By Ben Zdencanovic, University of California, Los Angeles

The Medicaid system has emerged as an early target of the Trump administration’s campaign to slash federal spending. A joint federal and state program, Medicaid provides health insurance coverage for more than 72 million people, including low-income Americans and their children and people with disabilities. It also helps foot the bill for long-term care for older people.

In late February 2025, House Republicans advanced a budget proposal that would potentially cut US$880 billion from Medicaid over 10 years. President Donald Trump has backed that House budget despite repeatedly vowing on the campaign trail and during his team’s transition that Medicaid cuts were off the table.

Medicaid covers one-fifth of all Americans at an annual cost that coincidentally also totals about $880 billion, $600 billion of which is funded by the federal government. Economists and public health experts have argued that big Medicaid cuts would lead to fewer Americans getting the health care they need and further strain the low-income families’ finances.

As a historian of social policy, I recently led a team that produced the first comprehensive historical overview of Medi-Cal, California’s statewide Medicaid system. Like the broader Medicaid program, Medi-Cal emerged as a compromise after Democrats failed to achieve their goal of establishing universal health care in the 1930s and 1940s.

Instead, the United States developed its current fragmented health care system, with employer-provided health insurance covering most working-age adults, Medicare covering older Americans, and Medicaid as a safety net for at least some of those left out.

Health care reformers vs. the AMA

Medicaid’s history officially began in 1965, when President Lyndon B. Johnson signed the system into law, along with Medicare. But the seeds for this program were planted in the 1930s and 1940s. When President Franklin D. Roosevelt’s administration was implementing its New Deal agenda in the 1930s, many of his advisers hoped to include a national health insurance system as part of the planned Social Security program.

Those efforts failed after a heated debate. The 1935 Social Security Act created the old-age and unemployment insurance systems we have today, with no provisions for health care coverage.

Nevertheless, during and after World War II, liberals and labor unions backed a bill that would have added a health insurance program into Social Security.

Harry Truman assumed the presidency after Roosevelt’s death in 1945. He enthusiastically embraced that legislation, which evolved into the “Truman Plan.” The American Medical Association, a trade group representing most of the nation’s doctors, feared heightened regulation and government control over the medical profession. It lobbied against any form of public health insurance.

During the late 1940s, the AMA poured millions of dollars into a political advertising campaign to defeat Truman’s plan. Instead of mandatory government health insurance, the AMA supported voluntary, private health insurance plans. Private plans such as those offered by Kaiser Permanente had become increasingly popular in the 1940s in the absence of a universal system. Labor unions began to demand them in collective bargaining agreements.

The AMA insisted that these private, employer-provided plans were the “American way,” as opposed to the “compulsion” of a health insurance system operated by the federal government. They referred to universal health care as “socialized medicine” in widely distributed radio commercials and print ads.

In the anticommunist climate of the late 1940s, these tactics proved highly successful at eroding public support for government-provided health care. Efforts to create a system that would have provided everyone with health insurance were soundly defeated by 1950.

JFK and LBJ

Private health insurance plans grew more common throughout the 1950s.

Federal tax incentives, as well as a desire to maintain the loyalty of their professional and blue-collar workers alike, spurred companies and other employers to offer private health insurance as a standard benefit. Healthy, working-age, employed adults – most of whom were white men – increasingly gained private coverage. So did their families, in many cases.

Everyone else – people with low incomes, those who weren’t working and people over 65 – had few options for health care coverage. Then, as now, Americans without private health insurance tended to have more health problems than those who had it, meaning that they also needed more of the health care they struggled to afford.

But this also made them risky and unprofitable for private insurance companies, which typically charged them high premiums or more often declined to cover them at all.

Health care activists saw an opportunity. Veteran health care reformers such as Wilbur Cohen of the Social Security Administration, having lost the battle for universal coverage, envisioned a narrower program of government-funded health care for people over 65 and those with low incomes. Cohen and other reformers reasoned that if these populations could get coverage in a government-provided health insurance program, it might serve as a step toward an eventual universal health care system.

While President John F. Kennedy endorsed these plans, they would not be enacted until Johnson was sworn in following JFK’s assassination. In 1965, Johnson signed a landmark health care bill into law under the umbrella of his “Great Society” agenda, which also included antipoverty programs and civil rights legislation.

That law created Medicare and Medicaid.

From Reagan to Trump

As Medicaid enrollment grew throughout the 1970s and 1980s, conservatives increasingly conflated the program with the stigma of what they dismissed as unearned “welfare.” In the 1970s, California Gov. Ronald Reagan developed his national reputation as a leading figure in the conservative movement in part through his high-profile attempts to cut and privatize Medicaid services in his state.

Upon assuming the presidency in the early 1980s, Reagan slashed federal funding for Medicaid by 18%. The cuts resulted in some 600,000 people who depended on Medicaid suddenly losing their coverage, often with dire consequences.

Medicaid spending has since grown, but the program has been a source of partisan debate ever since.

In the 1990s and 2000s, Republicans attempted to change how Medicaid was funded. Instead of having the federal government match what states were spending at different levels that were based on what the states needed, they proposed a block grant system. That is, the federal government would have contributed a fixed amount to a state’s Medicaid budget, making it easier to constrain the program’s costs and potentially limiting how much health care it could fund.

These efforts failed, but Trump reintroduced that idea during his first term. And block grants are among the ideas House Republicans have floated since Trump’s second term began to achieve the spending cuts they seek.

The ACA’s expansion

The 2010 Affordable Care Act greatly expanded the Medicaid program by extending its coverage to adults with incomes at or below 138% of the federal poverty line. All but 10 states have joined the Medicaid expansion, which a U.S. Supreme Court ruling made optional.

As of 2023, Medicaid was the country’s largest source of public health insurance, making up 18% of health care expenditures and over half of all spending on long-term care. Medicaid covers nearly 4 in 10 children and 80% of children who live in poverty. Medicaid is a particularly crucial source of coverage for people of color and pregnant women. It also helps pay for low-income people who need skilled nursing and round-the-clock care to live in nursing homes.

In the absence of a universal health care system, Medicaid fills many of the gaps left by private insurance policies for millions of Americans. From Medi-Cal in California to Husky Health in Connecticut, Medicaid is a crucial pillar of the health care system. This makes the proposed House cuts easier said than done.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Ben Zdencanovic, University of California, Los Angeles

Read more:

• GOP lawmakers commit to big spending cuts, putting Medicaid under a spotlight – but trimming the low-income health insurance program would be hard
• Cutting Medicaid and federal programs are among 4 key Trump administration policy changes that could make life harder for disabled people
• From FDR’s food stamps to Trump’s harvest boxes: The history of helping the poor get enough to eat

Ben Zdencanovic does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Feature Image: President Lyndon B. Johnson, left, next to former President Harry S. Truman, signs into law the measure creating Medicare and Medicaid in 1965. AP Photo

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The Affordable Care Act (ACA) Marketplace opens its 2025 enrollment season, offering millions the opportunity to secure or adjust health insurance plans. This year’s opening enrollment is vital, particularly if Donald Trump is re-elected. The twice-impeached former president and MAGA Republicans have vowed to repeal the healthcare law, which would deprive an estimated 40 million Americans of coverage. Under Trump’s plan, millions of individuals with pre-existing conditions would also lose health insurance.

In 2024, approximately 4.2 million Floridians enrolled in an ACA health plan, marking a more than 200% increase from 2020, according to White House data. Florida, one of 10 states that hasn’t expanded Medicaid, is seeing around 823,000 residents lose Medicaid coverage.

More than 418,000 Michigan residents signed up for new health plans through HealthCare.gov—a nearly 30% increase over 2023. In Wisconsin, over 250,000 residents secured ACA coverage, as state officials reported. Meanwhile, 1.26 million Georgia residents enrolled, reflecting a 206% rise from 2020, with about 96% receiving an advanced premium tax credit to help cover premiums.

Maryland also saw a 33% increase in Black enrollees and a 30% increase in Hispanic enrollees. In Virginia, 389,568 residents enrolled, marking a 67% increase since 2020, with 88% receiving advanced premium tax credits to help cover costs. Meanwhile, 11,910 District of Columbia residents enrolled, although enrollment has decreased by 26% since 2020 — about 22% of D.C. enrollees qualified for advanced premium tax credits.

With increased enrollment nationwide, this year’s Marketplace offers more options than ever. According to the Kaiser Family Foundation (KFF), consumers can choose from a broader array of plans, with benchmark silver plans averaging a 4% premium increase and bronze plans up by 5%. However, enhanced subsidies introduced under the Inflation Reduction Act (IRA) continue to make coverage affordable, capping monthly premiums at a percentage of income. Most enrollees on HealthCare.gov can find plans for under $10 per month, despite unsubsidized premiums reaching $497 for a 40-year-old on a benchmark silver plan. KFF researchers noted that some states, like Vermont, Alaska, and North Dakota, face double-digit premium hikes, while others, like Louisiana, see decreases in low-cost plans.

Under the Biden-Harris administration, the ACA Marketplace has expanded to include more insurers, with an average of 9.6 participating insurers per state, allowing 97% of Healthcare.gov users to choose from at least three insurers. The range of options includes silver and bronze plans tailored to meet different healthcare needs. Silver plans, which serve as the basis for subsidy calculations, offer a balance of coverage and cost, while bronze plans provide lower premiums but higher deductibles.

Federal funding has also been allocated to ensure continued support for enrollees. The Biden-Harris administration committed $100 million to the Navigator program, providing more resources to help Americans understand and select the best health plan. Enhanced subsidies—initially introduced under the American Rescue Plan Act and extended by the IRA—are set to expire at the end of 2025 unless renewed by Congress. Without renewal, millions would face premium hikes in 2026, with costs doubling in some cases. A young family of four in Pennsylvania earning $125,000 would see an annual increase of $6,448, while a 45-year-old in Wisconsin with a $60,000 income would experience a $1,354 hike.

DACA recipients are eligible for ACA coverage for the first time, with subsidies that help reduce costs. Effective November 1, this new eligibility offers a special enrollment window for an estimated 100,000 DACA recipients despite ongoing litigation. Additionally, states like California and New Mexico are leveraging federal tax credits to reduce deductibles, enhancing affordability for those with lower incomes.

KFF found that further safeguards and protections accompany this year’s enrollment. Stricter fraud protections require brokers to secure consent before making plan changes and respond to complaints about unauthorized plan modifications. Non-ACA-compliant short-term plans are now limited to four months and must display clear disclaimers noting they lack comprehensive health coverage. Similarly, fixed indemnity plans, which pay a set amount for specific medical events but lack ACA protections, now carry required disclaimers.

New network adequacy standards for federal Marketplace plans also ensure timely access to care. Wait times are capped in 2025 at ten business days for behavioral health, 15 days for primary care, and 30 days for non-urgent specialty care. Compliance will be monitored through “secret shoppers” surveys to verify access.

Health officials said the ACA Marketplace’s enrollment success reflects expanded access under the Biden-Harris administration. However, political opposition from Trump and MAGA Republicans threatens these gains.

To register for health insurance for 2025, visit www.Healthcare.gov.

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By Stacy M. Brown
NNPA Newswire Senior National Correspondent
@StacyBrownMedia

In a big blow to health insurance in the U.S., a federal judge has ruled that insurers no longer have to pay for preventive care services like cancer and heart disease screenings.

The ruling comes as a result of a lawsuit brought by a group of insurers who argued that the Affordable Care Act (ACA) exceeded its authority by requiring them to cover certain preventative care services without being able to charge co-payments or deductibles.

The Affordable Care Act, or Obamacare, was signed into law in 2010 to make it easier for millions of Americans to get health insurance.

One of the law’s key provisions was the requirement that insurance companies cover certain preventative care services without cost-sharing, including immunizations, blood pressure screenings, and mammograms.

However, the recent ruling by U.S. District Judge Reed O’Connor of the Northern District of Texas has effectively invalidated this provision of the ACA.

In his ruling, Judge O’Connor wrote that the ACA’s requirement for insurers to cover preventative care services “exceeds the powers of Congress under the Commerce Clause” of the U.S. Constitution.

The ruling is likely to significantly affect health insurance in the U.S., especially for people who already have health problems like cancer or heart disease.

If insurance companies weren’t required to cover preventive care services, patients might be less likely to get the screenings and tests that could catch these health problems early.

Experts said this could lead to serious health problems and higher healthcare costs.

“The President is glad to see the Department of Justice is appealing the judge’s decision, which blocks a key provision of the Affordable Care Act that has ensured free access to preventive health care for 150 million Americans,” White House Press Secretary Karine Jean-Pierre stated.

“This case is yet another attack on the Affordable Care Act – which has been the law of the land for 13 years and survived three challenges before the Supreme Court.”

Jean-Pierre continued:

“Preventive care saves lives, saves families money, and protects and improves our health. Because of the ACA, millions of Americans have access to free cancer and heart disease screenings. This decision threatens to jeopardize critical care.

“The Administration will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests.”

Critics of the ruling include healthcare advocacy groups and politicians. They say it will make it more complicated and expensive for millions of Americans to get health insurance. In a statement, Dr. Patrice Harris, president of the American Medical Association, called the ruling “a clear step backward for our health system.”

“Preventative care is a cornerstone of good health,” Dr. Harris said. “It’s critical that patients have access to these services without cost-sharing to stay healthy and catch health problems early before they become more serious and more costly to treat.”

The ruling is also likely to face legal challenges in the coming months. Several states and healthcare advocacy groups have already said they will appeal the decision. They say that the Affordable Care Act’s (ACA) requirement that insurers cover preventive care services is a crucial part of the law’s goal to make more people eligible for health insurance.

In the meantime, patients and healthcare providers alike are left to grapple with the uncertain future of healthcare coverage in the U.S. Without the assurance of coverage for preventative care services, and patients may be forced to choose between paying out-of-pocket for these services or foregoing them altogether, potentially putting their health and well-being at risk.

“Once again, an extreme activist judge is taking a monumental swing at the Affordable Care Act, which has saved millions of lives and made Americans healthier for the last 13 years,” Congressional Black Caucus Chair Steven Horsford (D-Nevada) stated.

“The preventative care provisions in the law have ensured that, without concern for cost, Americans have been able to get screened for things like diabetes, breast cancer and heart disease.

“It also puts the brakes on critical preventative treatments like immunizations and PrEP for HIV.

“The impact of this ruling, especially on working Nevadans and communities of color, will result in the loss of lives, increased costs for treatment of preventable illnesses, and increased inequities in our already unbalanced health care system.”

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By Dr. Tyra Oldham

In the care process, it comes a time when an insurance company will deny service(s) for your loved one. The issue is that the insurance company fails to recognize the concerns you realize as the caregiver. The struggle is to convince the insurance company and Medicare that the care requirements are necessary within the bundled solutions within the plan.

The appeal process is short but daunting, and the ability to remain calm despite the urgent and emergent needs of your loved one. What is so surprising is direct care is not as challenging as the responsibilities for another’s care. The responsibility of economics, insurance, and management of it can lead to caregiver burnout. This article will focus on the role of insurance in caregiver life.

The nature of insurance is to pay for the probability of use in the future. It is that future that is important when it becomes present to collect on the previous payments for services today. Moreover, when ill, the direct or indirect services and how they are allocated are the difference between recovery.

Next, there is always the carrier’s potential for no care as an alternative solution. Sometimes the requested care is not granted, and the insurance company offers lower care services as an alternative. When the care demanded is not given, the option for the caregiver or the person with a power of attorney (POA) is to appeal.

The appeal takes ten-fifteen minutes, but the energy, focus, and communication required can be stressful. In the appeal, the wording on the patient care is vital to expressing the needs of your loved one to the appeals representative. This information is then pushed up the chain to a third-party doctor to approve or deny the claim. During the three days, you await an answer for the next steps. The caregiver is not given much time to act, so have an alternative plan of action. Care Corner is a great place to share some appealing tips.

1. To appeal do your homework. Do not take this quick process as something to be under-considered. Be mindful of your loved one’s need for services during the appeal process.
2. Get all the relevant short-term historical facts and records.
3. Remove the emotion. The agent you speak to is not the enemy. Be pleasant when communicating; it makes the process easier for all.
4. State the reasons for the appeal thoroughly and convincingly.

If your insurance company approves your appeal, you are on your way in the short term. Be prepared for the next step because the approval does not always mean long. If your request is declined, the next step is to accept or appeal again. When appealing, you are now sharing the same or more information with Medicare. If Medicare disapproves, the next step is to appeal for a hearing through an Administrative Law Judge (ALJ). The ALJ is a formal hearing with a judge from Medicare. The ALJ will provide the appellant with a judge of record and a hearing date.

In the end, the caregiver must weigh the health services for the care against the time, stress, and emotional health that the caregiver will face. For me, I have always appealed. I always fight for my mom’s care, but it does take its toll.

For more information on care support and caregiving advice, write or email the “Care Corner.” Want to discuss care? Care Corner is that place to talk care, address questions for current and potential caregivers, and provide suggestions on agencies, services, and tips to assist in a care journey. (Read more of the article from the Herald Newspaper– subscribe now) 

The Care Corner is for everyone, no matter their age or process in care. For more information on caregiving, send your questions to Care Corner at the Cincinnati Herald or via email at care@carecorner.info.

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