Opinion | We’re Getting the Medicaid Message Wrong — And It’s Costing Us

As doctors and healthcare advocates, we have spent years perfecting the art of delivering complex medical information in ways patients can understand and act on. We adjust explanations based on our patients’ health histories, personal backgrounds, and the urgency of a situation.

Yet, when it comes to explaining healthcare policy, we often fail to meet people where they are.

Nowhere is this failure more evident than in how we communicate about Medicaid and how federal policies surrounding the program directly affect their lives and communities.

Call Me By My Name — The One People Know

Medicaid serves lower-income adults, children, pregnant women, and people with disabilities, as well as dually-enrolled Medicare-Medicaid older adults. Despite the talking point that people on Medicaid “don’t work,” 92% of adults under 65 who are on Medicaid and don’t receive other social security benefits work full or part-time.

While 80 million Americans are insured through Medicaid, many people don’t think of themselves as “on Medicaid” — even when they are.

Why? Because Medicaid is not branded as Medicaid in most states. If you tell a patient in South Carolina they might lose Medicaid, their eyes may glaze over. Tell them Healthy Connections is at risk? You have their attention. In Tennessee, Medicaid is TennCare and in Ohio it is the Buckeye Health Plan. In Florida, Medicaid sounds like an orange juice brand: Simply Healthcare. (Seriously, it feels like that moniker should have an exclamation point behind it.)

Adding to the confusion, many states offer Medicaid coverage contracted through private companies. These types of plans are state-funded, private insurance-branded programs (called managed care organizations) often featuring actual private insurance logos, a fact that further distances them from their federally funded origin. No wonder Tennesseans shrug when we talk about Medicaid recipients. They don’t think, or even know, they are one. And if they do not know the issue applies to them, they may be less likely to oppose cuts.

In every state, we need to call Medicaid by its real name.

Articulate Impact at the Community Level

Do you remember the “Austin Powers” scene where Mike Myers, playing Dr. Evil, puts his pinky finger to the corner of his mouth and suggests holding the world hostage for — pause for effect — “one million dollars”?

Dr. Evil’s conspirators laughed. That is because they understood “one million dollars” was not a whole lot in the current global context. They could relate to a million dollars and think about it in concrete terms. As numbers get larger and larger, however, they become harder to apply to real life. A billion, a trillion — unless you are Elon Musk, those amounts are abstract.

This is why healthcare advocates need to translate the impact of cuts at the individual, family, and community level. Instead of saying “Republicans want to reduce Medicaid by $880 billion,” try, “If Republicans’ Medicaid plans come to fruition, you could lose your Buckeye Health Plan health insurance.” Or try explaining how these cuts could erode their child’s access to care. Nearly half of U.S. children rely on Medicaid and 40% of all births are covered by Medicaid. Cutting the program would destabilize pediatric practices, many of which already operate on thin margins. If parents think they already have to wait too long to get a well-child visit, just wait until these cuts take effect.

Healthcare practitioners can share these messages in their everyday visits, through direct community outreach, and on patient-facing websites and social media posts.

Advocates and clinicians must also demonstrate the financial impact of shifting about 20 million Medicaid patients to uninsured status. For example, at industry and association conferences, in executive briefings, and in professional publications, we need to help hospital administrators understand what Medicaid cuts would mean for their bottom lines: more uncompensated care, more emergency department overcrowding, and more financial strain. For patients, that means letting them know that, particularly in rural areas, Medicaid cuts may mean even more hospital closures. It may mean they have to travel even farther for care.

How to Talk To Policymakers About Medicaid Cuts

Unlike the federal lawmakers, legislators in most states must balance their budgets every year.

That means cuts to any federal aid program that flows to the states, including Medicaid, throws budgets out of balance. Indeed, federal Medicaid cuts could shift $44.3 billion in costs to the 41 state governments that expanded Medicaid. Local lawmakers will have to decide if they want to reduce access to healthcare or raise taxes; do they want to shift costs to hospitals — many of which already are facing closure in rural areas — or do they want to cut other vital services like public safety and education?

These are the choices Musk and President Trump are foisting on state lawmakers, including local Republicans. The healthcare community needs to make that clear through one-on-one meetings, economic impact reports, and targeted lobbying efforts.

Healthcare practitioners and advocates must help Americans understand it is their insurance at risk. We need to help hospital administrators and practice owners understand it is their business model at risk. And we need to help state lawmakers understand it is their ability to balance budgets and care for their constituents at risk. These are the kind of targeted, audience-specific communications that will move policy discussions from abstract debates to real-world opposition to the proposed cuts.

As clinicians, we do not explain heart disease to a patient the same way we discuss it with a medical resident. We do not prescribe the same treatment for every patient. We know: one size never fits all. The same holds true for health policy communications. If we want people to care about Medicaid, we need to use terms they understand and show them how it impacts their lives. By shifting how we communicate, we will not just win policy debates — we will empower people to fight for their own healthcare.

It is time we start meeting Americans where they are.

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