A proposed Republican-led budget plan to cut Medicaid—the United States’ largest public health program—could raise costs and reduce access to essential reproductive health services for millions of women. Health advocates warn that low-income women, communities of colour, people with disabilities, and rural residents may lose affordable care, including contraception, prenatal care, and important screenings.
For Thai readers, the U.S. debate serves as a cautionary tale about public healthcare funding. Medicaid currently covers more than 70 million people, including about 13 million women of reproductive age, and is a government-led effort to protect vulnerable populations. This bears some resemblance to Thailand’s 30-baht universal health coverage scheme, known locally as the gold card system.
If cuts go ahead, women’s health could suffer. Medicaid supports contraception and family planning, annual wellness exams, breast and cervical cancer screening, prenatal and postpartum care, and STI testing, including HIV. Federal policy already ensures that enrollees can access family planning services without out-of-pocket costs or restrictive referrals, a principle that removes cost barriers for millions.
Without Medicaid, reproductive health costs could rise sharply. Analysis shows annual expenses could reach about $150 for birth control pills, up to $1,300 upfront for an IUD, around $600 per year for over-the-counter contraception, and roughly $250 per STI testing visit. For households living paycheck to paycheck, even modest price increases can drive people to skip care. The Federal Reserve has noted that cost barriers led more than a quarter of U.S. adults to forgo medical care in 2022.
Experts emphasize the link between affordable coverage and health outcomes. Recent research indicates many people postpone care due to lack of insurance or prior experiences with surprise medical bills. Financial barriers also affect contraception use, with about one in five uninsured women reporting they stopped their preferred method because of cost.
The impact will not be felt equally. Rural women and people with disabilities face greater challenges in accessing care, and LGBTQI+ communities may encounter barriers to inclusive services. Communities of colour—Black, Latina, American Indian, and Alaska Native women—rely more on Medicaid and often experience higher rates of pregnancy complications, underscoring the unequal stakes of funding changes.
Medicaid is widely viewed as a cost-effective public health program. Per-beneficiary costs are lower than those of private insurance and have grown more slowly. While cuts are framed as fiscal discipline, many experts view them as a policy choice with tangible human costs, potentially limiting access to contraception, prenatal care, STI treatment, and other essential services.
From a Thai perspective, the U.S. discussion highlights the importance of stable funding for universal health schemes. In Thailand, annual budget debates about the gold card system recur during fiscal planning. Analysts note that universal health coverage has reduced catastrophic health expenditures for households, especially for women and children in rural areas, and is recognized internationally as a strong model for public health delivery.
The U.S. experience also illustrates a broader trend: when state support weakens, health disparities widen. In Thailand, a robust safety net is crucial as the population ages and non-communicable diseases rise. If Medicaid cuts proceed, public health officials warn of potential increases in unintended pregnancies, delayed cancer detection, and more untreated STIs.
Historically, rising costs and tighter benefits push economically vulnerable groups away from preventive care. This pattern strains public hospitals and social services in both Thailand and the United States. International research suggests that nations maintaining strong public health coverage see improvements in maternal and child health, life expectancy, and resilience.
Looking ahead, U.S. health advocates are mobilizing to oppose the Medicaid cuts, arguing that the policies erode public trust and health equity. For Thai policymakers and civil society, the episode offers lessons in safeguarding inclusive healthcare access and maintaining public confidence in universal coverage.
The practical takeaway for Thai readers is clear: universal healthcare gains strength when protected from political cuts. Vigilance, collective advocacy, and policy innovation are essential to preserve access for all, especially the most vulnerable. This remains a universal challenge, including in Thailand.