“The COVID-19 emergency has coincided with national recognition of the achievements and limitations of the ACA, now in its 10th year. Even before the pandemic, a chief limitation was the unaffordability of health care: one third of those who visit the health insurance marketplace do not buy coverage,5 and millions remain uninsured because they live in a state refusing to expand Medicaid (a problem created by the Supreme Court’s 2012 decision, not by the ACA) and have income that is too low to qualify for marketplace subsidies.6 Although the FFCRA and the HEROES Act are a beginning to interim reforms to strengthen insurance, a holistic response is imperative, one that addresses public health emergencies more broadly, not one illness or event at a time.”
Rebekah E. Gee, William R. Boles, Sara Rosenbaum, “Insuring the Population During National Emergencies Leveraging Both Medicaid and the Marketplace”, American Journal of Public Health 111, no. 4 (April 1, 2021): pp. 640-642.
“The nexus of politics, pandemic, and racial (in)justice points to the importance of viewing Medicaid capaciously—not only as a policy mechanism for improving health outcomes among vulnerable populations but also as a constrained product of racialized politics and as an often-overlooked producer of such politics. Only by understanding all of these facets of Medicaid can we adequately grapple with how to improve health policy and advance racial justice.
“As a new presidential administration takes hold, making progress on health policy will require attentiveness to Medicaid politics and its racialized contours. In this vein, a first-order priority for the incoming administration should be to reverse the suite of punitive Medicaid waivers that have emerged in the last four years. The most salient waivers include work reporting requirements, lockout penalties that prevent beneficiaries from accessing care, delays to the start of coverage until after premiums are paid, elimination of retroactive coverage, and loss of presumptive eligibility. These provisions undermine both political participation and health equity.
“Punitive waivers lead to disenrollment, which is associated with decreased rates of voting. Political demobilization can also occur as a consequence of the negative experiences engendered by burdensome and stigmatizing administrative processes. Even further, waivers have racially disparate outcomes. Work requirements, for example, affect Black policy beneficiaries more negatively.15 Federal intervention to eliminate onerous and racially unequal work reporting requirements is especially crucial because Black women—those most affected—are among the most engaged voting population in a number of the states that are implementing work requirements.
“Beyond waivers, the larger takeaway is that attentiveness to both racial justice and politics will be critical for expanding and enhancing Medicaid. This is especially true in the context of COVID-19.”
Jamila D. Michener, “Politics, Pandemic, and Racial Justice Through the Lens of Medicaid”, American Journal of Public Health 111, no. 4 (April 1, 2021): pp. 643-646.
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.
Page last updated March 15, 2021 by Doug McVay, Editor.