Understanding Medicaid's Impact on Health Equity

As a practicing surgeon, the proposed federal reductions to Medicaid and Medicare will significantly affect my surgical patients. These cuts could compromise the quality of care and patient outcomes, especially within underserved populations. Understanding the potential consequences of these decisions is important to build future expectations. Patient & Post-Op Care Impacts: Many low-income, elderly, or disabled patients rely on Medicaid for crucial home and community-based services (HCBS) after surgery. Federal cuts may force states to reduce or eliminate these "optional" HCBS, pushing patients into less appropriate institutional care (Nursing homes) or leaving them without essential home support. This raises complication and readmission risks, impacting surgical outcomes. Cuts also will increase number of uninsured patients who are less likely to access vital home health services. This significantly increases their risk of complications, infections, and reoperations, compromising long-term surgical success. Furthermore, existing health disparities for underserved populations will worsen, leading to delayed care, neglected post-operative needs, and poorer outcomes. Hospital's Impacts: Underserved hospitals, where many of my patients receive care, face severe financial strain from federal payment cuts. This revenue loss forces them to absorb higher uncompensated care costs when uninsured patients seek emergency care, shrinking operating margins. With less financial stability, hospitals are less likely to invest in home-based post-operative care infrastructure—technology, training, and resources. This directly affects my confidence in discharging patients to receive outpatient follow-up, which will increase hospital length of stay and further hospital losses. Medicaid cuts exacerbate home healthcare workforce shortages. Inadequate reimbursement makes it hard to recruit and retain skilled talents for crucial post-surgical home visits, meaning my patients may miss timely wound care, medication management, or physical therapy, jeopardizing recovery. The lack of home care will increase preventable complications and poor follow-up, significantly increasing hospital readmission rates. This not only burdens the system but also signals a failure in postoperative care continuity, reflecting poorly on patient outcomes. Societal & Economic Impacts: When professional home care is unavailable, the burden falls disproportionately on unpaid family caregivers, leading to burnout, financial strain, and workforce exits, with broader societal repercussions. In essence, federal funding cuts create a "domino effect": they destabilize hospitals, cripple home healthcare, and ultimately limit my patients' access to vital post-surgical support. This translates directly to poorer surgical outcomes, increased patient suffering, and higher long-term healthcare costs. As a surgeon, it is concerning that external factors directly hinder the success of the care I provide.

Medicaid expansion is saving lives and doing it cost-effectively. A new study quantifies the impact. --- A new study (in the comments) offers what may be the most precise estimate of how #Medicaid expansion under the ACA impacted mortality. The authors analyzed 37 million low-income adults using linked Census and IRS data and followed a preregistered analysis plan. That level of rigor is rare in observational #research. --- What did they find? - Medicaid expansion reduced mortality for the entire program by 2.5%. - For new enrollees representing a 12% increase in enrollment, that’s equivalent to a 21% drop in mortality hazard. - Between 2010 and 2022, a 21% drop in mortality would be equivalent to saving over 27,000 lives over that time. - If non-expansion states would have expanded Medicaid at the beginning in 2014 with a 21% drop in mortality for new members, the authors estimate 12,800 lives could have been saved. Medicaid costs for new members came in at $5.4 million per life saved and $179,000 per life-year saved. These values were well below the commonly used values of a statistical life in federal #government cost-benefit analysis ($10-$11 million per life saved and $217k-$313k per life-year). --- Younger adults made up nearly half the life-years saved (see attached image). Even though older adults had higher baseline risk, the benefits of coverage for younger adults were substantial, primarily due to their longer remaining lifespans. The study also estimated that universal Medicaid enrollment could close 5% to 20% of the mortality gap between low- and high-income Americans. #HealthInsurance isn’t the only driver of health disparities, but it is a meaningful one. --- This research proposes a clear conclusion: Medicaid saves lives at a cost less than the statistical life value from governmental cost-benefit analyses. How should this study contribute to the conversation in states that haven't expanded Medicaid as well as the current focus on federal Medicaid funding cuts?

Ongoing conversations surrounding changes to Medicaid have become increasingly relevant following the passage of the budget reconciliation bill by the House of Representatives last month. Major concerns are being raised about potential cuts and their impact on healthcare access for millions of Americans.     As a vital program that provides health coverage for low-income individuals and families, Medicaid serves as more than just a budget line item; it is a crucial pillar that supports health equity across the nation. According to Healthcare Dive, nearly 11 million Americans could lose coverage by 2034 due to changes including:    📍Work requirements mandating able bodied individuals complete at least 80 hours monthly of employment, volunteer service or educational activities  📝 Enhanced edibility verification with more frequent review periods  New cost-sharing provision that apply specifically to higher-income beneficiaries for certain services   📚 Beneficiaries who are automatically reenrolled in exchange plans will no longer be able to claim subsidies.     Cuts to coverage not only impact enrollees, but providers as well. Many healthcare providers, particularly in rural areas with limited care options, serve a significant number of Medicaid patients. Without those patients, offices and hospitals could be left vulnerable to revenue reductions, forcing them to cut services, reduce staff, or even close their doors. This highlights the critical role Medicaid plays in safeguarding health for vulnerable populations while illuminating the potential fallout for healthcare providers who rely on Medicaid for patient care and revenue.    With more than 70% of Americans worried these cuts will affect their coverage it is urgent to consider the broader implications of these proposed changes, impacting not only beneficiaries but also the healthcare system. Advocating for policies that protect and strengthen Medicaid is critical during this time. By continuing conversations about these challenges, we can work towards a future where everyone has fair access to the medical care they need. Let’s continue this dialogue exploring innovative solutions that can uphold the integrity of Medicaid, ensuring it remains a source of support for those who rely on it.

If you're reading this, you likely don’t have children on Medicaid. That’s exactly why you should care. More than half of America’s children rely on Medicaid or CHIP for their health coverage. And it shapes how every children’s hospital in this country operates. When even one child lacks adequate coverage, the effects don’t stay isolated. Clinics become overburdened. Emergency departments treat preventable conditions. Providers spend more time navigating payment complexity and less time with patients. Hospitals absorb financial strain that weakens pediatric infrastructure for everyone. As Susan Kressly, MD, FAAP, immediate past president of the American Academy of Pediatrics, has said: “𝘐𝘧 𝘸𝘦 𝘦𝘳𝘰𝘥𝘦 𝘵𝘩𝘦 𝘔𝘦𝘥𝘪𝘤𝘢𝘪𝘥 𝘪𝘯𝘧𝘳𝘢𝘴𝘵𝘳𝘶𝘤𝘵𝘶𝘳𝘦 𝘪𝘯 𝘵𝘩𝘦 𝘤𝘩𝘪𝘭𝘥𝘳𝘦𝘯’𝘴 𝘩𝘰𝘴𝘱𝘪𝘵𝘢𝘭𝘴, 𝘵𝘩𝘦𝘺 𝘢𝘳𝘦 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘩𝘢𝘷𝘦 𝘵𝘰 𝘮𝘢𝘬𝘦 𝘩𝘢𝘳𝘥 𝘥𝘦𝘤𝘪𝘴𝘪𝘰𝘯𝘴 𝘢𝘣𝘰𝘶𝘵 𝘸𝘩𝘢𝘵 𝘸𝘪𝘭𝘭 𝘣𝘦 𝘤𝘶𝘵. 𝘈𝘯𝘥 𝘪𝘯𝘦𝘷𝘪𝘵𝘢𝘣𝘭𝘺 𝘴𝘰𝘮𝘦 𝘰𝘧 𝘵𝘩𝘰𝘴𝘦 𝘱𝘳𝘰𝘨𝘳𝘢𝘮𝘴 𝘵𝘩𝘢𝘵 𝘸𝘪𝘭𝘭 𝘣𝘦 𝘤𝘶𝘵 𝘸𝘪𝘭𝘭 𝘦𝘹𝘵𝘦𝘯𝘥 𝘵𝘰 𝘺𝘰𝘶𝘳 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘺, 𝘢𝘯𝘥 𝘵𝘩𝘦𝘺 𝘸𝘪𝘭𝘭 𝘭𝘰𝘴𝘦 𝘢𝘤𝘤𝘦𝘴𝘴 𝘵𝘰 𝘵𝘩𝘦 𝘦𝘹𝘱𝘦𝘳𝘵𝘴 𝘪𝘯 𝘱𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘸𝘩𝘦𝘯 𝘵𝘩𝘦𝘺 𝘯𝘦𝘦𝘥 𝘪𝘵 𝘮𝘰𝘴𝘵.” When children have reliable coverage, every child benefits from smoother, more coordinated care. The AAP just released a new report examining Medicaid and CHIP. The data is striking: 42.2 million children — more than half of all U.S. kids — have relied on these programs for their health care. This isn’t about someone else’s child. It’s about the stability of the system your community depends on. I encourage you to read the report and consider what sustained investment in children’s health really protects. https://lnkd.in/grMUaMTx

our peer-reviewed study on Medicaid losses out today: https://lnkd.in/gsctAMfv Based on empirically derived parameters from prior studies of health outcomes, healthcare systems, and local economies, the estimated health and economic impacts (per 100,000 people losing Medicaid coverage) include: 13-14 excess deaths annually 810-924 preventable hospitalizations annually ~2,582 jobs lost annually ~$1.2 billion in reduced economic output annually Rural hospitals face heightened risk of closure, with impact disproportionate to coverage losses due to the high concentration of patients on Medicaid in rural areas. Federally qualified health centers (FQHCs) experience revenue reductions of 18.7-26.1%.

In the worsening US maternal health crisis, most high-risk pregnant patients are currently covered by Medicaid. Most of our Delfina Care members are covered by Medicaid. We have members who would not have survived their pregnancies without Medicaid covering their prenatal care enhanced by Delfina. Providers serving these patients are overwhelmed and need more resources - not fewer. I have previously worked with uninsured patients - some of whom had suffered without care for years rather than risk a financially crippling bill. Uninsured pregnant patients who similarly avoid prenatal care are more likely to have children with avoidable lifelong complications that end up costing millions of dollars. The evidence demonstrates that Medicaid is a lifesaving and cost-saving social program, particularly in maternal care. We need to continue expanding coverage, while using technology to maximize the positive impact of every dollar. A stronger Medicaid system will be a foundational pillar for our country to finally solve the maternal health crisis and deliver healthy outcomes for all families. https://lnkd.in/gjBFV6Tr

‼️"DHS and its partners focused funding and attention on decreasing racial and geographic disparities in disenrollment during the unwind and IT WORKED."‼️ I've BEEN excited to share the most recent report led by my team at Minnesota Department of Human Services that tracked how our state #Medicaid program did in helping Minnesotans navigate the "unwind" of renewal policies after the end of the federal COVID19 public health emergency. The unwind of continuous coverage in particular was Minnesota’s largest initiative around health insurance since the implementation of the Affordable Care Act. In our Minnesota Health Care Programs Renewal Equity Report we analyzed our disenrollment (people losing their Medicaid coverage) rates over the first 9 months of our "unwind" effort. The key takeaway: disparities in disenrollment for Black & most American Indian enrollees disappeared & disparities for Hispanic/Latine enrollees narrowed🙌🏾🙌🏾👏🏾👏🏾 We could not have seen this result without the guidance, co-creation & collaboration as trusted messengers from community based navigators, organizations, faith-based groups, our county partners & Tribal Nations, other state agencies & funding & people power from the state legislature & Office of Governor Tim Walz & Lt. Governor Peggy Flanagan As we note in the report, to keep this tremendous success requires sustained funding & support & despite this progress, challenges remain. "The data on Medicaid enrollees due for renewal who were disenrolled highlight persistent disparities in disenrollment rates among different race/ethnicity, age, and populations as ranked by ZIP code Social Vulnerability Index (SVI)...Helping someone keep their access to health care can have a profound impact on their health, their family's opportunity and how much their community thrives. Understanding where, with community partners, our collective efforts can best meet the need will continue to be critical as we emerge from the long shadow of the COVID-19 emergency and strive to keep what worked and avoid preventable disparities from re-emerging." Lastly, this reports delivers on a piece of accountability we put forth in our 2022 report Building Racial Equity into the Walls of MN Medicaid: a focus on U.S.-born Black Minnesotans. There we asked, "What will accountability to U.S.-born Black Minnesotans for Medicaid in enrollment and coverage renewals?" Our outcome answer, "Minimal disparity in the percent of U.S.-born Black Minnesotans who maintain coverage at the end of the federal public health emergency compared to average Medicaid enrollees." Yet another way we are showing that centering communities who are impacted most by structural racism can benefit us & all communities✊🏾 Check out the report, share your thoughts & please share as an example of how we can get closer to structural equity in our health care system!🙌🏾 https://lnkd.in/ggRkFF79

📢 New publication in JAMA Network Open— with an invited commentary. I’m excited to share our new study examining the long‑term impact of Medicaid expansion under the Affordable Care Act on survival among women with breast cancer. Using national data on more than 1.5 million women diagnosed between 2006 and 2021, we found that Medicaid expansion was associated with significantly lower overall mortality, translating to a meaningful reduction in 5‑year deaths. Importantly, survival gains were observed across disease stage, treatment modalities, and racial and ethnic groups, with the largest relative benefits among women with advanced disease and Hispanic women. Our findings underscore a powerful message: health policy saves lives. Insurance expansion is not just about access—it is about. timely diagnosis, continuity of care, and survival. At the same time, the persistence of racial and socioeconomic disparities reminds us that coverage alone is not enough and must be paired with targeted equity‑focused interventions. The accompanying invited commentary highlights the policy relevance of these findings, especially in the context of ongoing debates around Medicaid funding and the future of cancer care for vulnerable populations. doi:10.1001/jamanetworkopen.2025.54483 This work was also presented as a late-breaking abstract at the recently concluded FIGO 2025 World Congress in Cape Town, South Africa, underscoring its global relevance to women’s health and health policy. Grateful to an outstanding team of collaborators and mentors, and hopeful that this work informs evidence‑based policy decisions that protect—and extend—lives. doi:10.1001/jamanetworkopen.2025.54512 🔗 JAMA Network Open | Health Policy #MedicaidExpansion #BreastCancer #HealthEquity #HealthPolicy #CancerOutcomes #ACA

Chicago is a city of glaring health disparities. While it boasts world-class healthcare institutions and serves as the headquarters for the American Medical Association (AMA) and the American Academy of Pediatrics (AAP), its underserved neighborhoods tell a different story. The AMA’s recent study on maternal health in Chicago highlights how stark differences in health outcomes are shaped by ZIP code, race, and socioeconomic status (SES). Black women are six times more likely to die from pregnancy-related complications than white women, and their children often face delayed care, missed vaccinations, and preventable hospitalizations. In many low-income neighborhoods, Medicaid-dependent families struggle to find pediatricians, specialists, and preventive services. These areas are deserts for high-quality care, leaving children and families in a vicious cycle of poor health outcomes that begins at birth and extends throughout their lives. These disparities reflect a broader population health crisis: the social and economic conditions in which children live are among the most powerful predictors of their health, and yet our healthcare system remains unequipped to address them. These population health challenges are not unique to Chicago. Across the country, Medicaid-dependent children from marginalized communities face far worse outcomes than their peers. States with high Medicaid enrollment, such as Mississippi and Louisiana, consistently report some of the worst maternal and pediatric health statistics. Racial and economic inequities are compounded by Medicaid’s outdated fee-for-service payment model, which rewards high volumes of care instead of meaningful improvements in health. Pediatricians are paid far less to care for children with complex needs tied to poverty, food insecurity, and housing instability, while systemic barriers like transportation challenges and health literacy gaps leave families unable to access or follow through with care. If Medicaid is to fulfill its mission, it must prioritize population health and lead the way in addressing these disparities by shifting its focus to outcomes-based payment, preventive care, and team-driven solutions that tackle the root causes of poor health.

As the nation witnesses a decline in drug overdose deaths, proposed Medicaid cuts could jeopardize this progress. Medicaid has been instrumental in providing access to evidence-based treatments for substance use disorders (SUD), including medication-assisted therapies and counseling. In states that expanded Medicaid, there was a significant reduction in drug arrests and improved access to care. However, with proposed federal budget cuts targeting Medicaid, millions may lose access to these vital services. This not only threatens individual recovery journeys but also places additional strain on healthcare systems and communities already battling the opioid crisis. It’s imperative to recognize that cutting Medicaid funding doesn’t just reduce numbers on a report, it impacts real lives and the health of our communities. #MedicaidMatters #SUDTreatment #HealthcarePolicy #OpioidCrisis #PublicHealth