In Defense of Medicaid

Soon after taking office in January, Trump created a Department of Government Efficiency (DOGE) to get rid of "waste and fraud" in all government agencies. Trump's partner Elon Musk, richest man in the world, was assigned to head DOGE. Musk almost immediately began to "slash and burn" government agencies, intimidating and firing thousands of career civil servants. Contrary to Trump's frequent promises not to cut it, Social Security was another early target. Medicare and Medicaid are on the chopping block as well. In this article, I focus on Medicaid, the largest single source of health coverage in the U.S. and probably the least understood.

Medicaid is among federally funded programs that many people believe coddle the "undeserving poor." Its popularity, however, has grown along with that of the Affordable Care Act (ACA). 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 (or 1 in 4) people. Almost half of all children and one third of all births in Pennsylvania are covered by Medicaid. 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) 

In addition to healthcare coverage for individuals and families, Medicaid provides funds for school programs and services for children with disabilities such as autism, speech impairments, and intellectual disabilities. Medicaid 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 percent less likely to close. (PHAN)

Unless you have invested thousands of dollars 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 in order 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 the 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 needy 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 cutbacks 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 of these massive program cuts is to be able 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, writer, and project manager for several corporations, and a college administrator. She is a member of Gettysburg Democracy for America's Steering Committee and its healthcare task force. This article first appeared in the Gettysburg Times on March 20, 2025.