Budget Battles and Medicaid: Reframing the Debate

By Melissa Stevenson

As an ever-growing proportion of state budgets and the second biggest state expenditure after education, Medicaid presents itself as an easy target when budget cuts are imminent. Wider Opportunities for Women’s recent webinar on June 30th, “Budget Battles: Threats to Medicaid,” summarized the threats posed to Medicaid with presentations from Angela Shubert and Jen Beeson from Families USA, Renata Pore from the West Virginia Center for Budget and Policy, and Andy McDonald of BerlinRosen Public Affairs. The webinar discussion delved into how advocates can shift the perception of Medicaid among politicians and the public by reframing the conversation surrounding the Medicaid program.

Unlike Medicare and Social Security, which the vast majority of Americans will eventually collect in benefits, Medicaid is viewed as a program targeted to a very specific group with little political power – those in poverty. In reality, however, 25% of seniors and individuals with disabilities rely on Medicaid, with the elderly and disabled accounting for most of the spending. Despite the cost of the program, according to Renata Pore, Medicaid spending is growing at a slower rate than spending on private health care. One in five people will be on Medicaid at some point in their lives. The medical and mental health services that Medicaid provides to children will help them to become healthy, productive adult members of our society. Politicians and the public must understand how the very real benefits of the program are worth protecting, even during a budget crisis.

Oregon recently used a lottery system to randomly assign eligible people into the Medicaid program, thus enabling researchers to conduct an experimental study comparing the recipients of Medicaid to similarly eligible people not assigned to the program. A July 17th editorial in the New York Times summarizes the results: Medicaid recipients were far more likely to use medical services and take prescription drugs than the control group, and the enrollees also self-reported that their health was better than those who did not receive Medicaid services. Although more time will be needed to determine whether enrollees are healthier in the long-run, the current results are promising for advocates who want to convince the public that Medicaid is a necessary part of our health care system and far better than being uninsured.

By calling attention to the facts, we can take away the perception that Medicaid is a program aimed at a small minority of Americans and that it does not allow poor people to get the care that they need. Perhaps that perception is already dwindling. A recent Pew Survey poll shows that the majority of Americans do not support Medicaid reductions. In fact, as many as 50% of Americans say Medicaid is important to themselves and their families. It is important that in addition to statistics, advocates continue to document and publicize individual stories of people who have relied on Medicaid in the past to put a local and personal face on the budget crisis.

What progressives need in these budget battles is a renewed focus on messaging. We must work to communicate to the public not only the importance of Medicaid to the poor, but that in a volatile economy, any American can become reliant on Medicaid at any time.

Melissa Stevenson is a Research and Programs Intern with the National Council for Research on Women. She is pursuing a Master of Public Administration at the Robert F. Wagner Graduate School of Public Service at New York University.


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