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Hello, Rapp Up! Readers! There are two things we know about our health care system. First, it is way too expensive for any but the richest of us to afford on our own. Second, that “system” is in fact a crazy patchwork of programs that too often fail to cover everyone. And let’s face it, everyone needs health care coverage.

Of course, working Americans are supposed to get their health coverage through their employer.  Supposed to, however, doesn’t mean they do.  In fact, millions of Americans are working but don’t receive an employer-sponsored health plan.  Why not?   Small businesses (employing less than 50 people) are not required to provide health insurance and, especially in rural areas, many cannot afford the additional cost. 

Still, those small businesses do need their employees to be healthy!  And luckily for them, the government has their backs: it provides over 15 million working Americans with the medical coverage that they could not afford on their own and don’t get from their employer.

This amazing program should be called the Small Business Employees Health Program because of the essential benefits it supplies -- not just to those workers and their families but to small businesses themselves.  Indeed, guaranteeing the health care of those workers just might be the best support that government gives our small business community.

Sounds like a great program, right?  One that all politicians enthusiastically should support.

And the real name is…. Medicaid?

There is just one problem.  This amazing program is not in fact called the Small Businesses’ Healthy Employees program.  No, in actuality is called…. Medicaid.   And largely because of that one word, conservative politicians are falling all over themselves trying to kick people – often working people – off the program.

Now you might be thinking:  Isn’t Medicaid just an “assistance program”?   The medical equivalent of welfare?  Something we “give” to the “hapless” in our community – but not for too long lest they become “dependent” on government handouts? 

In fact, 60 percent of Medicaid recipients are working!

That’s right: the truth is that 60 percent of Medicaid recipients are working full or part-time!  Moreover, another 20% are either full-time caregivers for an invalid family member or getting more education in order to get a better job.  So that leaves a mere 20% of Medicaid recipients – those with disabilities, for example -- who fall under the old way of thinking about Medicaid as an assistance program.

Furthermore, Medicaid is especially important in rural communities.   Individuals in rural areas face significant barriers to accessing care, including provider shortages, closures of rural hospitals, and long travel distances.  Rural populations are more likely to be low-income than in cities. And a larger share of employment in rural areas comes from small businesses, that do not offer health care coverage. For all of these reasons, Medicaid plays a central role in helping to fill gaps in private coverage in rural areas, covering nearly one in four non-elderly individuals there.

So why are many conservative politicians trying to kick working Americans off of this critical health care coverage?

Unfortunately, however, the misperception of Medicaid as welfare has played into the messaging of many conservative politicians who have been working overtime to kick people off Medicaid.  At the federal level, these politicians engineered the end of the Covid protections for Medicaid recipients. And subsequently, conservative-controlled state governments have been especially eager to cut their Medicaid rolls.

The result? As states such as Arkansas have rushed to slash Medicaid numbers, millions of workers and their families have suddenly found themselves without health care coverage. Even worse, many of them have lost coverage because of paperwork snafus or procedural reasons rather than because they were actually not eligible! And even among those who actually do not meet the new standards, many are in fact working but don’t get coverage from their employer.

In short, politicians’ overzealous attacks on Medicaid are hurting both workers and their employers.

It is long past time for politicians to stop grandstanding on Medicaid by pretending it is an undeserved give-away.  The truth is that almost none of us can afford to pay for our health care by ourselves. Medicaid is just one of several ways that have evolved to manage a health care system that is otherwise unaffordable for all but the very rich.  Medicaid in fact plays a vital role in ensuring a healthy society -- and economy.  In fact, the evidence is that expanding Medicaid eligibility actually raises employment rates.

So maybe we can start by asking Congress to rename Medicaid as the Small Business Employees Health Program.  Sure, it is not a perfectly accurate name – but it is a lot more accurate than calling it “aid”.

In the meantime, here in Virginia, we have an election coming up. Every voter can demand that politicians pledge to do the right thing by maintaining essential programs that benefit us all, like the Small Business Employees Health program – oops, Medicaid…

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