Proposed Republican-led budget cuts to Medicaid—the United States’ largest health insurance programme—could drastically increase healthcare costs and reduce access to essential health services for millions of women, according to recent reports. The potential policy shift is raising concerns among health advocates and experts who warn that low-income women, communities of colour, those with disabilities, and rural residents may be left without affordable care, including birth control, prenatal services, and vital screenings.
For Thai readers, the proposed Medicaid cuts in the United States serve as a cautionary tale about the risks of reducing public healthcare support, with clear parallels to ongoing debates over universal health coverage (UHC) and budget allocations in Thailand. The U.S. Medicaid programme, currently covering more than 70 million people—including 13 million women of reproductive age—is a model of government-funded health coverage aimed at vulnerable populations, similar in some respects to Thailand’s 30-baht healthcare scheme.
If the planned cuts are enacted, the consequences for women’s health could be severe. Medicaid currently ensures low-income women have access to a wide range of reproductive health services: birth control and family planning, annual wellness exams, breast and cervical cancer screening, prenatal and postpartum care, and sexually transmitted infection (STI) testing, including for HIV. Importantly, federal law guarantees Medicaid enrollees can access family planning services without out-of-pocket payments and without restrictive referral procedures—a principle that effectively removes cost barriers for millions.
Without Medicaid, costs for basic reproductive healthcare would soar. According to the analysis, annual expenses could include up to $150 for birth control pills, $1,300 upfront for a long-acting device like an intrauterine device (IUD), $600 yearly for over-the-counter contraceptives, and $250 for each STI testing visit. For women and families living paycheck to paycheck, even a modest increase in healthcare expenses can mean forgoing care altogether. This pattern is echoed in research by the Federal Reserve, which reported that more than a quarter of U.S. adults skipped medical care in 2022 because of cost constraints (msmagazine.com).
Expert opinion consistently highlights the critical link between affordable coverage and health outcomes. A recent study cited in the article found that over half of respondents had postponed needed care due to lack of insurance or because of bad prior experiences with unexpected medical bills. Financial barriers have a direct adverse impact on contraception use: one in five uninsured American women said they had to stop their preferred birth control method simply because they could not afford it.
The negative repercussions of Medicaid cuts will not be felt equally. Women in rural parts of the United States—where healthcare facilities are already sparse—and individuals with disabilities, as well as LGBTQI+ communities, face greater hurdles to securing inclusive, competent care. Black, Latina, American Indian, and Alaska Native women, who disproportionately rely on Medicaid, are especially vulnerable not only economically but also medically, as these groups already experience higher rates of pregnancy and childbirth complications.
Medicaid is widely seen as an efficient and cost-effective public health programme. Compared with private insurance, Medicaid’s per-beneficiary costs are notably lower and have grown more slowly. While the policy rationale for the proposed cuts is framed as budget discipline, experts argue it is a political choice with clear victims: those who rely on Medicaid for primary, preventive, and reproductive care. “Behind every dollar slashed is a human being who might lose their access to contraception, prenatal care, STI treatment, or other essential reproductive health services they rely on,” one health policy commentator noted in the original report (msmagazine.com).
From a Thai perspective, the U.S. debate underscores the importance of consistent funding for universal health schemes. In Thailand, debates over the budget for the 30-baht universal coverage scheme, known as the “gold card” or บัตรทอง system, resurface each year during fiscal planning. Many policy analysts stress that Thailand’s UHC has been foundational in reducing catastrophic health expenditures for Thai households, especially women and children in rural areas, and is seen internationally as a model for public health delivery (World Health Organization).
The U.S. experience also illustrates another trend relevant to Thai readers: when state support ebbs, health disparities widen. In Thailand, with its aging society and increasing cases of non-communicable diseases, a consistent, accessible healthcare safety net is critical. If Medicaid cuts proceed in the U.S., the Centers for Disease Control and Prevention (CDC) warn that the impacts could include increased rates of unintended pregnancies, delayed cancer detection, and more undiagnosed or untreated sexually transmitted infections (STIs).
Historically, when healthcare costs rise or benefits become restricted, economically disadvantaged populations tend to forgo preventive care. In both Thailand and the U.S., such cutbacks strain public hospitals, emergency departments, and social services. Internationally, studies have shown that countries maintaining robust public health insurance see improved outcomes not only in maternal and child health but also in overall life expectancy and economic resilience (The Lancet).
Looking forward, healthcare advocates in the U.S. are organizing to oppose the proposed Medicaid cuts, highlighting that such policy changes run counter to public opinion and health equity goals. For Thai policymakers, researchers, and civil society, these developments offer lessons in maintaining public trust and social cohesion through investment in inclusive healthcare access.
For Thai readers, the actionable takeaway is clear: universal healthcare’s benefits often become visible when threatened. Vigilance, collective advocacy, and policy innovation are essential to preserve access for all, particularly the most vulnerable. This lesson is as relevant in Thailand as it is in any country grappling with the future of public health funding.
Sources: msmagazine.com – Medicaid Cuts Will Raise Costs for Millions of Women, World Health Organization – Thailand’s Universal Health Coverage Success, The Lancet – Universal Health Coverage