let’s protect Medicaid’s legacy and future

Medicaid and I have grown up together. I started focusing on it as a graduate student in public health and policy, writing my thesis about some of its costs and benefits back in 1986. Medicaid was 24 years old when, as a presidential fellow on Capitol Hill, I worked on legislation that expanded it to include women and certain children up to 133 percent of the poverty line regardless of whether they were receiving welfare. By the time I was a Medicaid director, implementing seven new programs in the state of Maryland, Medicaid was covering low-income families, children living near the poverty line, people with disabilities, pregnancy, and long-term care, including community-based care.

Then, I got a call inviting me to think differently about health. What if, instead of focusing on medical coverage and health care, you could prevent ill health from happening in the first place? Wouldn’t that help more people to thrive, improve health outcomes, and be more efficient? This was in the early 2000s. The idea of addressing root causes was new, and really attractive to me. Prevention is, after all, the best medicine. As I answered that call, joining Nemours Children’s Health and eventually becoming chief policy and prevention officer, Medicaid was transforming into a catalyst for prevention, too. Today, with Medicaid covering 90 million Americans, it has become an unparalleled opportunity to address what we now call the social drivers of health.

These social drivers are things like education, the environment where one lives, interpersonal safety, and basic needs like food and transportation. Take housing, for example. If we don’t have a safe place to live, it’s going to affect our overall health. We also know that domestic violence is a significant driver of homelessness. These deeply rooted issues are interconnected; we often can’t solve one without addressing the other. They are also multigenerational; children who grow up in poverty or witnessing domestic violence are more likely to experience such things as adults.

What role does Medicaid have to play in all of these social drivers of health? It’s a platform to reach vulnerable populations, at scale. It does not have to pay for but can link people to other programs and services so they can help themselves and their families with things like food, transportation, economic opportunity, and housing. Medicaid is one of the greatest opportunities we have to give millions of Americans a fair shot at better health.

The employer-based health care system leaves too many people out. A lot of jobs don’t come with health care (as proven by the large number of working people who use Medicaid). We need a strong program like Medicaid so everyone can have a chance to thrive. That’s what health equity is all about.

This week, Medicaid celebrates 60 years as a lifeline for people across America. At the same time, it is facing cuts of close to $1 trillion over its next decade. The question for those of us who believe in Medicaid’s power and potential is: how can it continue to evolve from a health care system that treats symptoms to an engine of prevention and health equity for millions of people? We have seen abundant evidence that social drivers play a huge role in our overall health. Medicaid funding must reflect that. It must reflect our values as Americans: that everyone deserves an equal opportunity to be healthy. Ultimately, my birthday wish for Medicaid would be that its programs across all states are supported, protected, and available to all people who need them so they can live their lives to the fullest. The future of health in America is in our hands, just as it was 60 years ago. Let’s do everything we can to keep the legacy strong.