Catastrophic cuts are in the offing for Medicaid, the nation’s largest single source of health coverage, serving primarily low-income Americans. But catastrophe isn’t inevitable.

For some time, Republican lawmakers and allies in conservative think tanks have formulated plans to shrink Medicaid’s health care coverage for the 72 million people it benefits: low income families, adults with disabilities, low-income seniors needing long-term care. As Donald Trump and Republicans in both houses get ready to assume power in January, they’re also getting ready to turn these plans into policy.

Through Medicaid, individuals and families gain access to life-saving medications, critical care for acute diseases, and care for chronic conditions like diabetes, cardiovascular disease, obesity, and liver disease. It funds two out of every five pregnancies in the U.S., and it is the nation’s largest payer for behavioral health services and long-term care.

But proposals floated this year by House Republicans and by analysts working for the Heritage Foundation’s Project 2025 would severely underfund or cut these services entirely for many people. While the federal government currently provides 90 percent of matching federal-state funding to ensure that all eligible individuals are covered (according to a provision of the Affordable Care Act), the House Republican plan and the Project 2025 proposals would reduce the federal share significantly, transferring costs to the states and to individuals.

And, if other Republican or Project 2025 proposals are adopted to fund Medicaid through block grants to states or to cap allocations to individuals, people covered by the program would experience higher out-of-pocket costs, reduced benefits, or loss of benefits entirely – leading to significantly increased rates of medical debt and bankruptcy.

Yet another proposal, to link a work requirement to health benefits, would also negatively impact people’s coverage. Two-thirds of non-elderly adults on Medicaid already work, and those that don’t work have disabilities, are caring for family members, or are attending school. Even with exemptions for cases like these, the experiences of states that have attempted work requirements (e.g. Arkansas, Georgia) have shown that the paperwork and administrative barriers associated with such requirements will mean loss of coverage for many people.

The Congressional Budget Office has projected what these various proposals would mean in monetary cuts to Medicaid, showing, for example, that capping overall Medicaid spending could result in a cut ranging between $459 billion and $742 billion over nine years. These figures take on extra significance because, as Republicans move forward to cut Medicaid, they’re simultaneously advancing plans to make permanent the individual tax cuts that the Trump administration got Congress to pass in 2017.

As studies have shown, the 2017 cuts favored the wealthiest Americans, giving the most generous benefits to those in the upper 5 percent income bracket while eroding the nation’s revenue base and doing little to boost household income for most Americans. That same year, Trump also signed into law permanent corporate tax cuts that largely benefited the wealthiest, as rising corporate earnings and profits went mainly to executives and wealthy investors. Now Republicans are trying to make the individual cuts permanent as well.

These budgetary moves may seem remote to many people. Yet they have everything to do with people’s health and well-being. When Medicaid is fully available, as it should be, it’s a critical lifeline to a single mother whose son has to be hospitalized for asthma or to parents needing treatments for a child with special needs. If eligibility is cut, the consequences can devastate, as occurred when a woman died from a brain bleed because she couldn’t afford medications to lower her blood pressure.

We’re moving to a critical inflection point in which benefits and services for millions of people may be eliminated to offset tax cuts benefiting the wealthiest in our society. Yet this further shift from poor to wealthy is avoidable if sufficient awareness can be awakened and enough people mobilized. To borrow a term from political scientist Maria J. Stephan, “bridging” is needed across key groups and networks to build a broad front coalition: media, organized labor, professional health groups and associations, faith organizations, advocacy and rights groups, and business groups, to name just a few.

A strategically effective “big tent” approach can go a long way in helping raise awareness that we all have a stake in the health and well-being of all people in the nation – and in helping thwart egregious damage. But a new administration will soon take over, and time is running short. Dr. King’s ringing phrase, “the fierce urgency of now,” compels more than ever.

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