The story of Medicaid and its role in the United States cannot be told without addressing its profound impact on the health and well-being of families. As the largest health insurer in the country, Medicaid provides coverage to over 77 million people, including two in every five children. Despite its foundational importance, Medicaid is often misunderstood and undervalued, and looming cuts threaten to unravel the safety net it provides. These cuts risk devastating ripple effects, not just on healthcare access, but on housing, hunger and the overall stability of families.
I spoke with Stephanie Ettinger de Cuba, executive director of the nonpartisan network of children’s health experts Children’s HealthWatch, about her decades of work on social determinants of health, the challenges posed by Medicaid cuts, and the power of storytelling and data collection in advocating for a human-centered safety net.
Devon Gray: You’ve spent decades working on social determinants of health for children and families. What first drew you to this work, and how has it shaped your perspective on Medicaid and other basic needs assistance?
Stephanie Ettinger de Cuba: Honestly, I sort of fell backward into this work. I always knew I was interested in health, nutrition, kids, languages and culture, but I never knew quite how to put that together.
When I was in the Peace Corps in Bolivia, I had the opportunity to work with a doctor running an inpatient ward for children with severe malnutrition. He was frustrated because the same families were returning, so he wanted to design an educational support program. A lot of the mothers weren’t literate, so it had to be very culturally appropriate and pictorial. We ended up creating a telenovela with a theater group, weaving in nutrition and hygiene messages. That was the moment I realized, “Oh, there’s a way to put all these threads together.”
That experience galvanized me to study public health. I ended up doing domestic policy work, getting really deep into Supplemental Nutrition Assistance Program (SNAP) outreach and policy, which launched me into this whole world. At Children’s HealthWatch, I’ve been able to bring these passions together to make a difference for young kids and their families.
What has kept me in this work is that all these things are interconnected, yet we address them in silos. Our job is to make those connections plain. This is what comes through with Medicaid. People talk about it as if it’s separate from everything else in people’s lives, but healthcare is so incredibly fundamental. How can you possibly think it’s not related to your ability to work, have stable housing or put food on the table? They’re all the same thing. It’s one budget in a family.