Slides from Dr. Jamila Michener's presentation at Georgians for a Healthy Future's 10th annual Health Care Unscrambled

1. HealthEquity
& Democracy
Jamila Michener, PhD
Cornell University
@povertyscholar

3. Medicaid: A Pillar of Support
• Medicaid covers over 70 million Americans (1 in 5)
• Medicaid works within and supports crucial institutions and
systems: hospitals, community health centers, schools,
substance abuse and mental health treatment facilities,
• Medicaid is ubiquitous: 70 percent of Americans report having a
personal connection to Medicaid (via family, friends or
themselves).

4. Medicaid: A Well-Being Lens
Health Poverty
EducationFinances

5. Medicaid: A Well-Being Lens
• Medicaid improves health in the long term (Boudreaux et al. 2015;
Goodman-Bacon 2018; Sommers et al. 2012).
• Medicaid improves educational outcomes (Cohodes et al. 2014).
• Medicaid improves financial outcomes (Brown et al. 2015).
• Medicaid reduces likelihood of families being in poverty (Remler et
al. 2017).
• Medicaid has largest effect on child poverty compared to all non-
health means tested programs (5.3% point reduction).

6. Medicaid: AVulnerabilityLens

7. Medicaid: An Equity Lens
• Over 65% of Medicaid beneficiaries in Georgia are Black
or Hispanic/Latino
47%
32%
15%
6%
Distribution of Nonelderly Medicaid
Beneficiaries in Georgia by Race/Ethnicity
Black
White
Hispanic
Other

8. Medicaid: A Civic/Political Inclusion
Lens

9. Terrie
“My name is Terrie and I have a 16-year-old son,
he’ll be 17 soon. I have traveled a lot so the
difference between state to state with Medicaid
and what it offers and the programs and how
consistent they are; I have a lot of experience with
that. Being in [Medicaid] 17 years, you know, it has
just been a whirlwind with keeping [my son] safe
and healthy.”

10. “Ohio is the easiest, they care about their people.”
“California, their process is probably faster, but
there are so many people and it’s so rapid that it is
out of control.”
“In Georgia, there are limitations in everything that
they offer … you either can get this and can’t have
that, or you can have this and can’t get that … you can
only go to this doctor on this day at this time.”
Terrie

11. “When I knew I was going to meet you, I got upset a little bit
thinking about it, because I’ve got a lot to say about
Medicaid…for something that’s provided by the
government…you’re limiting the use of something meant to
make people better…Bottom line AIDS, cancer, bacteria, food-
borne illnesses, terroristic threats. Everyone in America needs to
be covered so America is covered, do you get that?”
Terrie

12. Terrie
“If it was about helping people, you would say yes, let my
state be more productive and healthy so that we do not
have people losing their lives [and] so that they can be
productive citizens.”
“White noise is the people that choose to say well, if they
give it to me, they give it to me, if they don’t, they
don’t…white noise also means that you feel like in your
world, you have no say, no say in the process if you don’t
agree with what is going on in Medicaid. It’s demeaning, you
know, the process…I have never seen anyone really stand
up about Medicaid…I don’t know why we don’t fight.”

13. Ladonna
“[Medicaid beneficiaries] probably want, you know, a better
Medicaid system but the process that you have to go through
just to get Medicaid you don’t even want to go through that
again. You are just satisfied that you have it that’s why most
people don’t really like care, they don’t, really don’t care about
whether it’s expanding it or making it stay the same, they are
just glad that they have it so they don’t they don’t have to go
through another headache trying to get it.”

14. Lucy
“They still look at you in a different way because you have
Medicaid. I got burned last year, third degree. I could not get
Medicaid in Georgia. And I only make $7.50 an hour, but that
was too much for them and I have four kids. I was out of work
for almost two months. I had to fend for me and my kids.”

15. Medicaid Enrollment & Political
Engagement

16. State Policy Context
1. Expansions/Retractions
“the policy is changing…making it hard for anyone to pretty much go to a
doctor, just to get a general pap exam or any kind of exam.”
2. Scope of Services
“…withWell Care I pay for thirty percent dental and vision is free.We have bad eyes, so I’ll
take free vision and pay thirty percent dental ‘cause we have great teeth.You see what I’m
saying?We have no cavities, so I picked that plan for the total free vision. Which means [my
son] can get glasses free.”
3. Administrative Capacity
“it’s not enough case workers…You have six, seven case workers to all these
people but instead of trying to break it down or hire more case workers, they
get to you when they can get to you.You just better hope you have everything
ready to go when they call you. If not, there’s another 10 to 12 days.”

18. WhatMattersto People?
• Access
• Dignity
• Administrative Ease
• Voice

19. Doespolicyreflectthis?
• Work reporting requirements
• Co-pays/premiums
• Optional benefits (transportation)
• Beneficiary voice

20. WhatDoestheEvidenceSay?

21. WhatDoestheEvidenceSay?

22. AVitalLenson Medicaid

23. Thank You!