EI Series_Month 6_9.29.25

Month 6: The War on Poverty Who Benefited and Who Was Left Behind? In January 1964, President Lyndon B. Johnson declared an “unconditional war on poverty” in his State of the Union Address, framing poverty as not only an economic challenge but also a moral one. The subsequent rollout of Great Society Programs represented one of the most ambitious attempts in American history to reduce poverty and expand opportunity. These initiatives touched nearly every part of social life—healthcare, education, urban and rural development—and continue to influence policy today. Yet the War on Poverty raises a persistent question: who truly benefited, and who was left behind? This paper examines the impact of the Great Society across two key areas: healthcare access through Medicaid and early education through Head Start. While these programs transformed the lives of millions, gaps in implementation and long-term outcomes reveal the uneven legacy of Johnson’s vision. The expansion of Medicaid and the ongoing gaps in healthcare access Medicaid was established through the Social Security Act of 1965 as part of the Great Society, with the intention of providing health coverage to low-income and vulnerable populations. Over time, its expansion, especially under the Affordable Care Act (ACA), further extended coverage. Yet gaps remain in access, enrollment, and outcomes. According to a KFF report, by 2024, 44 million people were enrolled in ACA‐related coverage, including 21.3 million who gained coverage through Medicaid expansion. States that expanded Medicaid saw significant improvements in insurance coverage, access to regular sources of care, and fewer delays in treatment due to cost. Recent studies have also shown measurable health impacts, estimating that Medicaid expansions saved tens of thousands of lives between 2010 and 2022, reducing mortality risk by approximately 2.5% overall among those who gained coverage. In the states that have not adopted Medicaid expansion under the ACA, among them Texas, Tennessee, Georgia, South Carolina and Florida, roughly 1.5 million adults remain uninsured despite having incomes that fall below the poverty line, reinforcing the coverage gap. This is due to ineligibility under state rules, which disqualify individuals from both Medicaid and subsidies in the health insurance marketplaces. Rural residents face additional barriers even when eligible, as they are less likely to take up Medicaid or other coverage, have access to fewer healthcare providers, longer travel distances, and lower awareness. A 2025 study found that rural residents had lower enrollment than their urban counterparts, and that the gap widened in some respects