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Major Medicaid cuts to address the increasing federal deficit are misdirected

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Words are weapons in the Trump administration’s “War on Poverty, 2018,” a term recently coined by Sara Rosenbaum, a professor at the George Washington University Milken Institute School of Public Health. The original War on Poverty, announced by President Lyndon Johnson in 1964, included a number of programs designed to “not only to relieve the symptom of poverty, but to cure it and, above all, to prevent it.” Medicaid and Medicare are the crown jewels of Johnson’s War on Poverty.

The Trump War on Poverty 2018 is misnamed as “A Brighter American Future.” Rather than painting a picture of a brighter future for poor people, the Republican budget proposal makes a dim picture dimmer. It signals a switch in the War on Poverty from one that addresses the root causes of poverty and provides assistance to poor people to one attacking poor people with words and a million cuts.

{mosads}The U.S. Census Bureau reported 40.6 million Americans or 12.7 percent lived in poverty in 2016. The south has the highest rate of poverty at 14.1 percent and rates are highest in rural areas. A May 2018 report by Save the Children also demonstrates how hard poverty hits children, particularly those in rural areas (23.5 percent). Five states in the U.S., all but one in the southeast, have rural child poverty rates at or above 33 percent.


The attack on Medicaid by President Trump is an example of how words are being used to justify significant cuts to needed benefits. Criticizing Medicaid as a welfare program gone amok illustrates how words have been weaponized, focusing on negative connotations. Welfare generally refers to means-tested cash benefits such as food stamps, housing assistance, and Supplemental Security Income (SSI) and is meant to be short-term. Medicaid is not a classic welfare program and it provides higher value than Medicare or private insurance.

Medicaid has changed dramatically since the program started in 1965. Medicaid enrollment has grown 28.8 percent since the start of the Affordable Care Act. Medicaid expansion has been the major driver of growth.

Today, 34 states have expanded Medicaid and 74.2 million Americans receive Medicaid. Nearly 8 in 10 adult Medicaid beneficiaries live in a working family and 60 percent are working themselves. Medicaid is the primary source of coverage for people needing long-term services and people with disabilities.

The 2019 Trump budget proposal calls for $5.4 trillion in cuts over the upcoming decade, including $1.5 trillion in cuts from Medicaid. The cuts will be achieved by turning Medicaid into a block grant program, slashing federal payments for traditional Medicaid, and the elimination of federal payments for Medicaid expansion.

The Trump budget proposal has been presented as a much needed response to the ballooning national deficit and debt. This is incongruent given that the president’s 2017 new tax law will significantly exacerbate debt and the deficit. The budget proposals attack on Medicaid will benefit the richest Americans while further burdening poor Americans.

Being uninsured has serious consequences. The value of having Medicaid coverage versus being uninsured has been demonstrated in a plethora of studies. When adjustments are made to account for the sickness level and complexity of Medicaid patients, numerous analyses have shown lower per enrollee costs for Medicaid than Medicare or private insurance.

Spending on entitlement programs, including Medicaid, must be checked. How we do this divides Americans. Suggesting major cuts to Medicaid to address the burgeoning federal deficit is misdirected. Poverty and the far-reaching consequences of poverty are a cancer in America. As a country we cannot thrive by further marginalizing poor people, ignoring the importance of healthcare, and building a larger in income gap between Americans richest and poorest citizens. Stop the war and words and death by a million cuts.

Carole R. Myers, R.N., is a senior fellow with the George Washington University Center for Health Policy and Media Engagement and an associate professor at the University of Tennessee College of Nursing and Department of Public Health.

Tags Donald Trump Health care Medicaid

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