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Medicaid has been making headlines recently due to the One Big Beautiful Bill Act (HR 1), a major budget reconciliation bill in Congress. With so much attention on this vital healthcare program, we at the Independent Center wanted to break it down in a way that’s easy to understand—especially for independent voters who often prioritize pragmatic, issue-driven solutions over partisan talking points.
Medicaid is a safety net healthcare program designed for low-income individuals. It covers groups like children, pregnant women, parents, seniors, and people with disabilities. Thanks to the Affordable Care Act (ACA), coverage expanded to include non-elderly adults earning up to 133% of the federal poverty level (FPL). People with end-stage renal disease also qualify under a separate program.
Medicaid was created in 1965 as a voluntary program for states. States that met federal requirements received funding to help cover costs. It wasn’t until 1982 that all states had adopted Medicaid. Even today, ten states have not expanded Medicaid under the ACA.
Medicaid is a federal-state partnership, meaning each state runs its own version of the program. As the saying goes, “Once you’ve seen one Medicaid program, you’ve seen one Medicaid program.” States choose between fee-for-service, managed care, or hybrid models. These decisions shape how care is delivered and funded.
In 2023, Medicaid covered 21.2% of the U.S. population, while Medicare covered 14.7% and employer-based insurance covered 48.6%. Medicaid also paid for 41% of all births and 46% of long-term care services.
Rural areas, often home to independent voters, rely heavily on Medicaid. Federally Qualified Health Centers, Indian Health Services, and Rural Health Clinics depend on Medicaid payments to stay open. For example, Arizona even reimburses equine-based medical transport for remote communities near the Grand Canyon.
States like Louisiana show how Medicaid can be deeply embedded in local life—a third of residents are on Medicaid, and it covers two-thirds of all births in the state.
Federal law requires Medicaid to cover:
States can expand coverage to additional groups, including:
Medicaid offers traditional benefits and Alternative Benefit Plans (ABPs). ABPs allow states to tailor coverage to specific populations, using benchmarks like federal employee plans or commercial HMOs. This flexibility helps states meet the needs of diverse communities, including independent-minded voters who value choice and efficiency.
Medicaid is funded jointly by states and the federal government. The Federal Medical Assistance Percentage (FMAP) determines how much federal funding each state receives. FMAP is based on state income levels and ranges from 50% to 83%. ACA expansion populations receive a 90% federal match.
States can apply for Section 1115 waivers to test new approaches. These waivers allow for pilot programs that expand coverage, restructure benefits, or add work/community requirements. Some waivers even cover non-traditional services like housing support.
Independent voters—who now make up 51% of the electorate—are reshaping American politics. They’re not tied to party loyalty but vote based on values and solutions. In 2024, independents made up 34% of voters, outpacing Democrats and nearly matching Republicans.
They also engage in split ticket voting, choosing candidates from different parties based on issues rather than ideology. For example, independents voted for Trump in 2024 but helped elect Democratic senators in key states.
As one Independent Center article puts it: “Independent voters are the free agents of the electorate. They are fiscally focused and socially tolerant.”
Understanding Medicaid is crucial for independent voters who care about affordability, healthcare access, and government accountability—issues that consistently rank as top priorities.
Medicaid is a complex but essential program that touches the lives of millions—including many independent voters. As we continue this series, we’ll explore how Medicaid intersects with other key issues like economic policy, rural healthcare, and political reform.
Stay tuned for Part 2, and remember: independent voters are the deciders.
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