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Medicaid is the most widely used health insurance program in the country. It’s a key source of health-care coverage for people with low incomes or disabilities, including millions of women and young adults across the country who rely on it for sexual and reproductive health care. In fact, Medicaid provides health care to more than 13 million women of reproductive age (ages 19 to 49), according to the National Partnership for Women & Families. For these women — including roughly 2.6 million Black women, 3.6 million Latinas, and 643,000 Asian American and Native Hawaiian/Pacific Islander women — the program is about more than just access to medical care. It’s a lifeline. Women represent the majority of Medicaid enrollees.
In late February, House Republicans in Congress passed a budget resolution (which directs different committees to come up with specific budget plans) that would require the House Energy and Commerce Committee to cut spending on programs under its purview by at least $880 billion over the next decade. Experts have warned that the only way to meet this reduction goal would be to make drastic and destructive cuts to Medicaid and the Children’s Health Insurance Program, which helps fill in Medicaid gaps for kids up to age 19 as well as some pregnant women. Slashing the programs’ funding would undoubtedly hurt millions of Medicaid enrollees.
One of the most critical aspects of Medicaid is providing access to comprehensive and affordable contraception and family planning services. Under federal law, state Medicaid programs are required to provide coverage for family planning services with no cost-sharing (copayments, coinsurance, or deductibles). States have discretion in what family planning benefits they offer through the program, but most provide coverage for a range of services such as prescription contraceptives, health education and promotion, testing and treatment for sexually transmitted infections (STIs), and pre-conception services, screenings, and examinations.
Since the 1980s, Medicaid has also been the primary source for publicly funded family planning care, particularly in states that have expanded their Medicaid eligibility for family planning under the Affordable Care Act (ACA). As of 2015, Medicaid covered 75% of all public funds spent on family planning services, according to the Guttmacher Institute, the reproductive health research and policy organization. Medicaid is one of the major public programs that makes birth control affordable and accessible for millions of low-income women.
The program is also a vital source of prenatal and postpartum care and is the largest payer of maternity care across the country, per the American College of Obstetricians and Gynecologists. The most recently available data from the Centers for Disease Control and Prevention shows that Medicaid pays for nearly half (about 41%) of all births in the United States, and the percentage of births covered by Medicaid is even higher for Black women (roughly 64%) and Hispanic women (almost 59%).
My colleagues at the Center for American Progress estimate that if House Republicans do choose to slash Medicaid, congressional districts throughout the country would lose an average of $2 billion in federal funding. Under one scenario, close to 16 million people could lose their coverage, according to a report from the think tank, the Urban Institute. While it’s unclear exactly how House Republicans would tackle the cuts they are planning, one thing seems certain: The future of Medicaid depends on politicians who have an eye toward ostensible “waste, fraud, and abuse.” Let’s be clear: No matter how much fraud or improper spending is caught in the Medicaid program, it wouldn’t be nearly enough to reach the $880 billion target. That means benefits would have to be cut, plain and simple.
The potential gutting of the Medicaid program should alarm everyone. Because of the people Medicaid serves, cuts would disproportionately affect women of reproductive age, threatening their access to birth control, maternity care, and other essential reproductive health services.
Without Medicaid, many women will lose access to affordable contraception and be forced to forgo it along with other essential family planning benefits. That matters because contraception isn’t just about preventing pregnancy. It’s about ensuring that women and all people who can become pregnant have the ability to control their bodies and their economic stability. Birth control allows women to pursue careers, education, and personal goals without the fear of an unplanned pregnancy derailing those plans. Medicaid is directly connected to the health and future of entire families.
As upsetting as potential cuts to the Medicaid program are, the rationale is worse: House Republicans are pursuing these cuts to pay for tax cuts that my Center for American Progress colleagues have found would largely benefit the rich. The goal is to balance their imprudent budget on the backs of vulnerable Americans. The truth is that cutting Medicaid while putting more money into the pockets of wealthy people won’t solve the country’s financial problems. It will only create new ones, especially for the millions of young women who rely on the program.
Medicaid is indispensable. For many people, especially young women, it represents the difference between accessing reliable, affordable reproductive health care or simply going without. Lawmakers claiming to support family values while actively dismantling the systems that help Americans plan their families and futures is wildly inconsistent. Now is the time for all of us to unabashedly defend this vital program and to do so loudly enough that our policymakers will hear us and do something about it.
