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The Medicaid Voter
Executive Summary
Medicaid and CHIP help nearly 82 million new mothers, growing children, members of working families, and aging seniors.
Medicaid is not an “us versus them” issue. Medicaid is US.
Historic Low Rates of Uninsured. The Congressional Budget Office estimates the rate of uninsured Americans at 7.7 percent in 2024, down from 10.3 percent in 2019. According to estimates from the National Center for Health Statistics, this means 8.2 million fewer people were uninsured over that four-year period. This is thanks in no small part to the Medicaid expansion enacted as part of the Affordable Care Act, which has played a key role in reducing the number of uninsured.
Accordingly, health care occupies a less-urgent space in the American political consciousness. In an April 2024 Gallup Poll, health care ranked 16th in a Gallup Poll survey of the most important problems facing the country today, down from 2nd place in 2017.
The Impact Of Medicaid Unwinding. But the number of uninsured has risen as pandemic-era Medicaid continuous eligibility policies came to an end–and will continue to increase if enhanced premium subsidies are not extended. An August 2022 analysis from the HHS Office of Health Policy for the Assistant Secretary for Planning and Evaluation estimated that 15 million individuals would lose Medicaid coverage following the expiration of the public health emergency. CMS data show that 18.7 million people had been disenrolled through April 2024; as of press time, all but five states and the District of Columbia had been thought to have completed their redeterminations surrounding the unwinding.
Medicaid In a Post-Pandemic World. Medicaid has always functioned as a safety net and payor of last resort. During the COVID-19 pandemic, Medicaid functioned as intended, providing a health care coverage and services for tens of millions of Americans, including for people facing medical emergencies and economic dislocation.
Now, it is up to advocates to make the case for Medicaid all over again – reminding policymakers that common-sense reforms to the eligibility criteria can reduce churn, increase preventative medical care, improve health outcomes, and ultimately save taxpayers money.
Medicaid Benefits Working Americans. Nearly 60 percent of adults with Medicaid coverage work. Nearly half of them work for small businesses with fewer than 50 employees. The vast majority of those who do not work have reasons for not working, such as sickness or disability. Nearly two-thirds of older and disabled Americans rely on Medicaid to help pay for nursing homes and care, so that their family members need not choose between being a caregiver or continuing to work.
Since 2019, ACAP’s white paper series The Medicaid Voter has tracked the role of Medicaid in election campaigns. This white paper also provides data about the number of persons in each state and congressional district enrolled in Medicaid and CHIP, and the estimated number of Americans who have benefited from Medicaid expansion under the Affordable Care Act.