Donald Trump and Republicans in Congress are about to seek major cuts in Medicaid to pay for deep cuts to the taxes of the ultra-rich and wealthy corporations.
We often talk, with pride, about our American civilization as a high mark of the West. Yet what makes for civilization?
Human history is full of great and powerful kingdoms and empires led by, and mostly serving the good of, kings, emperors, and monarchs. They weren’t civilized by our standards. The aim of most of those grandees was not to help those they ruled but to take from them to enrich and elevate themselves.
What makes the United States different and truly civilized is that we have attempted to create a government by and for the people, one in which the powerful are constrained by the people to serve the people. And that means everyone, including those who are, in the words of Matthew 25:40, “the least of these brothers and sisters.”
By that standard, one of our most important achievements as a civilization was the creation of Medicare and Medicaid in 1965.
Ensuring everyone could afford health care meant little when doctors and hospitals couldn’t do much. But once the development of greater medical knowledge, techniques, and pharmaceuticals—much of it paid for by the federal government—gave medical care the power to save and extend lives, we recognized that it must be provided to all, not just those who could afford it. Health care is a right—not a privilege.
Medicaid was initially a small program designed to take a small share of our national income to serve those with very low incomes. It was expanded over time to cover a broad spectrum of the American public. And then it was expanded dramatically by the Affordable Care Act, which doubled the number of adults covered by the program by raising the eligibility level from 100% to 138% of the federal poverty level.
Now, more than any other government program, Medicaid helps people who are in trouble, who are suffering, who are in despair, and who desperately need the support of their fellow citizens. Few people receive Medicaid benefits for more than a few years of their lives. But almost two-thirds of Americans will, at one time or another, benefit from it.
In Pennsylvania, Medicaid provides health care for more than two million adults each year. It covers nearly half of all children in our state (1.4 million) and is not only the leading funder of birth control but also pays for more than 40 percent of births.
It is the largest funder of long-term care services for seniors in assisted living residences and nursing homes, covering more than 400,000 people.
It’s the largest funder of mental health services, serving 1.4 million, including 307,000 who need treatment for substance use disorder.
And Medicaid helps everyone indirectly. Few community hospitals in both rural and urban areas could survive without it. And in many states, including Pennsylvania, it partly funds school nurses for all.
While doing all this is costly—the total federal and state cost is $607 billion—it is still only a 2.2% share of our $27 trillion dollar economy. The federal government pays the largest share. In Pennsylvania, Medicaid costs $48 billion of which $31 billion comes from the federal government.
Yet despite the immense benefit of Medicaid, President-Elect Trump and the Republicans in Congress plan major reductions in the program. How much we don’t yet know. But even modest reductions could cost the state $4-$5 billion per year. We hope Pennsylvania and other states would make up for some cutbacks. But no state is capable of making up the whole difference. The result would be a sharp reduction in eligibility and coverage of the program.
Why do Trump and the Republicans want to cut Medicaid? Not because it is inefficient—Medicaid is beyond question the most efficient health insurance in America.
The reason is to pay for an extension and expansion of the Trump tax cuts of 2017, which went disproportionately to ultra-rich Americans and wealthy corporations.
The bottom 20% of families received a tax cut of $70 on average. The middle 20%, $910. But the top 1% received $61,090, on average, and the top .1% received an average cut of $252,300.
And our economy did not benefit much from the 2017 tax cuts. Investment barely increased. Economic and job growth did not grow faster. On average, workers’ wages went up less than $100. The tax cuts most certainly did not pay for themselves but instead led to a loss of revenues on the order of $250 billion per year.
The Trump / GOP tax plan is designed to take a big chunk of that small share of national income that goes to Medicaid and use it to reward the richest and most powerful people in our society. Doing that would undermine the federal program that relieves the most suffering, that helps the most people, and that is our boldest step in creating a civilized society.
The barbarians are at the gates. Medicaid is under attack by wealthy marauders who, if we let them, will enrich themselves by taking from the least among us and undermine our civilization in the process.
