Independence Is the New Health

Medicaid plays key roles in supporting our nation’s health. Under the Affordable Care Act, Medicaid took an even more central position in public health endeavors by extending coverage in all interested states to millions of adults who typically fell through the health care cracks. Nevertheless, the Trump administration is now undoing these gains by actively encouraging states to curtail access to Medicaid in key respects while using the rhetoric of health. This article examines Trump administration efforts in two contexts: (1) state § 1115 waiver applications seeking to better align their Medicaid programs with cash welfare and food stamp programs, and (2) changes to Medicaid funding for contraceptive and other reproductive health services. It concludes that, to better protect Medicaid and strengthen public support for it, it may make more sense to focus not on granular medical outcomes when evaluating Medicaid’s success, but rather on the larger role it plays in supporting beneficiaries’ lives. The Trump administration is right that independence is healthy. However, it is difficult to be independent if one lacks health, or faces financial ruin if one needs healthcare, or has unreasonable or nonexistent family planning and reproductive health choices. Evidence suggests that stable, secure access to coverage via Medicaid, as one piece of our safety net, makes beneficiaries feel more emotionally and financially secure and provides them improved access to needed services. As such, if Medicaid were allowed to remain both expansive and stable, we may reasonably expect gradually to see more stability in communities supported by Medicaid and other social supports, and more freedom of opportunity for beneficiaries and their families. Such a strategy would call the Trump administration on its own rhetoric while providing working-class Trump supporters, among many others, with means to help attain their desired ends.