Related Articles
-Editorial
The nation’s largest health insurance program, Medicaid currently provides free or low-cost coverage to more than 83 million people in the US. But approximately 23 million—including 3 million children—have lost or stand to lose coverage due to the end of pandemic-era continuous coverage protections, also known as “the great unwinding.” Of the 23 million people who will lose or have lost coverage, 69 percent have been disenrolled not because they were ineligible, but because of paperwork and procedural technicalities.
Expanding Medicaid to close the coverage gap is one of the most significant ways states can increase coverage rates and achieve health equity, particularly after the unwinding. Yet 10 states, largely in the South, still choose not to expand their Medicaid programs under the Affordable Care Act. These states have some of the worst health inequities in the country.
Speakers at this Ethnic Media Services panel discussed how to strengthen the Medicaid program to provide equitable health coverage to all and why states must act to close the coverage gap that disproportionately affects communities of color.
Katherine Hempstead, Senior Policy Adviser at the Robert Wood Johnson Foundation, addressed a recent panel on Medicaid, emphasizing the program’s complexity and the challenges it faces. “Medicaid is a very complex program,” Hempstead noted, “and while you could spend hours discussing its intricacies, my role is to provide a high-level overview and touch on key issues.”
She explained that Medicaid, established in 1965, operates as a Federal-State partnership, making it unique compared to Medicare, which is a federal program. “Medicaid is essentially a combination of 50 different programs,” Hempstead said. “Each state manages its own Medicaid system, which can vary significantly.”
The program, which provides health coverage to approximately 82 million people, predominantly serves children, pregnant women, low-income adults, seniors, and those with disabilities. Hempstead highlighted the recent Medicaid expansion under the Affordable Care Act (ACA) and the challenges that have emerged from it. “The ACA aimed to expand Medicaid eligibility, but due to a Supreme Court ruling, this expansion is optional for states,” she explained. This has led to a coverage gap, particularly affecting low-income individuals in non-expansion states.
Hempstead also discussed the ongoing issues of Medicaid unwinding and redetermination, which have intensified bureaucratic hurdles for beneficiaries. “The redetermination process, especially after three years without it, has exacerbated problems of ‘churn,’ where individuals frequently lose and regain coverage due to administrative challenges,” she said.
The Robert Wood Johnson Foundation remains focused on closing the Medicaid coverage gap and expanding coverage for immigrants. Hempstead concluded, “We are committed to advocating for comprehensive coverage and addressing systemic issues like churn to ensure more stable and equitable access to care.”
Young Invincibles (YI), a national advocacy organization focused on amplifying the voices of young adults, is sounding the alarm on significant healthcare challenges facing the 18-34 age group. Martha Sanchez, Health Policy and Advocacy Director at YI detailed these issues in a recent briefing, emphasizing the urgent need for reform to address gaps in healthcare access.
Founded in 2009 amid the drafting of the Affordable Care Act, Young Invincibles has been a steadfast advocate for policies benefiting young adults. Sanchez highlighted the organization’s early efforts, such as pushing for provisions that allowed young people to remain on their parent’s health insurance until age 26. Despite these advances, Sanchez pointed out that many young adults continue to face substantial health challenges.
“Despite our name, we understand that young people are not invincible. We need healthcare, we get sick, and we face several chronic issues,” Sanchez remarked. She cited a 2019 CDC study revealing that at least half of young adults have at least one chronic condition, including obesity, diabetes, and mental health issues. The COVID-19 pandemic has exacerbated these problems, with a third of young adults now facing a mental health crisis.
Sanchez emphasized that young adults are the highest uninsured population, with 47% of those in the Medicaid coverage gap being from this age group. She noted troubling trends, including rising rates of severe cancers among young people, and criticized the current healthcare system’s failure to meet their needs.
Young Invincibles is working to improve health literacy among young adults, ensuring they are aware of and can access affordable care options. Sanchez stressed the importance of Medicaid and the need for continued advocacy to strengthen the program and ensure it meets the needs of young adults transitioning out of Medicaid.
“The goal is to provide health literacy and make sure that young people know their options and how to access them,” Sanchez concluded. “We must continue to fight for Medicaid expansion and ensure that young adults are not left behind as they navigate their healthcare needs.”
Stan Dorn, Director of the Health Policy Project at UnidosUS, addressed the impact of Medicaid unwinding on communities of color. Dorn highlighted the severe consequences of the recent Medicaid coverage reductions, particularly for Latino and African American populations.
“We’re the nation’s largest Latino civil rights and advocacy organization,” Dorn stated. “We lack precise data on racial and ethnic impacts, but our conservative estimates reveal staggering losses. Even with conservative assumptions, the reductions in Medicaid coverage for communities of color have far surpassed previous records.”
Dorn explained that nearly 4 million fewer Latinos have Medicaid coverage compared to before the unwinding, a loss three times greater than the largest previous annual decline. Similarly, around 3 million African Americans have lost coverage, compared to 700,000 during the 1990s welfare reform legislation.
The majority of these terminations were due to administrative issues, not actual ineligibility. Dorn cited a survey indicating that 30% of individuals never received termination notices, and among those who did, 60% faced significant procedural barriers.
Dorn emphasized that the unwinding has exposed deep disparities among states, with some states experiencing up to a 29% drop in children’s Medicaid coverage, while others saw losses of only 2% or less. “If all states performed as well as the top 10 in protecting children’s coverage, we could have avoided losing 4 million children from Medicaid,” he said.
He called for reforms to reduce administrative burdens, such as utilizing existing government data for eligibility renewals, providing accessible assistance for form completion, and ensuring continuous coverage. Additionally, Dorn suggested enhancing federal incentives for states to improve performance and audit errors in both directions to ensure fair coverage practices.
Dorn concluded, “The Medicaid unwinding has spotlighted longstanding issues. We must seize this moment to reform the system and ensure equitable healthcare access for all.”
