As a Medicaid advocate for almost two decades, I’ve done a lot of writing and other agitating about the uninsured and the importance of Medicaid and the Children’s Health Insurance Program (CHIP) for the poorest kids in our country. Over the years, my colleagues and I have worked hard to raise awareness about Medicaid and CHIP to be sure that all kids are able to get the medical care they need be healthy, like routine check-ups and vaccines, care for ear-infections, asthma, allergies, stitches, and broken arms, as well as care for special needs kids and those experiencing serious illnesses. We like to think lots of people were paying attention but we know the reality – very few were hearing our message.

Like everyone else, the Supreme Court’s decision on the Affordable Care Act came as a surprise. I am certainly concerned about the ruling’s impact on the very poorest and most uninsured segment of our population (a blog for another day), but with Medicaid now in the daily headlines, this is a good time to try again to get the word out about how important Medicaid is for kids. For starters, did you know that in 2011, 45 percent of all kids in America – 35.3 million – relied on Medicaid or CHIP for their health insurance? While this is a shockingly large portion of the child population, it shouldn’t come as a surprise given that nearly 25 percent of kids in America live in poverty. I regret the Court’s decision but now that people are talking about Medicaid I wanted to share the facts about Medicaid, how it works, who it covers, and why it is essential for kids.

Here is what every American needs to know:

Medicaid is Designed to Help People When Times are Tough – That’s the Point. Medicaid serves an essential role in our health care system because it ensures that our nation’s poorest and most vulnerable citizens, primarily children and the elderly, are able to get care when they need it most. Medicaid is an income-based program so when the economy is weak and people lose their jobs (and their health insurance) those with the greatest needs (children, the elderly, those who are disabled or with serious illnesses) are not left out in the cold. Medicaid enrollment is countercyclical so when the economy sours more people rely on Medicaid for their coverage. While this increases costs temporarily, it helps vulnerable people stay healthy and able to attend school and work.

Medicaid Protects the Health of a lot of Americans, Mostly Kids. Medicaid and CHIP are the source of coverage for nearly half (45 percent) of our nation’s children. It is the single largest insurer of children. Medicaid makes sure that kids have access to medical care from well-child visits to care for chronic and serious illnesses, eyeglasses and hearing aids to wheel chairs and dental care. Medicaid also pays for care for 70 percent of all nursing home residents. Without this source of coverage the very poorest and most vulnerable people in our country would be uninsured.

Right now Medicaid is Not Available to All Who Are Uninsured. Despite the high rates of uninsured Americans, not everyone who is uninsured is eligible for Medicaid. Medicaid covers certain populations of Americans – children and pregnant women, the most impoverished elderly, the disabled, and those with serious chronic disease. To give you a sense of the income threshold below which one may qualify for Medicaid, in 2008 Medicaid covered only 45 percent of all poor Americans who lived below the poverty line (those with annual incomes below $22,025 for a family of four). Non-elderly adults without dependent children, no matter how poor they are generally ineligible for Medicaid unless they are pregnant or disabled. The Affordable Care Act included a requirement for states to expand eligibility to all who are poor with incomes below 138 percent of poverty but the Supreme Court’s June 28th decision means that states instead have the option to expand eligibility to this population.

Medicaid Saves Lives and Money in the Long Run. It is not only the right thing to do to provide care for the poor, the fact of the matter is that without Medicaid our health care system would be much more expensive. Those with modest means would still get sick, but they would likely delay care until they were sicker and would seek care through the emergency room where treatment is much more expensive. When patients are uninsured, the hospitals that have to foot the bill ultimately pass these costs onto the rest of us. Medicaid mitigates the impact of uncompensated care and, more importantly, it allows access to preventive care before people get sick. Medicaid also plays a big role in making sure that care is available during public health crises, natural disasters, 9/11 types of events, and it prevents overcrowding in emergency rooms so that the trauma system works effectively.

While I regret the recent circumstance that initiated this dialogue, I am glad people are talking about Medicaid. For 46 years, Medicaid has been enormously successful in protecting the health of the poor, especially poor children, making sure that Americans don’t go without medical care because of cost. The fact of the matter is most families are one illness or accident away from financial catastrophe. With health insurance and out-of-pocket medical costs continuing to skyrocket, every parent can imagine the urgency they would feel if someone in their family needed to go to the doctor but couldn’t afford it. And, most people can understand how important the Medicaid safety net would be if they had a special needs child or seriously-ill family member. I have to believe that the more people know about Medicaid the more they will understand how important it is to protect it and keep it strong.

For more information about Medicaid please see a First Focus report from last summer that highlights these facts and Medicaid’s other successes in addressing the health and financial needs of those who are most vulnerable.