Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


Medicaid plays key roles in supporting our nation’s health. Under the Affordable Care Act, Medicaid took an even more central position in public health endeavors by extending coverage in all interested states to millions of adults who typically fell through the health care cracks. Nevertheless, the Trump administration is now undoing these gains by actively encouraging states to curtail access to Medicaid in key respects while using the rhetoric of health.

This article examines Trump administration efforts in two contexts: (1) state § 1115 waiver applications seeking to better align their Medicaid programs with cash welfare and food stamp programs, and (2) changes to Medicaid funding for contraceptive and other reproductive health services. In the process, it concludes that, when ideology trumps public health, it not only leads to bad health outcomes, but also, potentially, to bad legal outcomes. Those who value Medicaid as a strong safety net and public health program need to alter their rhetoric in seeking to protect and bolster it by focusing on Medicaid’s role in supporting individuals and communities. Independence is healthy, and Medicaid can play a key role in supporting our independence when we all accept and support its role as a robust safety net program on which all Americans should be able to rely if necessary.