Unrequited Engagement: Misadventures in Advocating for Medicaid Expansion

Health reform in the United States is in peril. Although the Affordable Care Act (ACA) expanded health-care access to twenty million people, ongoing Republican attempts to dismantle the ACA make clear that these gains are extremely vulnerable. If the US Senate’s Better Care Reconciliation Act had passed in June 2017, for example, the Congressional Budget Office (CBO) estimated that fifteen million Americans would have lost their health insurance by 2018 and twenty-two million by 2026 (CBO 2017a). Likewise, the CBO estimated that if the recently passed tax reform bills—which would eliminate the individual mandate of the ACA—are signed into law, then thirteen million Americans would lose their health insurance (CBO 2017b), premiums would increase by approximately 10 percent per year (CBO 2017b), and the federal deficit would increase by 1.5 trillion dollars (CBO 2017c)—a move that many health advocates suggest would reduce Medicaid coverage over the long run as Republicans seek to cut so-called entitlement programs. In this uncertain context, this essay is written with two primary aims. First, we turn an ethnographic gaze onto one of the major benefits of the Affordable Care Act: expanding Medicaid to low-income adults. Though the ACA is not perfect, and we analyze its faults at length in other places (Mulligan and Castañeda 2017), it is nonetheless important to take a public stand in favor of preserving the positive aspects of the law, including—and particularly— maintaining the expansion of Medicaid access to low-income adults. Based on our collective research experiences and the uniquely holistic approach of anthropology, we put human faces to the data to argue that Medicaid-facilitated access to health care saves lives. Conversely, we underscore that the absence of health coverage in the Medicaid “gap” leads to job loss, disability, and death.