The Left is not in a position to win Medicare for All under the Trump administration. But we have an important battle that can position us for future victories: defending Medicaid, which demonstrated the power of public health care during the pandemic.
As Donald Trump retires from the campaign trail to the halls of his Mar-a-Lago court, the hollowness of his alleged populism is resurfacing. The president-elect has so far named a corporate lobbyist as his chief of staff, invited a cast of neoconservative war hawks to serve in his cabinet, chosen climate deniers to head up the Environmental Protection Agency and Department of Energy, and designated billionaire hedge fund manager Scott Bessent to lead the Treasury. The results will no doubt be devastating for the American working class — and it will hurt in few places worse than in health care.
Many health care experts worry that Trump will slash Medicaid funding, placing millions of poor Americans at risk of losing coverage and putting serious financial pressure on local hospitals. The Affordable Care Act marketplace could collapse when key subsidies run out in 2025, especially since Trump has long sought to dismantle these supports, while his plan to force seniors into private Medicare Advantage plans threatens to gut traditional Medicare and drive up costs. Drug companies are likely to see their profits soar under Trump’s looser regulations, reversing Joe Biden’s attempts to rein in the pharmaceutical industry. We are watching in real time as the Republican Party reasserts its dominance and pushes further on the path toward privatization.
Of course, the march of privatization is not Trump’s doing alone. It has been fairly steady for the last half-century of American life, spearheaded by both Republicans and Democrats to varying degrees. There was only one reprieve in recent memory: COVID-19 created the conditions for a temporary expansion of public investment in citizens’ well-being. During the pandemic in 2020, over two hundred million citizens received stimulus checks, and about sixty million children benefited from the child tax credit, while the pain of pandemic unemployment was eased by programs targeting their predicament. For many Americans, this was a novel experience.
Predictably, our legislators let these benefits expire as soon as they could, and by the end of 2021, the federal government had withdrawn all this relief and returned to business as usual. Even the child tax credit was left by the wayside, despite its extraordinary efficacy in reducing child poverty. One pandemic program was able to survive a little longer: Medicaid Continuous Coverage. Up until March 31, 2023, states were prohibited from disenrolling the seventy-one million Medicaid recipients in exchange for more federal money to keep these citizens covered. Ostensibly, our leaders recognized that being uninsured amid a deadly pandemic was cruel, unusual, and irresponsible. During this time, Medicaid also enrolled many of those who lost their employer-sponsored health care during the pandemic’s spike in unemployment.
But despite controlling both chambers of Congress, President Biden signed into law a $1.7 trillion spending bill (half of which was allocated to defense spending) for 2023 that effectively ended the Medicaid Continuous Coverage program. Health care advocates warned that up to nineteen million people would be terminated from the program — or “unwound,” in bureaucratic speak.
The unwinding of Medicaid is now well underway, and the Kaiser Family Foundation recently released its study of the effects. The study shows that Medicaid enrollment increased during the pandemic, which the researchers attribute to a few factors: the pandemic urged many eligible but unenrolled people to sign up for Medicaid; states have taken steps to streamline the renewal process, historically ridden with red tape; and five states adopted Medicaid expansion during the pandemic. The study also found that twenty-five million people, or 31 percent, have been disenrolled during the unwinding. In six states specifically — Texas, Montana, Utah, North Dakota, Idaho, and Oklahoma — the disenrollment rates are over 50 percent.
Since his election, Trump’s advisers and congressional Republicans have reportedly been mulling over ways to offset costs associated with extending Trump’s 2017 tax cuts. Republican representative Jodey Arrington — the chairman of the House Budget Committee who, before coming to Congress, owned a “health care innovation” holding company — recently proposed putting Medicaid on the chopping block first. Should Trump and his collaborators get their way, estimates suggest that a further fifteen million people will lose their coverage.
Since the Affordable Care Act introduced Medicaid expansion, the value of Medicaid for health outcomes has been well researched. The program is responsible for monumental increases in mammograms, increased testing for cholesterol and diabetes, timely treatment for chronic diseases, reductions in opioid overdose deaths, and decreases in maternal and infant mortality, among many other successes. The data is unambiguous and unsurprising: when people can obtain preventive and primary care, their health improves.
There is no humane reason why the state should subject its citizens to a market-based, means-tested insurance system at one moment and then drop the entire premise at another. While the pandemic was a world-historical event that prodded the government into action, a mass movement of people centering the message of health care as a human right can create the same urgency for the state to uphold its responsibility to us in a similar way. As Republicans proceed to whittle down Medicaid, we must highlight the inhumanity of those cuts and advocate for a commitment to take care of each other.
Medicare for All Eventually, Medicaid Protection Now
Despite Bernie Sanders himself chairing the Senate Health, Education, Labor, and Pensions Committee, his presidential campaign’s marquee proposal of Medicare for All has been put on pause during the Biden administration. We can attribute this to many factors, not least the president’s own antagonism to this project; he even threatened to veto Medicare for All should it come across his desk.
The ongoing campaign for Medicare for All is unlikely to find much success in the legislature under the upcoming administration. In the meantime, Medicaid is distinctly positioned as a program to fight for over the next four years while we work to recenter health care as a human right. The Kaiser Family Foundation study found that two-thirds of US adults “have a connection to Medicaid” and that a large majority of the population views the program favorably. Couple this with the 80 percent of people who view Medicare favorably, and it becomes quite clear that there is a political basis for a push to expand, not reduce, the reach of a public, comprehensive, single-payer health care program.
Aside from a brief moment when Kamala Harris, as the newly anointed Democratic presidential candidate, spoke convincingly of her intention to fight for an expanded child tax credit, the party’s presidential campaigns have made no effort to claim the successes of pandemic programs and campaign on their revival. Health care itself was almost absent from the presidential election — an enormous oversight given how energizing Medicare for All had been for the Democratic base in the 2020 primary and how surprisingly well it polled with Republicans. No wonder the Harris campaign failed to inspire.
Now Trump has been reelected, and existing public health infrastructure is back in the crosshairs. Health care industry lobbyists are no doubt salivating as we approach a second Trump presidency. Their work will include not only kneecapping Medicaid but also privatizing Medicare, with the overall aim of increasing the power and profits of insurance and drug companies.
The Left must accept the implausibility of making material headway on Medicare for All while Trump is in office. Nevertheless, Medicare for All remains the gold standard — and protecting Medicaid provides a base to build on our project. During the pandemic, people saw firsthand how effective public health care can be, and they flocked to Medicaid in droves, to great effect from a public health standpoint. The pandemic should not be memory-holed. We should remind people that public services were there when Americans needed them most — and that with dedicated organizing, we can make this a permanent reality.