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Khadija Gurnah's picture

My first job out of grad school was working on Medicaid outreach. One of the first people who called me for help was a young woman of color who asked for my advice in accessing healthcare. She was experiencing complications in her pregnancy and didn't have insurance - she was looking for help on how to manage her pregnancy without using an emergency room as her primary source of care. She didn't know she qualified for Medicaid for pregnant women. We enrolled her in Medicaid that same day, but it was too late for any intervention and she wasn't able to carry her pregnancy to term. She called me many years later to let me know she was pregnant again and had enrolled in Medicaid right away - she was given excellent care in bringing her baby girl into the world.

Medicaid is one of the most important safety nets our country has. In any given month, Medicaid protects and enhances the lives of 31 million children, 19 million adults (mostly low-income working parents), 5 million seniors, and 9 million people living with disabilities.

The social gains experienced by those enrolled in Medicaid are proven. Unexpected medical expenses and the resulting medical debt are two of the leading causes for systemic poverty and wealth inequity – providing quality coverage to those who need it most not only provides needed care, but also protects families from financial devastation.

Medicaid is also an important tool for addressing inequality as it is effective in lifting Black, Latino and disabled communities out of generational poverty and has long term positive effects for children. Children enrolled in Medicaid are more likely to finish high school and attend college which leads to higher life-time incomes and which impacts future generations.

This is not a theoretical argument for me, I have seen first hand that Medicaid is critical for our nation's maternal health care and to addressing health inequities.

A key provision in the The Affordable Care Act (ACA) was designed to extend Medicaid eligibility nationally, however a Supreme Court ruling struck down that mandate and allowed individual states to decide whether they wanted to expand the program. States that declined to expand Medicaid, such as Texas, Florida and Georgia, have large Black populations that are historically and economically disenfranchised. As a result, Black families and individuals are much more likely to find themselves in a coverage gap where they earn too much for Medicaid eligibility but too little to afford ACA marketplace coverage, even with subsidies.

The consequence of this is that even as the ACA has provided coverage to millions, health outcomes for Black communities are actually getting worse in that chose not to opt into Medicaid expansion. One startling example is the increasing maternal mortality rates for Black women in Texas. Medicaid provides coverage women who are pregnant who wouldn't normally qualify for Medicaid. There is such a strong correlation between Medicaid and maternal health outcomes that 60% of maternal deaths in Texas occur six weeks after birth, which is after Medicaid coverage ends.

Removing the  ACA Medicaid expansion gains - or moving Medicaid to a block grant- would not only affect mortality and health, (which would disproportionately affect the Black community), but also push more people into poverty and undermine the economic gains that Medicaid has made this far.

I believe in the ACA because I know that it is the first step to on the pathway to health care reform in our country were so many of us experience gaps in coverage. It has helped millions. If it had been implemented with national Medicaid expansion, it would have helped millions more.

We are stronger financially as a nation when we have early intervention and universal coverage. Emergency care and untreated conditions cost money and lives and severely undermines the potential of our children. Protecting and expanding Medicaid is not only the compassionate thing to do, it is also the economically sound thing to do.

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