America's war on the poor
Congressional Republicans used President Trump's "Big, Beautiful" tax law as cover for their true long-time goal: Killing government-funded healthcare.
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Photo by billycm
At one point in American history, the nation waged war on poverty. Now it's waging war on the poor.
Blaming the overt campaign now underway against the underprivileged on President Donald Trump's so-called "Big Beautiful" tax bill would be easy.
The legislation passed by Congress not only cuts food aid for America's needy; it also slashes Medicaid, the crucial government healthcare plan for the poor -- all so Trump can sustain tax cuts for the rich.
The so-called "Big, Beautiful" bill represents just one part of the story, though. In passing the legislation, the Republicans in control of both houses of Congress took a giant step toward their decades-long drive to gut public healthcare, a significant program for the poor.
Not all Republicans harbor deep-seated historical hostilities to national healthcare. However, the record suggests that congressional Republicans capitalized on President Trump's heavy-handed push for his bill as cover to destroy key programs designed to alleviate problems faced by the poor.
Ever since January 8, 1964, when then President Lyndon Johnson summoned America to an "unconditional" war on poverty, the Republican party has opposed the group of federal programs he created that dramatically slashed the nation's poverty rate in half, falling from 20 percent under President Johnson to about 11.1 percent in 2023, the latest figures available.
Medicare and Medicaid have become key elements in reducing poverty, which now defines a family of four as poor if it earns $32,150 or less per year. It's impossible to predict what will happen to the poverty rate under the new GOP policies. But it's a good bet it will rise. The non-partisan Congressional Budget Office estimates that the so-called "Big, Beautiful" tax cut law will result in a $1 trillion cut to Medicaid over the next decade, the most significant cut in the program's history.
Republican loyalists who joined Trump's bandwagon for tax cuts say the law doesn't hurt the poor. Under the GOP's logic, the law helps impoverished Americans by strengthening Medicaid, removing from its rolls people who don't deserve the healthcare it underwrites, such as immigrants, another group in Trump's crosshairs.
Trump and his congressional allies vow that they will not touch the more popular Medicare program, which affects approximately 68 million Americans. But that's what they said about Medicaid.
Indeed, the GOP's portrayal of Medicare contradicts the party's long-term opposition to any government-run healthcare system.
What makes the party's actions remarkable is the passion, durability, and depth of its rejection of government-run healthcare. The opposition's deep, historical roots suggest it's part of the GOP's political DNA.
The late President Harry Truman first advocated national health insurance as the central plank in his unexpected defeat of Thomas Dewey in the 1948 presidential election. Along with their allies in the American Medical Association (AMA), Republicans strongly backed the medical profession’s extraordinary drive, not just to kill Truman's idea but also to defeat the idea of any national healthcare program.
Ironically, President Truman had modeled his proposal on a plan created by the late Earl Warren, a liberal Republican governor of California.
Warren embraced the cause of government-run healthcare after a severe kidney infection hospitalized him and made him wonder what would happen to someone who suffered a similar fate but lacked his means. The plan he presented to California voters resembled today's Social Security Trust Fund -- a small withholding tax on wages to fund a statewide compulsory health insurance program.
A canny politician, Warren tested the political waters of the time and expected little opposition, particularly from the California Medical Association, the lobby for the state's doctors. He was wrong.
Alarmed by the proposal, the California branch of the AMA hired Campaigns, Inc., a public relations firm that had helped Warren win a tough race for governor of California. A forerunner of today's ubiquitous political consulting and advertising firms, Campaigns Inc. launched a drive that torpedoed the legislation, according to Jill Lepore, a Harvard professor and writer who detailed the healthcare narrative in her excellent book, "In These Truths, a History of the United States."
"They stormed the legislature with their invective," Lepore quotes Warren," and my bill was not accorded a decent burial." It was the most significant legislative victory at the hands of Admen the country had ever seen. It would not be the last, Lepore wrote.
Lepore meticulously documents the story of how the advertisers used hyperbole, propaganda, and misinformation to tarnish the idea of government healthcare and how their claims went unchallenged in the media. The same thing is happening now.
Hoping to replicate the success of their California colleagues when Truman unveiled his plan, the AMA hired Clem Whitaker and Leone Baxter, the two Republican political operatives behind Campaigns Inc. The first order of business: deliver a fatal blow to Truman's proposal.
The admen went beyond the initial goal with a significant media campaign that served as a model for the misinformation we see today. They equated national health care with communism, launching their campaign at the dawn of the Cold War, when Communist or Socialist ties were political poison in America.
A confidential memo unearthed by Lepore reveals how they sought to undermine the idea of national healthcare, aiming to "put a permanent stop to the agitation for socialized medicine in this country." Whitaker and Baxter outlined a three-point plan:
Awaken the people to the danger of a politically controlled government-regulated health system;
Convince the people of the superior advantages of private medicine, as practiced in America, over the state-dominated systems of other countries.
Stimulate the growth of voluntary health insurance systems to take the economic shock out of illness and increase the availability of medical care to the American people."
"Basically," Whitaker and Baxter wrote, "the issue is whether we are to remain a free nation in which the individual can work out his destiny, or whether we are to take one of the final steps toward becoming a Socialist or Communist state. We have to paint the picture in vivid verbiage that no one can misunderstand, of German, Russia and finally England."
The Whitaker and Baxter plan cost the AMA $5 million, the equivalent of $67 million in today's dollars, and it took more than three years. But it worked. They defeated the Truman plan.
Over the next several decades, the Republican Party obsessively tried to defeat every attempt at some form of national health insurance, regardless of its face or form.
A vivid example of the party's tactics was its drive to defeat Obamacare, President Barack Obama's signature health insurance program. The measure, officially known as the Affordable Care Act (ACA), was passed by Congress on March 23, 2010. It gained popularity once the public realized it prohibited health insurance companies from denying coverage to anyone due to a prior illness.
Since that date, Republicans have attempted to repeal the ACA at least seventy times, including on July 28, 2017, when the late Republican Senator John McCain cast his infamous thumbs-down vote against repealing the law. President Trump strongly backed the repeal of Obamacare.
Ironically, the AMA, which remains a significant source of funding for the Republican party, now opposes cuts to Medicaid and cuts in payments to physicians under Medicare. The medical lobby may be having second thoughts about its previous positions on government-run healthcare programs. However, the record suggests that the Republican Party, with or without Trump, hasn't changed its mind.
In the "Big, Beautiful" bill, Congress again went after Obamacare by making it harder for individuals to enroll in and retain ACA marketplace coverage. The law also limits Obamacare premium subsidies for certain low-income groups.
The White House claims Medicare is unaffected by the law, but that's not true. The legislation reduces federal funding for Medicare by rolling back recent improvements to the Medicare Savings Programs, which help low-income enrollees afford health insurance premiums and out-of-pocket costs.
The Republican controlled Congress cleverly timed the cuts so they won’t take effect until after the mid-term elections on November 3, 2026
Nonetheless, the Congressional Budget Office projects that the Medicare cuts, combined with reductions in Medicaid and the ACA, will result in approximately twelve million people losing coverage. The measure will also result in higher costs for those who remain in the program. The numbers could be higher. The primary population affected by the legislation: the poor.
—James O’Shea
James O’Shea is a longtime Chicago author and journalist who lives in North Carolina. He is the author of several books and has held various positions, including former editor of the Los Angeles Times, managing editor of the Chicago Tribune, and chairman of the board of the Middle East Broadcasting Network. Follow Jim’s Substack, Five W’s + H here
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