The Trump administration believes there are two types of people in the country: givers and takers. Givers are taxpayers and takers are people who receive benefits from the government paid for by taxpayers. President Trump’s budget director, Mick Mulvaney invoked this description while introducing the administration’s budget proposal, which cuts $800 billion from Medicaid over the next decade.
This description will sound hollow to millions of middle-class families whose elderly and disabled relatives depend on Medicaid to provide long-term care services and medical care. These middle-class families might have strong memories of their now aging relatives who defended the U.S. in wars, taught in our schools, built our highways, and worked hard in our factories to make America what it is today. Other middle-class families might have family members who became disabled in their working-age years because of a stroke or back injury or amputation due to their job.
Seniors and the disabled account for about two-thirds of Medicaid expenditures. Most require assistance with the activities of daily living. Medicaid pays for long-term care of more than a million residents of nursing homes and institutions. Millions of others in need are able to remain in their homes and communities because Medicaid pays for their long-term care services.
These Medicaid recipients worked for many years and paid taxes to help create our safety net of social programs that the Trump administration wants to gut. Most never expected that they would need Medicaid. But they have become Medicaid beneficiaries because their medical expenses and needs for assistance cost more than their retirement or disability income. Many exhausted their retirement savings before they turned to Medicaid.
If the administration and Congress slash Medicaid’s federal funding, the states will be forced to pit the needs of the elderly and disabled against the needs of children and non-disabled adults. These groups, too, are covered by Medicaid for only short periods of their lives.
Children make up half of all enrollees in Medicaid but their health care needs are cheap. They account for only a fifth of all Medicaid spending. Dozens of evaluations show the benefits of their Medicaid use far exceed costs. It is simply a smart investment – a paying forward – so when these kids are adults, they will be productive American taxpayers.
Over the course of their lives, most Americans are not permanent members of one group or another. Most of us are likely to be both “givers” and “takers” at some point in our lives – and bad things sometimes happen to good people through no fault of their own.
In contrast to Budget Director Mulvaney and many Congressional Republicans, most Americans understand this because they know a former taxpayer who now receives government benefits. We have an ailing parent or grandparent or Uncle Jim or know a neighbor who was injured on the job or became pregnant while uninsured – all of whom depend on Medicaid to help cover their health care costs.
Medicaid provides essential benefits to many middle-class people who are paying or have paid their fair share towards a safety net that should remain in place for everyone who needs help. Politicians like Mulvaney, who want to slash Medicaid, are the real takers.
Commentary by Katherine Swartz, professor of health policy and economics at Harvard University’s T.H. Chan School of Public Health. She is also author of the book Reinsuring Health: Why More Middle-Class People Are Uninsured and What Government Can Do from the Russell Sage Foundation.
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