Medicaid has been a bedrock for the less fortunate for 60 years. The Medicare and Medicaid Act of 1965 was a promise to Americans, one that aligns with our deeply held values: Helping people in need and providing everyone, regardless of their background or situation, the chance to thrive.

That makes Medicaid a lifeline for more than 75 million Americans, including one in 10 veterans. The program is also the largest payer for substance use disorder treatment and mental health services in the country. Of the people Medicaid covers, roughly two in five have a substance use or mental health challenge, with one in four having been diagnosed with a mental illness and substance use disorder. The program is also vital to older Americans living in nursing homes.

So much great work has been done to reduce overdose deaths and get people the help they need, and we have programs like Medicaid to thank for that progress. 

Creating more barriers to accessing care would not only be catastrophic for the millions who rely on Medicaid for mental health and substance use treatment and care but also wouldn’t accomplish the goal of saving money. It would drive costs up across the entire health system.

Few programs have helped organizations expand access to mental health and substance use care as much as Medicaid. In states that expanded Medicaid, “community health centers are more likely to offer medication-assisted treatment for opioid addiction.” Medication-assisted treatment, when combined with conventional therapy, is considered the gold standard in opioid use disorder care.  

We finally saw a reduction in year-over-year overdose deaths this past year. That victory would tragically be erased if people lose coverage and can’t pay for their medication that helps prevent an overdose. 

Now that the Senate’s amended budget resolution has passed both chambers and will be used to craft a reconciliation bill, the federal government could effectively force states to make a choice — raise taxes significantly to match the lost funding, restrict the number of people covered or provide fewer benefits. 

Any of those choices would greatly reduce utilization of services and have unintended consequences for health care providers, workforce, state economies and people dealing with a mental health or substance use challenge. 

Significant cuts also would devastate community-based health providers, with uncompensated care costs rising and total patient revenue declining. That could mean organizations reduce staff and services and potentially even close their doors. Where would people go for care then? Most likely, hospitals. 

Medicaid is an investment, a large one, to be sure. But it’s one that produces great returns. Having coverage means better access to preventative care, which reduces the need for costly emergency services. If large swaths of the population lose their coverage, emergency rooms could become the de facto primary care provider for people in crisis, and the result of that uncompensated care drives up costs across the system. In states that expanded Medicaid, uncompensated care in hospitals was reduced by about 40 percent.  

A number of studies show that states that have adopted Medicaid expansion have realized budget savings, revenue gains, overall economic growth as well as observed positive effects on the finances of hospitals and other health care providers, according to the Kaiser Family Foundation, a nonprofit policy organization. In addition, Medicaid’s administrative costs are less than 4 percent of total Medicaid spending, while administrative costs can be up to 17 for those with private insurance. 

Not only is Medicaid one of the most important federal health care programs available, it’s also one of the most popular. Recent polling from leading Republican firm Fabrizio Ward shows widespread Republican voter support for Medicaid, including among swing voters and Donald Trump voters, with majorities opposed to cutting Medicaid. More than three-fourths of adults overall (77 percent) hold a favorable view of Medicaid. 

No government program is perfect, but Medicaid has helped significantly reduce the number of uninsured people in America, improve health outcomes, reduce mortality and help people get back on their feet. Families are strengthened by health care coverage. Children experience better outcomes when their parents are healthy and financially stable. Medicaid helps working families maintain self-sufficiency, particularly in rural and economically challenged areas where job opportunities may offer limited benefits.  

To truly Make America Healthy Again, we should collaborate to strengthen programs like Medicaid, not aim to significantly reduce their funding without concrete plans to improve access to care.

Chuck Ingoglia, MSW, is president and CEO at the National Council for Mental Wellbeing