A health care cliff is coming


March 2, 2023

I’m one of the 84 million Americans who get our health care through Medicaid. And I’m one of the 18 million who might lose it starting this spring unless our policymakers take action.

I went to college, got a degree, and planned on being self-sufficient. But in my early 20s, I was struck by an autoimmune condition that caused painful, chronic flare ups that affected my ability to stand or walk.

I worked some desk jobs, but the health coverage was inadequate. I struggled financially, relied on thrift store wheelchairs, and lived with pain for 10 years before I got Medicaid. It changed my life — I was finally able to get a diagnosis and treatment. Today, I work as a dental hygienist.

But Medicaid is full of holes and paperwork. You have to reapply frequently. And small increases in income can throw you off the program, even if you don’t make enough to buy insurance on your own.

For a while, Medicaid was improved during the pandemic. In exchange for increased federal matching funds, states agreed not to kick anyone off the program until the end of the federal Public Health Emergency. We didn’t have to keep applying — we could focus on staying healthy, taking care of our families, and doing our jobs.

That enhanced coverage will end on March 31.

The Urban Institute estimates that 18 million people will lose coverage as a result. That includes an estimated 7 million eligible people who will lose care anyway thanks to paperwork confusion and inefficiencies, the Center on Budget and Policy Priorities reports.

Children, Black, and Latinx people will be disproportionately affected. But people of all ages and races will be impacted. The majority of people on Medicaid are working class white people like me.

My modest pay is just high enough that I will likely lose coverage, and my contract job doesn’t offer health benefits. I can get a plan through my state’s disabled workers program or the Affordable Care Act’s marketplace, but if I have to pay those premiums, I’ll be living in fear of car repairs, extra medical bills, and rent increases.

Federal action to keep Americans from falling off this cliff is unlikely in a divided Congress. So states need to start preparing now to make sure eligible recipients don’t lose care.

States will need to do outreach to Medicaid patients, field questions, and re-enroll people with their existing information rather than requiring unnecessary paperwork that could result in them losing coverage. And they must broadcast widely that everyone has the legal right to file for an appeal if they’re cut.

States governments need to make sure renewal agencies have the correct mailing addresses, email addresses, and mobile numbers for enrollees. And they’ll need to collaborate with trusted community-based organizations to reach everyone who might be impacted.

Inexcusably, 11 states still refuse to expand Medicaid under the Affordable Care Act. That needs to change. But states that did expand Medicaid will cut patients off, too. In Pennsylvania, where I live, nearly 1.2 million could lose care.

The deeper problem is that our system treats health care as a source of profit for the wealthy. If we guaranteed health care as a public good, we could all get the care we need — with less paperwork and at lower cost than the private market.

Care should be a human right, for everyone — no matter where we live, what we look like, or how much money we make. That’s why I’m part of a national network called the Nonviolent Medicaid Army. We believe that those with the most to gain and least to lose from uprooting our profit-driven health care system must come together and fight back.

Wherever you live, you can do something! Share your story about why Medicaid matters to you, join up with us, and tell your policymakers to start preparing now.