Threats to Medicaid and Health Equity Intersections

Abstract

2017 was a tumultuous year politically in the United States on many fronts, but perhaps none more so than health care. For enrollees in the Medicaid program, it was a “year of living precariously.” Long-promised Republican efforts to repeal the Affordable Care Act also took aim at Medicaid, with proposals to fundamentally restructure the program and drastically cut its federal funding. These proposals provoked pushback from multiple fronts, including formal opposition from groups representing people with disabilities and people of color and individual protesters. Opposition by these groups should not have surprised the proponents of “reforming” Medicaid. Both people of color and people with disabilities carry disproportionate burdens of ill health and face more significant barriers to accessing quality health care than other groups. As a consequence, the Medicaid program is particularly important to both groups.

Ultimately, defensive strategies by people with disabilities and people of color helped stymy both the efforts at “repeal and replace” and proposed changes to Medicaid. This successful advocacy raises a question about what other health-related concerns people with disabilities and people of color share. Considering those groups’ interests in contemporary Medicaid policy issues is a good place to start. To that end, this article explores the relevance of race to states’ Medicaid expansion choices and the vulnerability of community-based services for people with disabilities in the event of funding cuts to Medicaid. I also suggest that marginalized groups like people of color and people with disabilities may have similar concerns relating to Medicaid policy initiatives in two additional areas: growing interest in Medicaid work requirements and experiments with adopting value-based payment models for Medicaid providers. These are areas where collaborative advocacy may enhance the ability of people of color and people with disabilities to protect their common interests.

Keywords: Medicaid, disability, race, work requirements, value-based reimbursement, discrimination, health care, Affordable Care Act, health disparities