If you know Timothy McBride, you know how much he cares about Medicaid, a federal and state program that helps cover medical costs for people with limited incomes.
McBride, MS, PhD, the Bernard Becker Professor of Public Health at the School of Public Health at Washington University in St. Louis, was involved in the successful effort to pass Medicaid expansion in Missouri in 2020. He and fellow health economist Abigail Barker, MA, PhD, a research associate professor at WashU Public Health, wrote a fiscal analysis that showed Medicaid expansion would be largely revenue-neutral and might even save Missouri money, meaning it could be implemented without a tax increase.
When Missouri voters in August 2020 approved Amendment 2 — a ballot initiative to amend the state constitution to expand Medicaid under the Affordable Care Act — it represented a victory for evidence-based health policy.
Not five years later, that hard-won victory came under threat when President Donald Trump signed into law on July 4 legislation that is expected to cut $1.02 trillion from Medicaid nationally over the next decade.
“I can tell you that when the Medicaid expansion initiative passed in 2020 and the Missouri Supreme Court later affirmed the voter initiative, I cried,” McBride said. “I had been working on this for so long; I had started working on Medicaid expansion in 2005, literally 15 years before it got through the ballot. It was a passion, a real labor of love.
“When I was appointed to Missouri’s Medicaid (MO HealthNet) Oversight Committee, I was put into the ‘consumer seat,’ to represent the consumer. I always view it that way.”
McBride continues to monitor the effects of Medicaid expansion through his role as co-director of the Center for Advancing Health Services, Policy & Economics Research (CAHSPER) at WashU, where he heads the Rural Health Policy Lab. His data reveal that Missouri’s expansion exceeded all expectations, with enrollment reaching record highs. More people on Medicaid meant emergency departments saw fewer uninsured patients and more Medicaid-covered patients. Hospitals provided less uncompensated care, which improved the hospitals’ bottom lines. It also means, importantly, that recipients face lower out-of-pocket costs.
In contrast, the looming cuts to Medicaid mean that rural hospitals that depend heavily on Medicaid revenue now face potential closure.
While McBride and his team navigate the current moment in American health care, he has not lost his commitment to the cause.
“This work is personal to me,” McBride said. “I care deeply about people who rely on Medicaid or lack insurance, and I see it as a privilege to use my role as a professor and, formerly, dean to be their voice. That’s what gets me up in the morning.”
McBride talks here about his work and his thoughts on the university’s newly launched School of Public Health.
Q: What makes health-care systems and infrastructure your passion?
“I’m a health economist by training. I spent the first part of my career focused on economics more broadly, but I was drawn into health policy almost 30 years ago while working at the Urban Institute — and I’ve stayed with it ever since. I teach health economics now, and one thing I always emphasize is how unusual our health-care markets are compared to others — like food, energy or technology. From an economist’s perspective, the health market is deeply dysfunctional in ways that would take hours to unpack.
“These market failures are part of why we need programs like Medicare, Medicaid and public health infrastructure. We don’t talk about ‘public’ in the context of computers or consumer goods, but we do in health, because people see health care as a right, and because the market itself doesn’t function like others. The U.S. has the most expensive health-care system in the world, approaching 20% of GDP. Understanding how we finance that system, and how we can create better incentives within it, is the core of my work.”
Q: You’ve dedicated decades to Medicaid policy. What keeps you motivated through the ups and downs?
“This gets a little deeper, but my passion for social justice really comes from my mother. She was a political reporter at the White House in the 1960s — covering Kennedy, Johnson, and Nixon — while raising seven kids. She had been vice chair of the Democratic Party in Wisconsin and was deeply committed to equity. She helped integrate her suburb, helping the suburb’s first Black family move in; got women into the Milwaukee Press Club for the first time; and taught us to care about people who needed help. That was instilled in all of us.
“So, when I think about why I do what I do, it goes back to that. I care about social justice, but I also care about making good public policy. If you want to help people access medical care, Social Security, or disability benefits, you have to ask: What’s the best way to do that? To me, that means evidence-based policy. When I came to WashU and met people like Ross (Brownson) and Debra (Haire-Joshu), I saw that same passion. My role is to help policymakers understand the best options. They may not adopt them — but at least we can make sure they know what’s possible.”
Q: How do you feel about the new School of Public Health, its launch and the direction it is taking?
“First, it’s important to recognize that this is the first new school at WashU in 100 years — a major commitment. The trustees, the chancellor and university leadership saw this as an opportune moment to launch a school focused on public health.
“I was part of the original group that came to WashU 15 years ago to create the Master of Public Health program at the Brown School. I served as the first associate dean, and in just four years, faster than what is typical, we earned accreditation and quickly rose into the top 20 public health programs.
“We had both the challenge and the opportunity to build something from scratch, and we chose to focus on transdisciplinary public health. That means tackling complex issues like obesity, diabetes or cancer, not just from a public health lens, but by integrating insights from economics, demography, sociology, biology, medicine and social work.
“Our new dean, Sandro Galea, is deeply committed to transdisciplinary public health. These problems are too complex to be solved by one discipline alone. We need team science, with diverse skill sets working together to build better health systems and financing models. That’s been our foundation, and we’re ready to expand it further.”
Q: What would you like to see included in the school’s focus?
“Long term, I’m concerned with the sustainability of our broader safety net: Medicare, Medicaid and Social Security. My dissertation focused on Social Security and the baby boom generation, and I’ve returned to that work periodically. With 70 million baby boomers aging into retirement, the elderly population is set to double between 2000 and 2035. That presents major challenges for how we finance these programs. Social Security, for example, is projected to face a shortfall in about six years. The 1983 amendments to Social Security have held for over 40 years, which is remarkable for any government program. But it’s time for adjustments.
“I don’t claim to have all the answers, but these are the kinds of problems I hope our school will help tackle, both through research and by training the next generation of public health leaders.”
Q: What advice do you have for students applying to a master of public health (MPH) program?
“When I was associate dean, I always told students: Find the best professors and take their courses, regardless of the subject. Even if it’s not your favorite topic, the opportunity to learn from someone exceptional can be life-changing. At WashU, our program is still relatively small and accessible, which means you can actually take courses with many of the top faculty.
“I also encourage students to take full advantage of our transdisciplinary approach to public health. Our courses are built around timely, community-relevant issues. We don’t teach theory in a vacuum, we focus on problems that matter here and now, especially in St. Louis. This region offers a microcosm of some of the biggest challenges in public health: deep disparities, persistent poverty, and immense wealth, all alongside a world-class medical school. That contrast creates a unique learning environment. So my advice is: Engage deeply, not just with your faculty and peers, but with the community around you.”
Hayley Abshear is the School of Public Health’s digital content strategist and social media coordinator. She holds a bachelor’s degree in journalism from Webster University and was previously a freelance writer for national publications and a content creator at a PR firm. She brings almost a decade of experience in writing, content strategy and social media marketing to the team.