I’ve been listening to Viola Davis’s memoir, Finding Me, and it’s been sitting heavy on my mind. She vividly describes how being both Black and poor isn’t just a struggle—it’s a one-two punch that shaped every aspect of her life. It’s not just about lacking resources; it’s about being trapped in a system that was never designed to let you win.

That message keeps hitting me because I’ve seen it firsthand.

Ten years ago, I had an experience in the ER that permanently changed how I saw Medicaid and the children who rely on it. It was a moment where I thought I could help—only to realize that I was the one who needed to see things differently.

The ER moment that changed how I saw Medicaid

It was one of my first shifts back in the pediatric ER after a decade practicing outside my specialty. I was fresh, still hopeful that more access, more coverage, and more spending could solve the system’s failures. I had a new tool—the electronic health record (EHR)—and I could finally see a patient’s full history in one place.

That’s when I saw it.

A 2-year-old Black boy, healthy, no chronic conditions.

A low-grade fever and cold symptoms—a completely routine case.

His 26th ER visit.

Twenty-six visits. At two years old.

I walked into the room, thinking I could help—not just with tonight’s fever, but with what I assumed was the real problem: a lack of primary care.

“I see he’s been here a lot,” I said gently. “Can I help you find a pediatrician?”

His mother didn’t hesitate. She cut me off before I could go any further.

“Doc, you don’t get it. I work Monday through Friday, 9 to 5. If I don’t go to work, I don’t get paid. If I don’t go to work, I get fired. My child is assigned to a community health center that sees patients Monday through Friday, 9 to 5.”

I had walked in thinking I could “fix” something. Instead, I was the one being educated.

She didn’t want to be in the ER. She didn’t want to take two buses to get there. But she had no other option.

And that’s when I understood—Medicaid wasn’t helping this child. It was trapping him.

Medicaid’s uppercut: More coverage, no better care

Viola Davis’s words keep ringing in my head:

“Being poor is not just a financial state—it’s an all-encompassing fog, a system that keeps you stuck, no matter how hard you fight.”

Medicaid is supposed to be the solution. But for too many Black families, it’s just another part of the fog—a program that promises coverage without actually delivering care.

We keep expanding Medicaid, spending more, and celebrating the numbers—but what if the numbers don’t mean progress?

More spending. More enrollment. No better outcomes.

Medicaid spending has more than doubled over the past two decades.

Black infant mortality is still twice that of white infants.

Black children are still more likely to end up in the ER for preventable conditions like asthma.

Black Medicaid patients still experience longer wait times, fewer referrals, and worse overall health outcomes.

What if more Medicaid coverage isn’t fixing the problem, but just cementing the status quo?

Where does the money go?

In another piece I wrote, Is Medicaid Working for Kids?, I asked a fundamental question: Are we paying for the right things?

Medicaid is now an $800 billion-a-year program. But who actually benefits?

Insurance companies? Yes.

Hospitals and health care corporations? Yes.

Black children on Medicaid? Not nearly enough.

Medicaid is spending more than ever before, but too much of that money is going into hospital systems, insurance profits, and administrative costs—instead of directly improving child health.

We’re paying for:

More hospitalizations and ER visits—but not fewer sick children.

More high-cost services—but not better outcomes.

More Medicaid enrollees—but not more access to pediatricians or family practitioners in underfunded communities.

If Medicaid were truly working, would Black children still be dying at twice the rate of white children? Would a two-year-old need 26 ER visits just to get basic primary care?

But let’s be clear: The solution isn’t just cutting Medicaid—it’s making Medicaid work better. Cutting services without fixing care delivery won’t save money; it will just push more children into hospitals, where care is even more expensive.

We won’t fix Medicaid by more neglect. We won’t fix Medicaid by shifting even more care to emergency rooms. We’ll only fix it by making sure children get the care they need before they end up in crisis.

Medicaid in the South: The highest enrollment, the worst outcomes

In Black Belt: Forgotten and Ignored, I wrote about how Southern states have some of the highest Medicaid enrollment rates—even in states that never expanded Medicaid.

The numbers tell a clear story:

Mississippi didn’t expand Medicaid, yet 55 percent of children there are covered by Medicaid or CHIP.

South Carolina, where Viola Davis grew up, has some of the worst Black infant mortality rates in the country.

The South has been hit hardest by rural hospital closures, making care even harder to access.

This isn’t just an issue of Medicaid expansion—it’s about what Medicaid actually provides once you’re enrolled. And in too many Black communities and poor communities, the answer is not enough.

Time to rethink Medicaid: Invest in health, not just coverage

Instead of spending more, we need to spend smarter—on things that actually improve outcomes.

Pay for healthier kids, not just more medical bills. Reward systems that reduce ER visits and keep children out of crisis care.

Fund primary care over tertiary care. Expand after-hours clinics, telehealth, and community-based urgent care centers so working parents don’t have to choose between work and their child’s health.

Hold Medicaid insurers accountable. If a Medicaid plan isn’t improving child health, is creating more hassles than outcomes, why should it keep getting government dollars?

Make Medicaid work for working parents. Employers and daycares should rethink requiring notes for parents of Medicaid-covered kids. We should think about how we can ensure these kids can get well-child visits and sick visits.

Medicaid reform shouldn’t mean fewer services—it should mean better services. We’re already spending over $800 billion a year, yet we’re still failing Black children. If we focus on keeping kids healthy before they get sick, we won’t just improve lives—we’ll save money in the long run.

Final thought: Medicaid shouldn’t be another punch

Viola Davis describes poverty as a fight you can never seem to win—a system that knocks you down again every time you try to get up.

Medicaid was supposed to be a way up. Instead, for too many Black children, it’s just the next punch in the fight.

Because what good is an insurance card if you still have nowhere to go? What good is more spending if Black children are still getting sicker, still dying younger, still trapped in a cycle that was never built to serve them?

Medicaid isn’t the solution. It’s the illusion of one.

And until we stop paying for more of the same failures—and start demanding that Medicaid actually improves health outcomes—Black children will keep getting hit.

They deserve more than just coverage. They deserve care.

Mick Connors is a pediatric emergency physician.