As Project 2025 unfolds before our eyes during the Trump regime’s current iteration and our democracy weakens by the minute, our nation’s most vulnerable communities are increasingly targeted. Trump’s maniacal administration methodically cuts services and programs for students, for the poor, the sick, and even the elderly.
But what happens when programs serving the poor, sick, and elderly are attacked simultaneously?
Medicaid and Medicare are the safety net payors for our health care system in the United States. If your family member goes on hospice, Medicare becomes the insurer. I know this from personal experience when my daughter, who died of cancer, was placed on hospice in 2022. Recently, Dr. Oz’s CMS announced it was pausing new Medicare hospice patients to, allegedly, “crackdown” on fraud.
But this is only one way Trump is using claims of fraud to gut the nation’s social safety net. The Trump regime is also using claims of fraud to deny reimbursements to states for their Medicaid programs, starting with California. The rollout of managed care for Medicaid in Oklahoma has once again been disastrous … by design. In Oklahoma, they found exactly … 10 people, who probably had incorrect information, in a program with over one million enrollees. But the audit was started to combat claims of fraud in the Oklahoma Medicaid program.
Republicans cry “fraud!” to gin up support and whip their base into a frenzy against those they perceive to be the main recipients of these safety net programs: undocumented immigrants, the lazy, the unwilling. And – surprise! – they all have brown skin.
What they won’t tell you is that the white working class and underclass are the main enrollees in these programs. But Medicare, specifically, covers more than just our elderly – it covers our dying family members, regardless of age.
There is an even more urgent concern to the cuts to Medicaid and Medicare, and it’s largely gone unnoticed. When do we begin to see the Republican gutting of our safety programs for what it is – modern-day eugenics, to cull the herd of the unworthy? When do we identify the rightwing attacks on public sector health care as the pro-death platform that it is?
Because the research has shown for decades this will be the net effect of cuts to Medicaid and Medicare: people will get sicker from lack of access to health care providers, who do not want uncompensated care on their books.
When states can no longer reimburse health care providers contracted with Medicaid, those providers will stop accepting them as patients. Medicaid patients come from some of our most fragile communities – they are largely very poor women and children because of the patchwork of eligibility requirements between states, but also middle-age individuals with sometimes chronic conditions that did not receive care until they qualified for Medicaid. The care for women and children is less costly, but the other groups historically on Medicaid can be very costly to insure. This is why the programs often fall in the crosshairs of politicians who don’t have the spine to admit they want to cut health care for the medically frail, so they claim fraud instead.
Until now.
Now, the Trump administration is more brazen in its attacks on Medicaid and Medicare, rolling back coverage of items like home health care and durable goods like walkers and wheelchairs. And by “rolling back,” I mean denying insurance coverage of extremely costly items that these individuals need to maintain their quality of life.
Here’s the thing: health care providers will take Medicare and Medicaid, because both of those programs are reliable payors, even if their reimbursement rates are lower than commercial insurers.
In other words, Medicare and Medicaid take the poor and sick and they get these folks to the doctors, who get paid SOMETHING for the care they provide. Commercial insurers like Cigna, United, etc., may pay … eventually … but they are slow, unreliable, and a bureaucratic nightmare for doctors and health providers. Think the prior authorizations that keep your doctor on the phone to get insurance coverage for life-saving care, like chemotherapy.
And when no one has access to health care, they let their illnesses get worse until they can no longer avoid going to the doctor, in this case, the ER, which is the most expensive form of health care on planet Earth.
And I suspect this is all by design by the murderous, maniacal, sociopathic goons at the helm of the Trump regime. Because it isn’t the wealthy, white collar class impacted by lack of health insurance [not yet anyways], it’s people like almost 99% of anyone reading this essay.
It’s highly likely that most of you are not millionaires. And it isn’t the affluent who have to forego care for routine illness that becomes a chronic, life-threatening condition. It’s you. It’s me. And it’s the people we love.
The thing is, this debauched rollback of health care will have far reaching consequences in for our health care system. Uncompensated care stresses the ENTIRE health insurance industry. Uncompenated health care causes ALL insurance rates to go up.
But it will impact us in other ways. Because we are the workers, the laborers, and the backbone of the economy. And if we can’t work because we’re sick, won’t have kids because we’re sick or it’s too risky to have children, then there won’t be workers. And before that, all health care providers and systems will feel the squeeze, either in their bottom line or in their abilities to practice in states placing legal cages around their abilities to practice medicine.
And we’re all at the mercy of this system.
Until we decide to do something about it.
If we don’t have our health, we have nothing.
What are you going to do? It’s an election year.
MaryAnn Martin is executive producer and co-host of Observercast.
