Medicaid Is Not a Top Campaign Issue. But for These Voters, It’s Crucial.

It has barely been mentioned on the presidential campaign trail, but few government programs are more entwined in the lives of Americans than Medicaid. The program, whose costs are shared by the federal government and states, provides largely free health insurance to 73 million people — roughly 1 in 5 Americans — many of whom are pregnant, disabled, elderly or chronically ill. Most have limited income.

Enrollment has soared in the decade since states were given the option of expanding Medicaid under the Affordable Care Act to cover adults without young children. It is the among the largest programs in the federal budget, costing more than $600 billion a year.

Presidential elections inevitably bring questions about the future of such a sweeping program, especially if the candidates are pitching costly policies of their own. Former President Donald J. Trump has promised to protect Medicare and Social Security, while also expressing support for a wide variety of tax cuts. Some health policy experts believe that Medicaid would be in the cross hairs as a result.

In his first term, Mr. Trump sought to repeal the Affordable Care Act, including its Medicaid expansion. He encouraged states to require some enrollees to work. And he proposed overhauling how Medicaid is paid for, in a way that would have substantially squeezed it.

Project 2025 — a compilation of proposals written by the conservative Heritage Foundation as a policy agenda for the next Republican administration — calls for work requirements, spending caps, and time limits or lifetime caps on Medicaid benefits. Mr. Trump has repeatedly distanced himself from the plan, but many of its authors, including the one who wrote its health care proposals, served in his first administration.

Danielle Alvarez, a senior adviser for the Trump campaign, said in a statement that only Mr. Trump and his campaign — “not any other organization” — can speak to plans for a second term. Asked whether Mr. Trump would pursue changes to Medicaid, the campaign provided a list of broad goals related to health care, such as, “Restore the health care safety net by eliminating waste and fraud and refocusing taxpayer dollars on those most in need.”

Vice President Kamala Harris would likely maintain the status quo with Medicaid. In particular, Ms. Harris has promoted a new option that states can adopt, allowing all women who have Medicaid during their pregnancies to keep it for a year after they give birth.

Asked about her plans for Medicaid, a campaign spokeswoman pointed to comments Ms. Harris made at a recent event in Las Vegas: “I firmly and deeply believe that access to health care is a right and should be a right, and not just a privilege of those who can afford it.”

Polls have consistently found Medicaid to have strong bipartisan support from voters, many of whom have personal experience with the program either for their own care or that of a family member. Still, many people may not know the full scope of its reach.

Here are the stories of five Americans and the role Medicaid plays in their lives.