The Lifelines that Shape Access to Care: Medicaid and Medicare

Written by The SHE+ Foundation

In the United States, access to healthcare is intrinsically connected to insurance coverage. For over 130 million Americans, that coverage comes from Medicaid and Medicare - public programs that serve as lifelines for older adults, people with disabilities, and low income families. 

But how do they work? 

And why are they so important? 

What are Medicaid and Medicare? 

Medicare is a federal health insurance program for people over the age of 65, and for younger individuals with disabilities or certain chronic health conditions. 

It covers over 65 million people nationwide, according to the Centers for Medicare and Medicaid Services (CMS, 2024) 

Medicaid is a joint federal and state program that provides coverage for people with limited income and resources. As of 2023, 85 million Americans were enrolled in Medicaid, including 42% of all births in the United States, according to the Kaiser Family Foundation (KFF, 2023) 

How Medicaid and Medicare Expand Access to Care 

Serving the Most Vulnerable

According to KFF, Medicaid covers 1 in 5 Americans. 4 in 10 children. And Nearly half of all non-elderly adults with disabilities. 

Similarly, Medicare is the single largest payer for health services for older adults. 

Improving Preventative Care 

According to the United States Department of Health and Human Services, people with Medicaid are more likely to receive preventative services, like cancer screenings, well-child visits, and vaccines (HHS, 2022) 

According to CMS, in 2022 alone, over 35 million Medicare beneficiaries received at least one preventative service. 

Supporting Rural and Underserved 

According to the National Rural Health Association, more than 40% of rural hospital revenue comes from Medicare and Medicaid. Without these reimbursements, many rural hospitals would not survive. 

Medicaid also helps fund community health centers, and safety net providers that serve millions of patients. (HRSA, 2023) 

Acting as a Safety Net 

In the United States, many individuals receive health insurance through their employer. 

Medicaid often steps in when people lose their employer-based insurance, become pregnant, or face long-term disability. 

According to Georgetown University’s Health Policy Institute, Medicaid is the largest payer for maternity care, covering 43% of all births. (2022) 

Challenges and Gaps in Coverage 

Medicaid coverage varies dramatically by state, especially in the 10 states that have not adopted Medicaid expansion under the Affordable Care Act. According to KFF, this leaves over 2 million low-income adults in a coverage gap (2023).

Many healthcare providers don’t accept Medicaid due to lower reimbursement rates, reducing access in some areas, especially for specialty care (Urban Institute, 2022).

Medicare does not cover long-term custodial care, and out-of-pocket costs—especially for prescription drugs and dental care—can still be high (Medicare Rights Center, 2023).

Why They Matter 

Medicaid and Medicare provide dignity, stability, and lifesaving care. 

According to research published in JAMA, Medicaid expansion was associated with a 6.1% reduction in adult mortality in expansion states between 2014 and 2017. 

Medicaid and Medicare are foundational to health equity in America. They improve health outcomes, reduce financial barriers, and ensure that millions of people can access care across every stage of life.

According to the National Academy of Medicine, protecting and expanding these programs is one of the most effective ways to reduce health disparities in the U.S.

When we fight for Medicaid and Medicare, we are fighting for a future where health is not a privilege, it’s a right.

Visit our Resource Hub to learn more about taking action.