Politico had an interesting article on the history of Medicaid and how Republicans choose to sabotage it.
In May 1965, Lyndon Johnson signed Medicaid into law–an afterthought tacked onto the administration’s Medicare bill, and one that LBJ scarcely mentioned when he signed both measures into law. Medicaid’s roots were humble, its ambitions modest. As originally conceived, the program provided health insurance to poor children, poor pregnant women and some qualifying parents. In its first year, its budget was less than $1 billion—about $7.7 billion in today’s dollars. Medicare and Medicaid were quintessential Great Society programs: limited in ambition in scope and designed to help groups of citizens who could not, by virtue of their age or condition, capture the advantages of prosperity.
Over 50 years, successive Congresses and presidential administrations vastly expanded the program’s scope to cover 80 million people, or almost one-quarter of the population. Its budget last year was $378 billion. Medicaid enjoyed broad backing from Republican leaders. The Social Security Amendments of 1965—the official name of the bill that established both programs—passed Congress with bipartisan support. In the House, 65 Republicans supported the legislation; 73 GOP members opposed it. In the Senate, Republicans voted 13 to 14 in favor of the bill.
With strong bipartisan support, Nixon extended the program to include disabled adults who qualified for Supplementary Security Income and allowed states to care for those in need of psychiatric care or suffering mental disabilities.
With overwhelming bipartisan support in Congress, Reagan expanded Medicaid by sharply raising the income eligibility level for women and children, created new categories of mandatory or optional coverage, and made it easier for people who lost eligibility because of rising incomes to remain in the program during a transition period.
Republicans didn’t set their sights on Medicaid until the mid-1990s, when Newt Gingrich’s conservative revolution turned the party’s caucus to the hard right.
Now, Republicans have proposed cuts to Medicaid which will leave many millions of poor people uninsured. For 50 years, Medicaid proved a highly elastic Band-Aid for many of America’s economic wounds. Over two-thirds of its spending benefits children, the elderly, or the blind and disabled. It covers costs for 64 percent of seniors in nursing homes and almost half of all births. It keeps afloat hundreds of rural hospitals, whose clients are disproportionately poor and elderly. Its desecration will leave us in an unfamiliar and dangerous place.
TrumpCare isn’t an attempt to insure more people—or the same number of people—with greater efficiency or better outcomes. It throws people off insurance to pay for tax cuts benefiting the wealthiest Americans, as Republican skeptics like Maine Sen. Susan Collins have noted.
“You and I have been dreaming of this since I have been around, since you and I were drinking at a keg,” House Speaker Paul Ryan told Rich Lowry, editor of National Review. The GOP’s full metamorphosis from the Party of Ronald Reagan to the Party of Ayn Rand is complete.
Some of its leaders can’t even get their heads around the idea of insurance—the means by which people mitigate risk, together. In the year 2017, GOP members of Congress honestly wonder aloud why men should be compelled to buy into plans that cover prenatal services. Shared risk and shared reward: It’s a concept so simple—so fundamental to living in a society—that they teach it in preschool. It’s why women who have children pay into insurance plans that also benefit men who develop testicular cancer. But today’s Republican Party has grown radically anti-social in outlook.
Medicaid was designed, and by increments expanded, to help certain disadvantaged groups: struggling single parents and their children, disabled workers, impoverished older people not yet eligible for Medicare, the underemployed, the working poor. But 50 years ago, no one expected the number of people in these categories to total one-quarter of the nation. It is a testament to the program’s elasticity that it has been able to paper over the inequities of the modern American economy for so long.