Edward Saltzberg
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By Edward Saltzberg | Security and Sustainability Forum
What if one-third of Americans receiving federal health care didn’t know they had it? And what if, in that confusion, they unknowingly cheered on efforts to take it away?
That’s precisely what’s happening with Medicaid. In 35 states, the program operates under different names — Arizona Health Care Cost Containment System in Arizona, MassHealth in Massachusetts, TennCare in Tennessee and Apple Health in Washington. These state-specific brands have successfully reduced perceived stigma but obscure the program’s federal identity.
And now, with Congress considering up to $880 billion in Medicaid cuts as part of budget negotiations, millions of Americans may not realize they may lose coverage.
A 2024 study by KFF Health News found that one-third of Medicaid enrollees don’t know they’re on Medicaid. They may assume some other state-run benefit covers them. That gap in understanding has serious consequences. When lawmakers discuss slashing Medicaid, many people think it won’t affect them. However, if you’re on SoonerCare in Oklahoma, KanCare in Kansas, or HUSKY Health in Connecticut, you’re on Medicaid. If this budget passes, your health care is at risk.
Medicaid is often viewed as a program only for the very poor. In reality, it provides health care to 80 million Americans, including working-class families, low-income children, seniors in nursing homes, and people with disabilities. Medicaid is crucial in preventing medical bankruptcy, funding hospitals and supporting state economies.
Because states administer the program, many have rebranded it with names that omit the word “Medicaid.” It’s the nation’s most extensive health safety net — and one of its most misunderstood.
During the first Trump administration, efforts to repeal the Affordable Care Act included significant Medicaid cuts. These proposals sparked widespread resistance, especially once people realized their local programs were at risk.
In 2024, a federal court in Tennessee ruled that TennCare had wrongly terminated coverage for thousands of people, often without providing proper notice or an opportunity to appeal. Many of those affected didn’t realize their benefits were part of Medicaid until the system failed them, reflecting the deeper awareness gap that leaves coverage vulnerable to political and administrative actions. Awareness drove action. When people understood their coverage was Medicaid, they organized, contacted lawmakers, changed the course of the debate and helped stop the repeal effort.
Let’s be clear: Medicaid is not a minor line item. It is 13% of the federal budget.
Reforming Medicaid should focus on efficiency and waste reduction, not slashing the safety net millions rely on. Rooting out fraud and misuse is essential to reducing the federal deficit, but it must be done without forcing millions into financial and medical crises.
The stakes couldn’t be higher with Medicaid funding decisions now before Congress. House Republicans are advancing a budget reconciliation bill that would slash Medicaid over the next decade to offset the extension of Trump-era tax breaks. The bill is expected to move forward, putting tens of millions of Americans at risk.
This is the moment to pay attention and make some noise — before Congress finalizes a decision that could unravel health care access for millions.
Here's what Americans can do:
• Find out what your state’s program is called. Awareness is power. Arizona’s Medicaid program is called AHCCCS, for Arizona Health Care Cost Containment System.
• Talk to friends and family. Help others understand that what’s happening in Washington affects them directly.
• Call your representatives.
• Share this piece. If you care about health care, help others understand what’s at stake.
• Amplify if you’re in health care or policy. Professionals and advocates: share this with your networks. You can help correct the record and inform your community.
• Write a letter to the editor, pitch a story to your local TV or radio station, post your story online and tag reporters or outlets. Local media coverage can drive public awareness and influence policymakers. Statewide and national publications can elevate the issue.
• Email your state lawmakers. Show up at a town hall. Ask how they plan to protect your state’s Medicaid coverage.
It is not too late for you to make a difference.
Editor’s note: Edward Saltzberg is the executive director of the Security and Sustainability Forum. He wrote this for InsideSources.com. Please send your comments to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.
