Conservatives have sought to end Social Security, Medicare, and Medicaid from the moment the programs were signed into law. The enemies of these three programs have been persistent. The efforts feel like a relentless game of whack-a-mole: the American people whack one effort, and another immediately pops up.
The whack-a-mole phenomenon is on full display for those paying close attention. It is no secret that Republicans are determined to repeal and replace Obamacare. What has been less widely reported is that they are using that effort as a cover to also repeal and replace Lyndon Johnson-care (i.e., Medicare and Medicaid).
Just two days after the 2016 election, which handed control of the White House and Congress to the Republicans, Speaker Paul Ryan could not hide his eagerness. He dishonestly tied Johnsoncare to Obamacare, fraudulently claiming, “You have to deal with [Medicare and Medicaid] if you are going to repeal and replace Obamacare.”
Trumpcare is a massive transfer of wealth to millionaires and billionaires at the expense of the health of the rest of us. There is a reason that Senator Elizabeth Warren describes the bill as blood money. But it is more than blood money, transferring wealth, in reverse Robin Hood fashion, to those at the top. It is also the opening salvo in an effort to starve Medicare of needed revenue. Billions of dollars of the Trumpcare blood money are raided from Medicare.
On that same Fox interview, Ryan falsely stated that, “because of Obamacare, Medicare is going broke.” The reality is that Medicare is not “going broke,” and Obamacare strengthened Medicare’s finances. Nevertheless, it is not hard to see the Trumpcare game plan: rob Medicare of needed revenue and then argue that fundamental change is needed because Medicare is “going broke.”
The Republican plan to repeal and replace Medicare appears to be unfolding in stages. The Trumpcare assault on the other part of Johnsoncare —Medicaid — is to demolish the fifty-two-year-old institution in one devastating blow.
Much has been reported about Trumpcare’s rollback of the Medicaid expansions contained in the Affordable Care Act. But what has been largely unreported is that Medicaid is not just rolled back; it is fundamentally changed in a way that ends it as we know it.
Medicaid provides comprehensive health and long-term care insurance to those who meet objective criteria. It is immaterial how many people meet those criteria. Everyone who does receives comprehensive coverage. If Trumpcare were enacted, this would no longer be the case.
Under Johnsoncare’s Medicaid, individuals are guaranteed that their doctor’s appointments, hospital visits, nursing home stays, and other insurance-covered expenses will be paid as a matter of right. The more people in a state who qualify for Medicaid, the more the federal government provides. In contrast, under Trumpcare, every state would simply be given a specific, capped amount of money to spend. If the amount is insufficient, too bad for those Americans left out in the cold.
That is a fundamental difference, one that will leave the poorest among us with substantially less economic security. And, the impact is not merely speculative. We have an example of the same transformation in another program long-hated by Republicans.
Aid to Families with Dependent Children (“AFDC”) was enacted as part of the Social Security Act of 1935. Like Medicaid, it guaranteed that the lowest-income families that met objective criteria received benefits, no matter how many people met those criteria. From the time AFDC was debated in Congress, conservatives hated the independence and security it provided. They demonized the families that received the benefits and claimed, in Orwellian logic, that they were really seeking to help the desperately poor families. They conjured bogeyman images of a supposedly widespread “culture of dependency,” from which they were “rescuing” those whom their repeal efforts in reality harmed.
The callous opponents of AFDC persisted, and after decades of effort, they finally succeeded in 1996. AFDC was replaced with Temporary Assistance for Needy Families (“TANF”). After sixty years of AFDC and twenty years of TANF, the damage is clear.
AFDC was inadequate, but TANF is much worse: Out of every 100 families with children in poverty in 1996, 68 received AFDC benefits; In 2015, only 23 received TANF — and those benefits were of limited duration with onerous requirements attached. The number of children living in extreme poverty doubled between the end of AFDC in 1996 and today. And unlike AFDC, where caseloads naturally increased during downturns in the economy, TANF caseloads did not increase at all, during the first seven months of the recent Great Recession. At the end of the Great Recession, in 2011, when the unemployment rate was at 8.5 percent, nearly one-third of states had fewer families receiving TANF than at the start of the Recession.
That is what is in store for seniors in nursing homes, poor children, and others covered under Medicaid, if Trumpcare becomes law. Just as TANF ended AFDC, Trumpcare would end Medicaid as we know it. The result would be millions with inadequate health insurance, and millions more with no insurance protection whatsoever. In addition, Trumpcare would fire the opening legislative salvo in the quest to end the other part of Johnsoncare, Medicare.
Trumpcare is like a zombie in a horror movie, continually coming back from the dead. The American people, who overwhelmingly oppose it, have, so far at least, continued to kill it again and again. But like a nightmare game of whack-a-mole, when one effort to end Medicaid, Medicare, and/or Social Security is knocked down, it pops up somewhere else.
The day after Senators Jerry Moran and Mike Lee put the proverbial stake in the heart of Trumpcare by announcing they would vote against a motion to proceed, House Republicans released a budget plan going after Social Security, Medicare, and Medicaid. And, a day after that, Trumpcare has returned to life, at least temporarily. You can be sure that when those moles are hammered down, the effort to end these vital programs will pop up somewhere else.
The mantra of the Resistance is Resist, Persist. And we must. No matter how many times we win, no matter how many times we whack that mole, the other side persists. Indeed, they have been persisting for decades. With control of all branches of government, they once more believe victory is close.
Fortunately, the American people overwhelmingly are with those of us fighting to defend and expand Social Security, Medicare, and Medicaid. The effort is neither a sprint nor a marathon. It is a relay. The baton has been handed to us from prior generations of Americans. If we persist, we eventually will be in a position, as those prior generations were, to pay it forward and expand Social Security, Medicare, and Medicaid. The facts, the American people, policy, politics, and time are all on our side. It is a battle not only worth fighting for. It is one we must win.