Medicaid Saved My Life. Now I’m Fighting to Save the Law I Teach.

The Friday before the 2024 presidential election, I talked with Bob Casey at a reproductive rights event in the Pittsburgh suburbs. I stood behind him as he heard painful stories of women whose lives were saved by abortion care, and as he reflected on what was at stake in the election.

Then when I got a few minutes of his time as the event came to a close, I introduced myself, telling him that I’m a public health professor at the University of Pittsburgh, and I mentioned that I had a book coming out on health insurance barriers. Then I told him something more personal: I thanked him for saving my life with his 2010 and 2017 votes on the Affordable Care Act, which allowed me to not only survive, but thrive and teach and write on health policy and how to improve it.

I had spent almost my entire life on employer-sponsored health insurance, on which I relied heavily, having had health challenges starting at a very young age. I watched Donald Trump’s first inauguration while hooked up to IV medications at New York Presbyterian-Columbia Hospital, fearful about the fate of the Affordable Care Act and democracy itself. And having just fought tirelessly to defeat the American Health Care Act, when I was between visiting faculty positions in 2017-2018, I lost access to my employer-sponsored health insurance and was not in a position to afford COBRA, through which one must pay 102% of the full premium.

I was terrified, because I’ve struggled for years with chronic endocrine and GI conditions, the former of which were occasionally life-threatening due to cardiac complications. I went to Healthare.gov to see what plans I might be able to afford, and unsure about subsidies, I gave them a call.

To my surprise and immense relief, thanks to Connecticut’s Medicaid expansion through the Affordable Care Act, I was able to enroll in Connecticut’s Medicaid program (Husky). I would have to establish with in-state doctors rather than continuing to go down to New York City to see my Columbia doctors, but apart from that disruption, I was going to get the care I needed.

During that period, I was sick and vomiting blood, and ended up being hospitalized for surgical procedures at Yale New Haven Hospital, where I received outstanding inpatient care along with maintaining outpatient follow-up treatment of my chronic conditions. And disconnected temporarily from research and teaching, I fell into a crippling depression and was able to obtain treatment that helped me to regain a sense of self and, in turn, propel myself back into the world of academia, eventually pivoting from a political science department to a health policy department.

I didn’t share all of this detail with then-Senator Casey, but I told him that I had required extensive treatment, without which I was not confident that I would be able to spend my days teaching the next generation of public health leaders and exposing the many cracks through which patients in the American health care system too often can fall.

I am a health insurance scholar first and foremost because I know all too well what health insurance can do to protect us, and the terror of coverage being kept out of reach, so I am not merely engaging with academic research in the abstract. Indeed, I have said in jest that much of my research agenda (whether on coverage denials or the burdens of COBRA) has been motivated by insurance nuisances that no one else was writing about.

I cannot imagine what would have happened had I been in a non-expansion state in 2017.

I take my role as a professor very seriously, in part because I think of the wonderful professors who inspired me to go down this path, and how I hope to emulate what they gave me. I give several hundred words of feedback on papers. I push my students and demand excellence, though I do my best to help them meet that challenge. And amid simultaneous threats to higher education and public health, my role as a health policy professor takes on an even greater significance as I bridge academic analyses of the health care system with contemporary threats to the social programs whose evidence bases we discuss, from social determinants to health insurance such as Medicaid and CHIP. I ensure that my students come out of my health policy class with, among other things, an appreciation for the significance of Medicaid in reducing racial and socioeconomic disparities in health — including, critically, its extension of postpartum coverage amid a Black maternal health crisis.

Now Republicans are trying to gut around $800 billion from Medicaid. They are trying to force the documentation of work hours by Medicaid beneficiaries, even though we know from Arkansas’s misguided 2018 experiment that Medicaid work requirements a) cause people to lose insurance, b) do so through the imposition of administrative burden, and c) do not produce corresponding increases in employment. The party that allegedly champions federalism and the 10^th Amendment is seeking to impede state sovereignty by reducing the FMAP of the 14 states plus the District of Columbia due to its provision of Medicaid benefits to the undocumented with their own state funds.

Republicans know that these cuts are as unpopular as they are misguided, and we know that because they’re debating amendments in the middle of the night and behind closed doors. Various organizations have estimated the adverse effect of the ever-changing proposals, such as identifying at least 21,600 avoidable deaths each year from the Medicaid cuts, and threatening the existence of nearly 200 hospitals – thus affecting the publicly insured and the privately insured alike. I don’t know why it’s so hard to get some Americans to care about the marginalized, but this affects them too.

Medicaid is a lifeline for so, so many. For the poor. For the pregnant. For nursing home residents. For those with mental illness and substance use disorder. For those in rural communities. And so many more.

And so through various organizations of which I am a part, I have been fighting against these cuts, both as a longtime health care advocate, and for all of the people in my former position and worse who fear for their health, and indeed, their lives when a change in employment comes their way.

If I were in a party that had spent decades pontificating about family values, I would step back and think about the destabilizing effect of stripping health insurance from millions of Americans. The problem is that it has never been about family values or even about personal responsibility. The problem has been greed.

Starve the beast to fund tax cuts for the wealthy, then use the subsequent deficit to justify further cuts to critical safety-net programs. Rinse, repeat. And though I am a faithful partisan, it is hard to escape the messaging failure that the Democratic Party so often falls short in public impressions of competence in handling a robust economy.

One of the critical challenges that institutions of higher education face amid the ongoing attacks is the perception that we operate in the ivory tower. I won’t claim that many in my orbit know the precarity of becoming Medicaid eligible, and what a literal lifesaver it can be to not fall through the cracks. I honestly don’t know. But what I do know is that we are all human beings who are, by definition, vulnerable to injury and illness, and we owe it to ourselves and to those around us to preserve these critical programs.

Mark Twain famously declared that history doesn’t repeat itself, but it often rhymes. Just as Republicans sought behind closed doors to repeal the Affordable Care Act, stripping millions of health insurance on which they depend for their very existence, so too are they seeking behind closed doors to make historic cuts to Medicaid as well as SNAP. Senator Casey narrowly lost his bid for re-election the same day that America cast its vote in favor of someone who has quickly transitioned from a wannabe dictator to an actual autocrat. Both results were a gut punch. But this time, there are no John McCains left to remind the Republican Party to come to its sense.

I often think back on the fear that I felt while on hold to find out whether I could reenroll in health insurance back in summer 2017 as Republicans were on the attack with health care, and the tears that streamed down my cheeks as I got my new insurance card in the mail. My heart aches thinking about the many who will lose that health and economic security if the Republicans have their way.

So let’s put a stop to these draconian efforts. Call your member of Congress. The Capitol switchboard number is 202-224-3121. All gas, no breaks. Let’s get to work.