Medicaid was signed into law 60 years ago. Trump's big bill is chiseling
it back
[July 31, 2025]
By LISA MASCARO
WASHINGTON (AP) — On this day in 1965, President Lyndon B. Johnson
signed legislation into law that launched Medicaid, creating a U.S.
health care safety net for millions of low-income Americans in what
would become one of the crowning achievements of his domestic legacy.
A year earlier, he did the same for food stamps, drawing on President
John F. Kennedy’s first executive order for the development of “a
positive food and nutrition program for all Americans.”
This summer, with the stroke of a pen, President Donald Trump began to
chisel them back.
The Republican Party's big tax and spending bill delivered not just $4.5
trillion in tax breaks for Americans but some of the most substantial
changes to the landmark safety net programs in their history. The
trade-off will cut more than $1 trillion over a decade from federal
health care and food assistance, largely by imposing work requirements
on those receiving aid and by shifting certain federal costs onto the
states.
While Republicans in Congress argue the trims are needed to rightsize
the federal programs that have grown over the decades and to prevent
rising federal deficits, they are also moving toward a long-sought GOP
goal of shrinking the federal government and the services it provides.
“We’re making the first changes to the welfare state in generations,”
House Speaker Mike Johnson said in a recent podcast interview.
As the tax breaks and spending cuts law begins to take shape, it is
unleashing a new era of uncertainty for the safety net programs that
millions of people in communities across the nation have grown to depend
on, with political ramifications to come.
Big safety net changes ahead
Polling shows most U.S. adults don’t think the government is
overspending on the programs. Americans broadly support increasing or
maintaining existing levels of funding for popular safety net programs,
including Social Security and Medicare, according to the poll from The
Associated Press-NORC Center for Public Affairs Research.
Local governments are scrambling to figure out how they will comply with
the new landscape, calculating whether they will need to raise their own
taxes to cover costs, trim budgets elsewhere or cut back the aid
provided to Americans.
“The cuts are really big, they are really broad and they are deeply
damaging,” said Sharon Parrott, president of the Center for Budget and
Policy Priorities, a research institute in Washington.
“The consequences are millions of people losing health care coverage,”
she said. “Millions of people losing food assistance. And the net result
of that is higher poverty, more hardship.”
At the same time, certain people who receive aid, including parents of
teenagers and older Americans up to age 64, will have to prepare to
work, engage in classes or do community service for 80 hours a month to
meet new requirements.
All told, the nonpartisan Congressional Budget Office estimates 10
million more people will end up without health insurance. Some 3 million
fewer people will participate in the Supplemental Nutritional Assistance
Program, known as SNAP.
“People are really concerned what this means for their fiscal health,”
said Mark Ritacco, chief governmental affairs officer at the National
Association of Counties, which held its annual conference the week after
Trump signed the bill into law.
The organization had pushed senators to delay the start dates for some
Medicaid changes, and it hopes that further conversations with lawmakers
in Congress can prevent some of them from ever taking hold. At its
conference, questions swirled.
“We're talking about Medicaid and SNAP — these are people's lives and
livelihoods,” Ritacco said.
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Pediatrician Irving Phillips, left, examines a 16-month-old boy at a
CommuniCARE+OLE clinic Thursday, June 26, 2025, in Davis, Calif. (AP
Photo/Godofredo A. Vásquez)
 GOP bill trims back health care
and food aid
Republicans insist the law is adhering to Trump's vow not to touch
Medicaid as the changes root out waste, fraud and abuse. A memo from
the House GOP’s campaign arm encourages lawmakers to focus on the
popularity of its new work requirements and restrictions on benefits
for certain immigrants.
“Those safety nets are meant for a small population of people — the
elderly, disabled, young pregnant women who are single,” the House
speaker said on “The Benny Show.”
He said the years since the Affordable Care Act, or Obamacare, came
into law, “everybody got on the wagon.”
“All these young, able-bodied, young men who don’t have dependents,
riding the wagon,” the speaker said.
Medicaid then and now
When President Johnson established Medicaid alongside Medicare — the
health care program for seniors — as part of the Social Security
Amendments of 1965, it was meant for low-income families as well as
the disabled.
And it quickly took off. Almost every state signed on to participate
in Medicaid by 1970, according to the KFF, an organization focused
on health policy. It soon went beyond covering its core population
to include pregnant women, school-age children and not just the very
poor but also those with incomes just over the federal poverty
limit, which is now about $15,650 annually for a single person and
$26,650 for a family of three.
In the 15 years since the Affordable Care Act became law under
President Barack Obama, Medicaid has grown substantially as most
states opted to join the federal expansion. Some 80 million adults
and children are covered.
While the uninsured population has tumbled, the federal costs of
providing Medicaid have also grown, to more than $880 billion a
year.
“There are a lot of effects Medicaid has on health, but the most
stark thing that it does is that it saves lives,” said Bruce D.
Meyer, an economist and public policy professor at the University of
Chicago who co-authored a pivotal study assessing the program.
The law's changes will certainly save the federal government “a
substantial amount of money,” he said, but that will come at
“substantial increases in mortality. And you have to decide what you
value more.”
Food stamps, which had been offered toward the end of the Great
Depression but were halted during World War II amid rationed
supplies, launched as a federal program when Johnson signed the Food
Stamp Act of 1964 into law.
Today, SNAP provides almost $200 in monthly benefits per person to
some 40 million recipients nationwide.
Democratic Leader Hakeem Jeffries, who delivered the longest speech
in House history while trying to stall the bill, said the changes
will hurt households and communities nationwide.
“Who are these people?” Jeffries said. “Ripping health care away
from the American people. The largest cuts in Medicaid in American
history. Ripping food out of the mouths of children, seniors and
veterans who are going to go hungry as a result of this one big,
ugly bill.”
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