Medicaid: Supporting Women’s Health, Fighting for Its Life

Medicaid is now at the center of a gathering national storm involving spiraling health care costs, soaring deficits, and budget cuts. What often gets lost in the mix is that Medicaid deeply affects the health of American women.

Medicaid remains the most important health care program for women with the fewest resources in our society. Women enrolled in Medicaid tend to be low-income, women of color, and less educated. They are more likely to be single parents and to have medical conditions that limit their ability to participate in the workforce.[1] Without Medicaid, these women would have worse health status and outcomes,[2] affecting not only themselves but also their families and communities.

Medicaid is often the only means by which eligible low-income women gain access to important primary and preventive care, such as doctor visits, Pap tests and clinical breast exams,[3] and a whole lot more. For example, Medicaid covers over one-third of all births[4] and is the largest payer of publicly funded family planning services[5] and HIV/AIDS care in the United States.[6] Women represent three-fourths of those who benefit from Medicaid-subsidized nursing home care.[7] Medicaid funds permit all 50 states and the District of Columbia to offer breast and cervical cancer treatment.

According to the Kaiser Family Foundation, 70 percent of Medicaid’s enrollees above age 15 are female. Countless additional women who are not enrolled in the program receive indirect benefits through the medical and supportive services provided to their dependent children and elderly relatives. Medicaid similarly benefits entire communities by supporting emergency rooms, trauma centers, hospitals and other service sites so they can keep their doors open for everyone. Indeed, Medicaid has become a pillar of America’s health care infrastructure.

Ideally, Medicaid would be available to all women (men and children, too). But substantial limitations narrow eligibility for necessary services. To qualify for Medicaid, a woman must not only be low-income (and sometimes have few assets), she also must fit into a “category”: she must be linked to a minor child or be pregnant, over age 65, blind or disabled. In addition, she must meet citizenship or immigration status requirements and state residency requirements.[8] (Some states will cover a woman if she needs specific services, such as family planning or breast or cervical cancer treatment.) These strict criteria leave 17 million uninsured women without access to Medicaid.

Rather than addressing this coverage gap with meaningful solutions, the administration and the Congressional Budget Committees want to cut the federal share of Medicaid dollars. The new Secretary of the U.S. Department of Health and Human Services and former Governor of Utah, Michael Leavitt, has been an advocate for spreading fewer Medicaid dollars more thinly among low- and higher-income people, likely leaving those with chronic and disabling conditions, including women, elderly persons, and children, with severely inadequate care. The administration proposes to cut Medicaid by $20 billion over five years ($60 billion over 10 years) by severely limiting how states can claim federal matching dollars and other measures. Although $15 billion of the cut would be reinvested in “new” Medicaid and SCHIP expenditures, some of the proposals are not so “new” (e.g., extending programs that are currently in place but expiring) or are unlikely to be used by the states, especially in face of the proposed cuts (e.g., funds for outreach to enroll more children in Medicaid and SCHIP).[9]

Congress is trying to outdo the White House. House and Senate Budget Committees voted last week to include “reconciliation instructions” in their Budget Resolutions that would require Medicaid cuts in the amount of $15 billion to $20 billion over five years with no reinvestments. These cuts would be significantly deeper than the president’s budget plan as estimated by the nonpartisan Congressional Budget Office (CBO). Such cuts would be devastating to state budgets, which already include aggressive Medicaid cost-cutting measures, and to women’s health.

Women and others who rely on Medicaid should watch these developments closely. If these cuts are enacted and achieved through “flexibility” proposals, this inevitably means discretion to increase out-of-pocket costs for enrollees, cut the number of those eligible, or reduce the scope of benefits. The only alternative to getting this level of federal savings is capping Medicaid spending. Capping Medicaid allows no room for coverage of more people during economic downturns, runaway prescription drug costs, or public health emergencies, precisely the situations in which a safety net is most needed.[10] This proposal also has the effect of shifting costs and problems onto other sectors of society. Although the increasing numbers of uninsured or underinsured suffer most directly, there is a ripple effect. Every member of the community suffers, for example, when an emergency room is overwhelmed by people who have nowhere else to turn or is closed due to lack of funds.

The budget cuts also ignore the fact that Medicaid, compared to private insurance, has proved to be an extremely efficient program. When the poorer health status of Medicaid beneficiaries is taken into account, Medicaid provides coverage at a lower per person cost than private insurance.[11] In recent years, Medicaid costs per person for acute care have grown at less than half the rate of private insurance premiums.[12]

What’s the alternative? Instead of undermining successful publicly funded health coverage and the safety net in local communities, policy makers should develop systems to extend comprehensive, medically necessary health services to all. These services should include comprehensive reproductive health services and services necessary for women who are elderly or disabled to live and work within their communities. Policy makers also need to address runaway drug prices and other rising health costs, and address the federal and state budget deficits, not on the backs of women, but by supporting a health care infrastructure that allows women and their families to lead healthy and productive lives.

Ms. Rivera is the managing attorney of the Los Angeles Office of the National Health Law Program and Director of NHeLP’s Initiative to Promote Reproductive Health for Low Income Women.