Medicare and Medicaid, two cornerstone programs of America’s healthcare system, just celebrated their 60th anniversary. Established in 1965, they have grown to insure more than 68 million seniors and 71 million low-income, elderly, and disabled adults. This milestone comes against a daunting backdrop. We believe these historic cuts to Medicaid now threaten that healthcare fabric for millions.
These programs started at a time of expansion under the Obama administration. In 2010, that time was characterized by the passage of the Affordable Care Act (ACA). This legislation had a tremendous impact on the reach of Medicaid. Now, it offers insurance for working-age single adults, deepening its roots beyond its historic pregnant women and family niche. President Donald Trump’s presidency started with a bang in 2017 by trying to repeal Obamacare. This move had the potential to strip nearly 15 million Americans of insurance coverage. The continued fight over these programs reveals an ideological war lurking just beneath the surface. This war on enforcement has raged in American politics for almost a decade.
The Foundation of Medicaid Expansion
The ACA was a crowning achievement for healthcare access in our nation, and for the administration. Under President Obama, Medicaid expanded to cover millions more Americans, ensuring that those who were previously uninsured could receive necessary medical care. This expansion was transformative for low-income people and families. It was a truly revolutionary moment in the way we thought about and provided health coverage.
In 2025, a nationwide economic study confirmed the strong economic effect of this expansion. The study provided powerful evidence that expanding Medicaid to millions more Americans probably saved more than 27,000 lives. This new piece of evidence goes far deeper in showing how integral Medicaid is as a true safety net and indeed a lifesaving program for millions.
Regardless of its widely praised successes, the program has been under a near-constant assault by conservative-led lawmakers. Cutting Medicaid has been a holy grail of Republican politics for decades. This move away from direct benefits started back in the Reagan administration with proposals to convert the program from an “entitlement” to a limited “block grant” system for states. While this shift helped to control costs, it threatened to cut many at-risk Americans off from crucial health care services.
The Coming Cuts and Their Impact
In fact, that Republican budget law Donald Trump just signed will eliminate $1 trillion from Medicaid beginning in 2026. This step is just the latest in a series of budgetary moves. These cuts represent the biggest cuts in the program’s nearly 70-year history. They have the potential to spell disaster for rural hospitals and low-income rural patients. Here’s what Paul Starr, a prominent healthcare scholar and former Clinton administration official, had to say about the cuts and what they portend.
“The cuts to Medicaid are out of step with reality,” – Paul Starr
These cuts will hurt individual beneficiaries in a big way. In addition, they threaten to wreak havoc on healthcare infrastructure, particularly in the nation’s most underserved communities. The policy changes in rural hospitals won’t begin to see their impact until about 2026. So, Republicans would be slapped with extremely negative press from constituents who rely on these facilities for their care.
Historically, Medicaid has served as a key safety net for people who might not otherwise be able to afford care. For the low-income people all around that can only afford to work at minimum wage jobs, healthcare is still out of reach. Starr emphasized this point, stating:
“A lot of people do work at the minimum wage, millions of people, and they’re still poor.” – Paul Starr
It’s no surprise that minimum-wage jobs rarely offer healthcare benefits. This dire prospect invites serious ethical consideration of the direction of American healthcare policy, where people might suffer the miserable fate of “just dying when they get sick.”
The Politics of Healthcare Reform
The current political discourse about healthcare has undeniably been marked by strong divides. For the past nine years, repealing Obamacare was a top priority for Republicans, finally leading to Trump’s repeal efforts during his presidency. Courts have struck down several Medicaid pilots designed to implement work requirements and other restrictions that could limit coverage. These pilots have now become an integral part of the One Big Beautiful Bill Act, Trump’s signature spending plan.
The rhetoric with which these Medicaid cuts have been framed has been loud and overwhelming. Critics have been quick to point out that these preventative measures are motivated more by political ideology than public health. Critics point out that decades of racial segregation within healthcare systems continue to have lasting impacts on access and equity. Starr pointed out:
“Hospitals were segregated and Black people did not have access to mainstream hospital care in many places.” – Paul Starr
Having the historical context in mind when looking at these disparities underlines the struggles that historically marginalized communities continue to face in accessing quality healthcare.