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Originally hailing from Phoenix, Arizona, Mimi Spalding is a reproductive justice activist and Medicaid policy analyst at Planned Parenthood Federation of America.

This year, the attacks on health care were deeply personal. Not only has Planned Parenthood — a place I went to for my birth control and Pap tests as an uninsured law student — been under attack, but the Medicaid program has also been at risk. I have family members who have Medicaid coverage (including my sister and my 5-year-old nephew who has special health care needs), and the thought of them losing access to life-saving care often kept me up at night.

I have been appalled by the ways in which this administration and extreme politicians have consistently tried to erase the experiences of over 68 million people with Medicaid coverage — many of whom come from underserved communities. For over 50 years, Medicaid has operated as a joint federal-state program that helps provide affordable health insurance coverage to people with limited incomes and resources in the United States. Medicaid is a vital part of our nation’s health care system, covering pregnant women, children, seniors, and people with disabilities. Without Medicaid, too many Americans would be forced to forgo receiving basic health care.

Attacks on Medicaid aren’t likely to end anytime soon, so this holiday season I will continue to uplift the importance of Medicaid and center the conversation on the dangerous impact that the following policies would have on real people and families. Here are the top four things to keep in mind when discussing threats to Medicaid.

1. Funding cuts to Medicaid will result in women and families losing critical access to care.

Over the past year, one of Trumpcare’s most sinister proposals was to slash the Medicaid program to its bare bones by cutting trillions of dollars from the program — making it impossible for states to continue providing coverage to the more than 16 million women ages 19-64 enrolled in Medicaid today. And just last week, Congress unveiled their tax bills, which would not only hobble the Affordable Care Act by effectively eliminating the individual mandate, but they would also take Medicaid coverage away from five million people.

Let’s be clear about what Congress is trying to do: pay for tax cuts that mostly benefit the wealthy by taking away money from programs that provide health coverage for millions of people with low incomes in the United States — including Medicaid. And unfortunately, due to the intersections of race, poverty, and gender in our country, women of color are the most likely to be low-income and have Medicaid coverage.

2. Medicaid work requirements are part of a larger campaign to weaken the Medicaid program. They are hidden ways to discriminate against women with low incomes and to take away necessary health coverage.

Work requirements, which the Trump administration has promoted and could approve at any time, would allow states to make Medicaid eligibility conditional based on a certain number of hours of work (or work-like activity) per week — meaning women and families will be at risk of being kicked off and locked out of health coverage for at least six months if they struggle to find and keep work.

These stigmatizing proposals are based on the false idea that Medicaid recipients do not work. This is simply not true: Research has found that most Medicaid enrollees who can work outside the home do. In fact, more than half (59 percent) of adult Medicaid enrollees ages 19-64 are working, and 78 percent of adult Medicaid enrollees are in families with at least one worker.

People with Medicaid coverage who are not working outside the home may have a disability or family caregiving responsibilities; they may be in school or looking for work — perfectly valid reasons. Medicaid work requirements would be particularly damaging to women, who are nearly two-thirds of the Medicaid enrollees likely to lose coverage because of work requirements. And women are also more likely to provide informal and undervalued caregiving to family members, which would typically not fulfill the work requirement.

Work requirements — which are unnecessary, unjust, and insulting — will take women and families backwards by blocking access to needed health care and services.

3. Attempts to roll back Medicaid expansion would cause millions to lose coverage.

On November 7, voters in Maine overwhelmingly voted to expand their Medicaid program — making it the 32nd state to do so and the first state to do so by ballot referendum. And yet, Gov. Paul LePage has vowed to thwart Medicaid expansion in the state. Mind you, the Maine legislature has voted five times to expand Medicaid — and LePage has vetoed each of the bills.

It’s clear that some governors and Congress are hell-bent on undermining Medicaid expansion. Yet an estimated 11 million people, including millions of women, gained coverage as a result of Medicaid expansion. In states that expanded Medicaid, the uninsured rate among women of reproductive age was nearly cut in half between 2013 and 2015.

4. Blocking low-income Medicaid patients from receiving health care at Planned Parenthood health centers is purely political and would prevent millions of people from getting the care they need.

While congressional efforts to block Medicaid patients from seeking care at Planned Parenthood have temporarily stalled, these efforts will continue at the federal and state levels despite their considerable potential for damage. Every year, 2.4 million women, men, and young people rely on Planned Parenthood for essential health care services including birth control, life-saving cancer screenings, and safe, legal abortion care. Many of these patients, particularly those in rural areas and medically underserved areas, will have nowhere else to turn to for care if Planned Parenthood health centers are forced to close their doors.

States like Texas have suffered serious public health consequences after communities lost access to Planned Parenthood. After politically motivated cuts to Indiana’s public health infrastructure forced a Scott County Planned Parenthood health center to shut its doors, the community was left without an HIV testing provider. Soon after, Scott County experienced an HIV epidemic that was officially declared a public health emergency.

For some members of Congress and the Trump administration, these policies may be a political game. But for millions of Americans, it’s about their lives. Instead of undermining the Medicaid program, let’s support people who rely on Medicaid by providing legitimate resources and opportunities for women and families — such as educational assistance, job training, affordable child care, and family planning services. This holiday season, I encourage you to talk with your friends and family about the importance of supporting Medicaid and ensuring coverage and access to care for everyone who needs it.

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