We must protect and support our health care safety net

As the White House deputy chief of staff at the time, I will never forget the sense of pride I felt when working alongside President Obama to pass the Affordable Care Act (ACA). With the ACA and other victories, Democrats are champions of expanding access to health care in the United States. The benefits are far reaching, including better health outcomes and greater economic security.

Centers for Disease Control and Prevention reported that in 2020, the population of uninsured Americans declined by about 1.6 million as Medicaid and other public health programs helped offset declines in employer-sponsored insurance.

Even with these gains in health care coverage, millions remain uninsured. Just as alarming, many Americans with health care coverage face significant disparities in access to high quality health care and related services. Health inequity is not specific to red states or blue states, or urban or rural communities. I applaud the Biden administration’s commitment to improving health equity and health outcomes for minority and underserved populations, many of whom rely on Medicaid for access to health care services.

It cannot be stressed enough that understanding the importance and the impact of Centers for Medicare & Medicaid (CMS) support for state Medicaid programs requires understanding the availability of access points and the demographic profile of states’ underserved communities.

For example, recent census data indicates that at least one county along the Texas-Mexico border is 90 percent Hispanic and the per capita income in the last 12 months is $17,430. Notably, 25.5 percent of the population in the county — more than double the national average — is challenged by extreme poverty.

With only one major public hospital along the entire 1,250-mile Texas-Mexico border, many of Texas’ most vulnerable individuals rely on a dedicated network of non-governmental hospital and rural health providers.

The resolve of safety providers and vulnerable populations like those in Texas continues to be tested as a result of the ongoing COVID-19 public health emergency.

Improving equitable access to high-quality care is rooted in Medicaid. For years, CMS and states like Texas have worked together to build successful Medicaid programs, including through CMS approval of Medicaid section 1115 waivers, related Medicaid supplemental payments and Medicaid managed care-directed payment programs.

Despite the proven success of Medicaid expansion, 12 states still refuse to expand their Medicaid programs, leaving millions of working poor Americans without access to affordable coverage. As frustrating as it is to see 12 states oppose expansion, we cannot lose sight of the fact that even without expansion, millions of Americans depend on these Medicaid programs for access to care. Thus, as Congress works towards closing the coverage gap, CMS and states must continue to collaborate to build on Medicaid successes and support the health care safety net.

For example, states now have even greater flexibility under Medicaid 1115 waivers to address and improve access to substance use disorder (SUD) and behavioral health services. Investments in these Medicaid 1115 waiver programs is even more important as the COVID-19 pandemic has only exacerbated existing challenges and disparities associated with behavioral health and SUD services. Further, I strongly support the Biden-Harris administration’s commitment to reducing maternal mortality rates and addressing related disparities. At least one state has already received approval of a Medicaid 1115 waiver aimed at reducing the rate of maternal morbidity and mortality.

As Congress pursues larger coverage goals, we must continue to invest in care innovation, prioritize alternative and quality driven payment programs, and implement new Medicaid 1115 programs; all are essential to reducing health disparities and supporting the long-term sustainability of the nation’s safety net.

Jim Messina is the chief executive of The Messina Group. Messina was the campaign manager for President Obama and White House deputy chief of staff. Follow him on Twitter: @Messina2012

This piece has been updated.