By Stacy Collins, MSW
Associate Director, Health Reform Implementation
In his first State of the Union address on Jan. 8, 1964, President Lyndon Johnson announced a national "War on Poverty." At that time, while the country was in a period of relative post-war prosperity, nearly a quarter of all American families lived beneath the poverty line. "The War on Poverty" became the unofficial moniker for a host of legislative initiatives proposed and implemented by the Johnson Administration. Many of these programs – Head Start, Food Stamps, Medicare, Title I, Job Corps and VISTA – remain in place today. A cornerstone of the War on Poverty was Medicaid, a program built on the belief that affordable health care is essential to lifting people out of poverty and maintaining economic prosperity. 2015 marks the 50th anniversary of the passage of Medicaid, which, over its history, has become a pillar of the U.S. social safety net – and a vital source of health coverage for women and families.
Medicaid had a profound effect on women, who make up two-thirds of Medicaid's nonelderly adult enrollees. Prior to the passage of Medicaid, most health care was privately funded. Few poor women had insurance for hospitalization or physician care, and infant mortality rates differed significantly by race and ethnicity. Over the years, Medicaid has played an important role in the lives of poor women by providing a wide range of benefits, including well-woman care, family planning and maternity care, hospital and physician care, prescription drugs, cancer treatment, and behavioral health care, among other benefits. Medicaid is the leading payer of maternity care in the United States, financing nearly 50 percent of all births. As a primary source of coverage for women of color, Medicaid is a leader in the national effort to reduce health disparities and advance health equity.
The evolution of Medicaid resulted in important coverage expansions for poor women. In 1972, family planning was added as a mandatory Medicaid benefit. Medicaid family planning coverage expanded again in the early 2000s, at which time states were permitted federal waivers to provide family planning services to women who no longer qualified for Medicaid eligibility (e.g., those who were beyond the 60-day postpartum period). Today, Medicaid accounts for three-quarters of all publicly funded family planning services in the United States.
Over the years, federal eligibility rules have broadened to allow access to early prenatal care for pregnant women. These eligibility expansions are credited with improved health outcomes for children, including reductions in infant mortality and low birth weight. Further expansions available through the Affordable Care Act offer the possibility of more continuous Medicaid coverage to low-income women of childbearing age. This may improve access to preconception and interconception care, which in turn can advance the health of mothers-to-be and result in better infant health outcomes.
The economic benefit of Medicaid coverage is as important as the direct health services it provides. By eliminating the burden of catastrophic medical expenses, Medicaid has promoted the economic security of women and families.
Through its groundbreaking efforts, the War on Poverty acknowledged the relationship between poverty and poor health. On its 50th birthday, Medicaid faces daunting financial and political challenges, but remains one of the War on Poverty's most impactful programs in the effort to improve the health of women and children.