During his campaign, Donald Trump told his supporters how much he would do for them regarding the economy and inflation, ending wars, creating a better health care system, and making America a “better place” by getting rid of immigrants and restoring the values of white Christian nationalism. No, he would not destroy Social Security or Medicare–just make them better. No worries.
We now know the truth about Trump’s promises. To quote Public Citizen, “Whatever can be said about any other person who has held the office — good or bad — no other president has actively initiated a full-scale dismantling of the federal government they lead. No other president so flagrantly, so recklessly, so spitefully operated as if he were a dictator or a king.” If Trump and Musk’s destructive actions are not halted by the courts, the suffering of all but the very rich will be terrible. MAGA devotees are likely to suffer the most as the economy sours and programs for the poor and the middle class are decimated.
Signed into law by President Lyndon Johnson in 1965, Medicaid is probably the least understood of major social safety net programs. Many people believe it “coddles the undeserving poor.” Its popularity, however, has grown along with that of the Affordable Care Act. In partnership with the states, Medicaid provides comprehensive health coverage and long-term care for 83 million low-income families, seniors, and veterans. Coverage includes essential medical services and 24/7 access to hospital care. (Kaiser Family Foundation, KFF)
In Pennsylvania, Medicaid insures over 3 million (1 in 4) people. It covers almost half of all children and one-third of all births in Pennsylvania. Three in 10 Medicaid recipients are seniors, pregnant women, and people with disabilities. The remainder are low-income working families. (PHAN, Pennsylvania Health Access Network)
Medicaid also provides funds for school programs and services for children with disabilities such as autism, speech impairments, and intellectual disabilities. It is a primary funder for nursing homes, home and community-based services for the elderly, mental health and substance use disorder treatment centers, and rural hospitals. Medicaid helps rural hospitals by ensuring patients can pay for their care. Rural hospitals in Medicaid expansion states are 62% less likely to close. (PHAN)
Unless you have invested in an increasingly expensive Long-Term Care policy and you need such care, you could be in financial trouble. If you are on Medicare, it will pay for long-term care only if you require “skilled” services, meaning a short stay in a skilled nursing facility or hospice care. After 100 days, Medicare stops paying anything. If you are not yet on Medicaid, you must draw down most of your income and other financial assets to be eligible for its coverage. In Pennsylvania, the average monthly costs of a semi-private room in a nursing home is close to $11,000, and a private room, $12,000. Most long-term care involves relatively low-cost, non-skilled assistance (help with eating, moving around, bathing, etc.). Not surprisingly, people with disabilities comprise the majority of people who use Medicaid for long-term care.
Nationally, Medicaid accounts for one-fifth of all healthcare spending, more than half of spending for long-term care for seniors and severely disabled people, and a large share of state budgets (KFF). States and the federal government share the costs, which totaled $880 billion in 2024.
According to a document Politico made public in January, House Republicans were considering federal deficit reductions of $5.5 trillion over ten years. This includes $2.3 trillion in cuts from Medicaid during this period. Below are proposals so far to accomplish this and their likely impacts (KFF and Center for Budget Priorities)
Block grants: Each state would be given a lump sum regardless of how many people are signed up for the program. As more families enroll, states would have to increase their own spending on Medicaid or restrict who gets it. Ending the federal match for states would likely result in loss of coverage for 20 million people.
Capping per enrollee spending: Proposed cuts of $532 billion to nearly $1 trillion over 10 years would harm millions of people as the costs and financial risks are shifted to the states. Depending on how states respond, as many as 15 million people would lose Medicaid by 2034.
Work requirements and work “reporting:” Nationally, an estimated 36 million people, most of them unable to work due to disabilities, would no longer have health coverage.
To suggest that massive cuts to federal programs that help the middle class and more vulnerable Americans are necessary to eliminate waste and abuse is smoke and mirrors. The real purpose is to extend the 2017 Trump tax cuts for millionaires and billionaires. Now I ask you, “Is this right or fair?”
Jeanne Duffy, Ph.D., has served as a college professor, an analyst and project manager for several large companies, and a college administrator in charge of foundation and government support. She is on the Steering Committee of Gettysburg Democracy for America and a member of its Government Accountability and Healthcare task forces.
Thank you, Jean, for your informative article. The old myths about “Welfare Queens” are just that, myths. People who have the idea that Medicaid enables people to not to work do not understand disabilities, poverty incomes, and trying to raise children alone. Instead of joining the bandwagon of what our barber says, we need to use our skills of reading, fact checking, and critical thinking before we make judgements of those less fortunate than ourselves.