2025 marks the 60th anniversary of the creation of Medicare and Medicaid. Medicare and Medicaid aimed to improve health coverage for some of the most vulnerable in our society, including elders, and these programs were an important step towards the goal of securing coverage for all Americans. 60 years ago, 48% of Americans 65 and older lacked health insurance. Those who did have insurance often had inadequate and expensive policies with limited coverage. By 1968, three years after the Medicare program started, the number of uninsured elders had dropped to 2%. Today, more than 40% of babies are born to mothers who have Medicaid, and it is the major source of public support for pregnant women, infants and children.
Medicaid also provides coverage to a greater proportion of rural residents than urban residents and is a crucial part of protecting the health and economic well-being of people in rural communities. Rural residents are much more likely to be low income, and there are fewer rural jobs that provide health insurance. Cutting or imposing unnecessary burdens on Medicaid applicants and recipients will disproportionately hurt rural communities.
NCLR is also very aware that because members of the LGBTQ community experience higher rates of poverty and discrimination, they disproportionately lack health insurance.
When I first began working at NCLR in 2008, some of the most difficult helpline calls we received were from people terrified about losing their health insurance, in addition to their source of income, when they lost their jobs, often with discrimination involved. At the time, almost all private health insurance plans had exclusions for pre-existing conditions, meaning even a short lapse in coverage could mean that a person’s serious ongoing health needs would not be covered by future health insurance plans offered by a new employer. For many LGBTQ people, who also face higher rates of chronic health conditions, this could be disastrous for their health and finances.
Often there were no good options for LGBTQ people facing the loss of their health insurance. Because legal recognition was not widely available, those in same-sex relationships could not rely on coverage through a partner or spouse. Medicaid eligibility for adults was extremely limited, and private insurance for individuals not linked to an employer was often difficult to obtain or prohibitively expensive.
For these reasons and many others, in 2013, before the Affordable Care Act (ACA) went into effect, 34% of LGBTQ low-income people were uninsured. By 2020, with the ACA’s expansion of Medicaid eligibility and subsidies for obtaining individual insurance, as well as its protections against discrimination in the provision of health insurance, that number had dropped by more than half to 16%.
During the first years of the COVID pandemic, the overall uninsured rate dropped further from 10% to about 8%, as Congress authorized additional subsidies for health insurance, and required states to keep people enrolled in Medicaid.
Unfortunately, Republican leaders now want to gut these essential and popular programs and make them harder to access, instead prioritizing tax cuts for corporations and the ultra-wealthy. Their proposals include adding work requirements for Medicaid despite most recipients already being employed, and adding even more burdensome paperwork to prove eligibility, which adds needless administrative costs and risks people losing coverage. These cuts and barriers would be devasting for the millions of LGBTQ people who are covered by these programs. Additionally, if enacted, a proposal to force states to pay more for Medicaid will put pressure on local and state budgets to reduce other programs and services like education, infrastructure or public safety.
Thousands of people die each year due to lack of health insurance. Thousands more face economic crisis because of the cost of essential healthcare. This does not need to happen. Medicare and Medicaid are vital programs that save money and lives. A huge majority of Americans across party lines support maintaining or increasing funding for Medicare and Medicaid. Protecting and expanding Medicare and Medicaid is essential for millions of people across the nation including LGBTQ people, the elderly, parents and families, those facing poverty, and those with a disability or who are otherwise unable to work. NCLR will continue to advocate for expanding these programs because we are committed to a future where no one is denied healthcare based on their personal traits or economic circumstances. We have made tremendous progress towards ensuring healthcare access for all, and this continues to be a key issue for LGBTQ communities.
