Over the first half of the decade, the proportion of women of reproductive age covered by Medicaid increased by one-third, from 9% in 2000 to 12% in 2005. Yet, this increase—of nearly two million women—was matched by an increase in the proportion of reproductive-age women who were uninsured (from 18% in 2000 to 21% in 2005). Both trends were likely driven, in part, by the continuing decline of employer-sponsored health insurance and by the recession that followed the 2000 stock market crash.

In 2005, 7.4 million women aged 15–44 looked to Medicaid (and related public programs, including the State Children's Health Insurance Program) for their health care, including contraceptive services and supplies, prenatal care and delivery services, screening and treatment for sexually transmitted infections, and other vital sexual and reproductive health services. Among women of reproductive age in families with incomes below the federal poverty line, 36% were covered by Medicaid in that same year. Yet, because Medicaid eligibility is severely restricted, and because poor reproductive-age women are unlikely to be offered or able to afford private insurance, 41% were uninsured.

The importance of Medicaid to women of reproductive age varies widely by state, reflecting differences both in states' economic climate and their eligibility criteria for the program. The proportion of reproductive-age women enrolled in Medicaid in 2004–2005 ranged from 6% in New Hampshire to 26% in Maine (see table); Maine covers working parents up to an income level nearly four times as high as the limit in New Hampshire. In eight states and the District of Columbia, at least 15% of such women looked to Medicaid for their care; in 13 states, fewer than 10% were covered under the program. Mirroring in part the same influences, the proportion uninsured ranged from 10% in Minnesota to 32% in Texas.

Decidedly uncertain is whether Medicaid can continue to serve as a levee against the tide of the uninsured. The Deficit Reduction Act of 2006 gave states new flexibility to impose cost-sharing and restrict their package of Medicaid benefits—flexibility that could undermine the program's provision of reproductive health services (related article, Spring 2006, page 2). Another provision of that law, which requires Medicaid recipients who are citizens to provide documentary proof of their status, has the potential to delay or deny care for millions of Americans (related article, page 7). Nevertheless, there are early signs of promise: As the political, economic and social costs of uninsurance become increasingly clear, federal and state policymakers, with Massachusetts leading the way, have renewed debate over ways to counter the problem, either incrementally or through some form of universal coverage.

—Adam Sonfield