Medicaid anniversary is no time to celebrate

As we approach the 60th anniversary of Medicare and Medicaid, we should be celebrating. Instead we’re mourning — because Republicans have finally found a way to gut these popular programs through President Donald Trump’s “Big Ugly Bill,” the latest reconciliation package.

It’s no secret most Republicans opposed the 1965 law that created Medicare for older Americans and Medicaid for low-income people. These programs aren’t perfect, but they’re lifesavers. They’ve improved public health, extended life expectancy and shielded families from medical bankruptcy. Yet our mix of public and private insurance is too expensive and leaves too many uninsured or underinsured.

Candidate Trump promised to lower health care costs. The Big Ugly Bill started by making the 2017 tax cuts permanent — paid for by cutting so-called“ waste” from Medicaid and other safety net programs. As usual, Republicans used the opportunity to shovel even more giveaways to the wealthy and corporations, ballooning the debt ceiling by $5 trillion. Let’s be clear: both parties have been irresponsible with spending, but this bill passed with 100% Republican votes. Every Democratic attempt to target tax relief toward the working class failed. Just one provision for the top 0.1% adds $60 billion to the debt — a tab for our kids and grandkids.

To pretend this was fiscally responsible, Republicans made key provisions for working families and seniors temporary. And to hide the pain, cuts to Medicaid and nutrition programs won’t kick in until after the 2026 elections.

There was hope this bill would finally tackle waste, fraud, and abuse in our health care system. But instead of going after the documented problems in private Medicare Advantage (MA) plans — which deny care, restrict networks, and up-charge for profits — Trump and Republicans rewarded them. In 2024 alone, MA plans will cost $83 billion more than traditional Medicare for the same people. Why? Because those billions flow into profits, salaries, and relentless advertising — not care. MA administrative costs run 13—18%. Traditional Medicare? Under 2%, with no profit motive.

Rather than phase out MA and invest in improving Medicare, the Trump regime increased MA funding by 5% and gifted Big Pharma a $5 billion loophole that weakens Medicare’ s ability to negotiate drug prices.

Medicaid fraud is also real — providers have been caught double billing or charging for phantom services. But instead of cracking down on scammers, Congress increased bureaucratic hurdles for patients. Most adults on Medicaid already work, but in states that tried work documentation, eligible people lost coverage simply because they couldn’t keep up with the paperwork.

The Big Ugly Bill also will destabilize the Affordable Care Act marketplace. Congress let the 2021 subsidies expire and made it harder to qualify again in 2026. Without help, premiums could spike 75%. That means healthy people will drop coverage, sick people will stay, and insurers will flee — because profit-driven companies don’t want to insure the sick.

And if that wasn’t bad enough, the bill’s debt explosion triggers automatic cuts under the PAYGO law — including $490 billion slashed from Medicare over 10 years. Payments to hospitals, doctors, drug plans, and MA plans will all take a hit. Congress could have waived PAYGO. They didn’t. That tells you who they’re really working for.

In the end, the Big Ugly Bill raises health care costs for everyone — not just people on Medicare or Medicaid, but also private insurance holders who’ll pay more as the uninsured population grows. And rising national debt means rising interest rates for all borrowers.

Republicans have tried to repeal the ACA nearly 70 times. This time, they found a backdoor — shifting health care dollars from patients to profits. So maybe it’s time we call our broken system what it really is: Trumpcare — or more accurately, Trump doesn’t care.

Kay Pence is Vice President, Iowa Alliance for Retired Americans. She lives in rural Eldridge..