Sixty-one years ago this week, President Lyndon Johnson signed Medicaid into law with a straightforward promise: no American should be abandoned at the moment they are most vulnerable.
This 61st anniversary of Medicaid arrives at an inflection point for the program: millions of eligible Americans risk losing coverage. The best way to mark this anniversary is to protect the program’s purpose.
Medicaid is often described as coverage for "the poor." In reality, Medicaid is an indispensable pillar of the American health care system, covering roughly one in five Americans—including children, pregnant women, seniors, and people with disabilities.
Medicaid supports families when illness or age outruns their resources. It is the single largest source of health coverage in the country. The program pays for about 40 percent of all births in the United States—and close to half of births in rural communities. It covers roughly four in ten of the nation’s children. Medicaid is the largest payer of long-term care in America, financing care for about six in ten nursing home residents.
Rural hospitals, community health centers, and nursing homes depend on Medicaid reimbursement to keep their doors open and their staff employed.
Medicaid's health is community health. Middle-class families have a direct stake in its future.
That is why the stakes of Medicaid’s future are so high. When Medicaid is described only as a line item that can be trimmed, the conversation misses what the program does for the entire health care system. As the funding cuts enacted by Congress last summer—the largest such cuts in the program’s history—take effect, millions of working American families will lose their health care, and hospitals that have already cut back services in response to the cuts may close altogether.
The consequences will not be abstractions. They will be felt by children who miss checkups, parents who cannot afford prescriptions, people with disabilities who lose the supports that let them live independently, rural hospitals that close their doors for good, and adult children trying to care for their aging parents.
The 2025 reconciliation law made sweeping changes to eligibility and state financing. The Congressional Budget Office estimates that its Medicaid provisions will reduce federal outlays by roughly $911 billion over a decade and increase the number of uninsured Americans by 7.5 million in 2034. CMS has issued rules implementing an 80-hour-per-month "community engagement" requirement for most adults covered through the Affordable Care Act’s Medicaid expansion. Most of these adults will also face eligibility renewals every six months rather than once a year.
To ensure Medicaid survives and thrives, federal and state policymakers must prioritize stability. Investing in Medicaid is an investment in the health of the entire nation. Policymakers must ensure that vulnerable populations—especially children, seniors, and those undergoing complex medical treatments—maintain stable, uninterrupted access to care.
As states and stakeholders work together to implement the provisions of H.R. 1, CMS must provide more time, more flexibility, stronger exclusion and verification protections, and clearer guidance for states and plans in order to achieve congressional goals without repeating the large-scale coverage losses experienced under previous Medicaid work requirement initiatives.
America must also bolster the frontline doctors, nurses, and community health workers who form the bedrock of the Medicaid network.
Marking Medicaid at 61 is not an exercise in nostalgia. It is a reminder that no one should be abandoned when illness, disability or age exceeds the resources of a family.
Reasonable people can disagree about how to modernize a 61-year-old program, and they should. Medicaid can and must evolve. But there is a test every proposed change should have to pass: Does it keep illness from becoming catastrophe for American families?
Margaret A. Murray is the CEO of the Association for Community Affiliated Plans (ACAP).
