Last week was brutal for anyone who cares about the future of health insurance for low- and middle-income Americans. On Tuesday, the federal government’s Medicaid funding portals temporarily shut down, sending doctors, patients and hospitals into a panic. The next day, President Trump’s nominee for health secretary, Robert F. Kennedy Jr., fumbled basic facts about the program during a Senate hearing, despite the fact that it covers more than 70 million Americans. In the House of Representatives, meanwhile, legislators are circulating a so-called menu of spending cuts that would gut access to health care.
It’s that last threat that could prove the most devastating and long-lasting. You see, the Trump administration faces a dilemma: The president has promised to extend the 2017 tax cuts (nearly half of which will go to the wealthiest 5 percent of Americans) at a hefty cost of $4 trillion over the next decade, but many Republicans are reluctant to add to the federal deficit.