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Medicaid

provides health insurance for those who can’t afford coverage — and the Trump-Pence administration tried to gut it

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Why It Matters

  • Nearly 70 million people with low incomes depend on Medicaid for health coverage.

  • About two-thirds of adult women enrolled in Medicaid are in their reproductive years.

  • Groups facing discrimination and systemic oppression in the health care system — including LGBTQ+ people, people of color, people with disabilities, and women — are more likely to have low incomes and more likely to use Medicaid. These groups would be the most hurt by losing access to Medicaid.

  • Without Medicaid, tens of millions of people couldn’t access a wide range of health care services. That includes dental care, mental health care, and sexual and reproductive health care — such as prenatal care, birth control, and STD testing. 

Related Players

Seema Verma

Administrator for the Centers for Medicare & Medicaid Services (HHS)

Nominated by Trump: 11-29-2016
Mary Mayhew

Former Deputy Administrator & Director of Medicaid & the Children's Health Insurance Program (HHS)

Resigned: 1-4-2019
Donald Trump

President of the United States

Elected to Office: 11-8-2016
Alex Azar

Secretary of Health and Human Services (HHS)

Nominated by Trump: 11-13-2017

How We Got Here & Where We're Going

Timeline

The Impact: Changes and cuts to Medicaid threatened health coverage for 16.75 million women ages 19 to 49

  • 1-30-2020
    CMS issues guidance encouraging states to block grant their Medicaid programs

  • 1-22-2020
    HHS decides to let Texas receive federal Medicaid funding for a state program that bars patients in the program from accessing preventive care at Planned Parenthood and other health centers that also provide abortion

  • 5-6-2019
    Proposed change to poverty calculation could cause millions to lose Medicaid

  • 10-15-2018 
    Trump picks Mary Mayhew — who undermined Medicaid in Maine — to lead Medicaid for the whole nation (she later resigns)

  • 1-19-2018 
    CMS encourages states to block Medicaid patients from care at Planned Parenthood

  • 1-11-2018 
    Administration encourages states to impose new work requirements for people with Medicaid

 

"I have family members who have Medicaid coverage, and the thought of them losing access to lifesaving care often kept me up at night."

Restrictions on Medicaid Are Also Restrictions on LGBTQ+ People’s Health Care Access

About 20% of reproductive-age women in the United States get health insurance through Medicaid. To put it another way: 1 in 5 reproductive-age women across the country are covered by Medicaid. 

Medicaid coverage also is critical to closing the gap in health care access for women of color. Due to systemic barriers, 31% of Black women and 27% of Latinas ages 15 to 44 are enrolled in Medicaid, compared to 16% of white women.

Discrimination and harassment in accessing health care also leave LGBTQ+ people disproportionately likely to live in poverty or without health coverage. Collectively, LGBTQ+ people have a poverty rate of 22% — much higher than the 16% rate for cisgender straight people. Among LGBTQ+ community, transgender people have an especially high rate of poverty: 30%.

All this makes Medicaid vital for the health of women, particularly women of color, and LGBTQ+ communities.

Background on Medicaid

Trump and Medicaid: Proposing to Cut Trillions of Dollars from the Program

During his presidential campaign, Trump promised he wouldn’t cut Medicaid. However, his FY 2021 budget plan proposed cutting $1 trillion from Medicaid and the Affordable Care Act (ACA) over 10 years. That would cut roughly $1 out of every $4 the government spends on Medicaid — so, tens of millions of Americans could lose their health insurance.

Center on Budget and Policy Priorities
New Medicaid Rules: Adding Work Requirements for Medicaid

The Trump-Pence administration encouraged states to require people to work a certain number of hours and adhere to frequent, detailed reporting in order for them to obtain and keep Medicaid. The Centers for Medicaid and Medicare Services (CMS) approved Medicaid work requirements in 12 states, and many more anti-Medicaid state leaders requested permission to enforce work requirements.

Commonwealth Fund
Threatening Planned Parenthood Patients

Cuts to Medicaid significantly affect Planned Parenthood patients, nearly half of whom get their health care through Medicaid.

Newsweek
The Problem with Medicaid Work Requirements

Many people who’d lose Medicaid coverage because of work requirements are actually working or trying to work, but have irregular hours, can’t navigate reporting procedures (often due to lack of internet access and language barriers), or simply do not know about the new requirements.

Vox
Medicaid Block Grants

HHS let Tennesee cap Medicaid spending. Under this “block grant” system, the federal government offered to give states a fixed amount of funding for Medicaid, instead of picking up the slack when states go over budget on Medicaid costs (such as when there’s a pandemic). The results of block grants in Tennessee: limiting Medicaid by enrolling fewer people, or offering fewer services, or paying health care providers less (which, in turn, would stop some providers from taking Medicaid patients).

Health Finance News
Risking Care for Millions of Reproductive-Age Women AnnuallLike his previous budget proposals, Trump

Like his previous budget proposals, Trump’s 2021 budget proposal — including the overall cuts and work requirements — threatened health coverage of birth control, STI testing and treatment, and pregnancy-related care for nearly 17 million women ages 19 t 49. About 54% of Medicaid beneficiaries are women. 

NBC News
Medicaid Expansion Covered Hundreds of Thousands of LGBTQ+ People

States with Medicaid expansion increased Medicaid coverage for lesbian, gay and bisexual individuals from 7% in 2013 to 15% in 2016. By January 2018, an estimated 1.7 million LGBT adults ages 18–64 were using Medicaid as their primary source of health insurance — but restrictions on Medicaid threaten those gains. Overall, Medicaid covers about 20% of the total U.S. population (75 million people nationwide). 

Thee Williams Institute
Greenlighting Texas’s Backdoor “Defund”

On the 47th anniversary of Roe v. Wade, HHS decided to let Texas receive federal Medicaid funding for a state program that blocks patients in the program from accessing preventive care at Planned Parenthood and other health centers that also provide abortion. This move upended longstanding federal law. In the past, the federal government refused to fund state Medicaid programs that aimed to take away the right of Medicaid patients to get care from the reproductive health care provider of their choice.  

Planned Parenthood Blog

Related Policies

The Title X Gag Rule

Planned Parenthood

The Health Agenda