On Saturday August 15, the New York Times editorial
board published an op-ed noting that the Republicans are trying to hide the
cuts they have made to health care in the U.S.
The editorial board called the expansion of affordable
health care to millions of Americans one of the great achievements of the
federal government in this century. Before the Democrats passed the Affordable
Care Act (ACA) in 2010 without a single Republican vote, about 18% of Americans
under 65 had no health insurance. With the passage and later expansion of the
ACA, also known as Obamacare, the number of uninsured had fallen below 10%.
But now, the journalists note, Trump and the
Republicans are working to uproot that achievement. While they extended Trump’s
2017 tax cuts for the wealthy and corporations in their July 2025 budget
reconciliation bill—the one they call the “One Big Beautiful Bill Act,” passed
without a single Democratic vote—they refused to extend subsidies that enabled
people to afford healthcare insurance in the ACA marketplaces.
The Democrats shut down the government last fall to try
to force Republicans to restore those cuts, foreseeing that higher prices for
premiums would drive healthier people out of the markets and out of healthcare
insurance, while the loss of those healthier people from risk pools would drive
up premiums for those remaining.
They were unsuccessful, and as they warned, without the
subsidies, people dropped their health insurance. A report from the Department
of Health and Human Services in late June 2026 showed that at least 5
million people lost health insurance in the first six months of the year, a
drop of about 13%.
For those remaining, premiums have spiked: the editorial
board notes that a middle-income, middle-aged couple with two children could
pay an additional $3,500 a year, more than doubling their premium from before the
cuts. Deductibles also jumped this year by about $1,000 a person as people
chose cheaper policies that offered less coverage.
Democrats shut down the government also because they
wanted to restore the cuts of about $1 trillion over the next ten years
Republicans had made in funding for Medicaid. In their budget reconciliation
bill, Republicans placed what they called a “work requirement” on enrollees,
requiring them to prove they have a job or a valid exemption.
But, as the editorial board notes, the “work requirement”
is really a “paperwork requirement” that will throw people eligible for the
program off it because they have not filed the right paperwork. As the board
reports, Elizabeth Zhang and Gideon Lukens of the Center on Budget and Policy
Priorities estimated that about two of the three people who will lose Medicaid
because of the new requirement are legally entitled to it.
They estimated that up to 15 million people are at risk
of losing Medicaid coverage. That, in turn, will force hospitals, especially
rural hospitals, to cut back services or close. Although still legally required
to provide services to everyone, they will not be reimbursed for the cost of
such care and will drop labor and delivery services, for example. Those
closures will not just mean poorer health care; they will mean lost jobs.
As the New York Times editorial board
noted, Republicans deliberately put off the implementation of most of the
Medicaid cuts until after the 2026 midterms.
New York Times reader KAM from Marin County,
California, noted in a comment on the story that Treasury Secretary Scott
Bessent defines onerous paperwork differently than Republicans in Congress.
Bessent recently announced the Treasury will no longer require shell companies
to disclose even the name, address, and identification of people who own an
interest of more than 25% or who exercise “significant control” over the
company, as Congress required in the 2021 Corporate Transparency Act. Congress
designed the law to combat money laundering, but Bessent says the paperwork
puts an undue burden on businesses.
In 1883, sociologist William Graham Sumner
published What Social Classes Owe to Each Other, concluding that
the answer was: nothing. In a time when unregulated industrialization was
making fortunes on the one hand and driving down wages on the other, creating
extremes of rich and poor, Sumner turned on its head the traditional idea that
the economy of the United States would provide a living to any man who worked
hard. Instead, Sumner argued that anyone who did not succeed in the United
States must be “negligent, shiftless, inefficient, silly, and imprudent.”
Not only was it unfair to make “the industrious and the
prudent” responsible for such shiftless men, but he also wrote, it would ruin the
country by destroying individual enterprise. Sumner called for a
“laissez-faire” world in which those who failed should be permitted to sink
into poverty and die to keep the U.S. from becoming a place where lazy people
wanted a handout. In the end, such people needed to be purged from society for
the good of the nation.
At the time, those succeeding in the industrializing
economy nodded along with Sumner. The Republican New York Times editor
wrote that even though Sumner’s “views are singularly hard and uncompromising,
it is difficult to quarrel with their deductions, however one may feel one’s
finer instinct hurt by their apparent cruelty.”
The Trump administration seems to have embraced Sumner’s
belief that the nation depends upon the survival of the fittest.
As microbiologist and senior health reporter Beth Mole
reported last year in Ars Technica, Health and Human Services
Secretary Robert F. Kennedy Jr. appears to believe that the key to health is
not to rely on the vaccines proven to prevent infectious diseases, but rather
to have a strong immune system fortified, as he wrote in a 2021 book, “through
healthy living, clean water, and good nutrition.” He accused those who support
vaccines of misleading the American public for the benefit of the
pharmaceutical industry and the healthcare industry.
This seems to explain why he has claimed—without
evidence—that the Texas children who died of measles were malnourished and that
“[w]e don’t know what was killing” the 83 Samoans who died in the country’s
2019 measles epidemic, during which Kennedy associated with members of the
anti-vaccine movement there. It would also explain why he promised to turn away
from promoting vaccination to exploring new treatments for measles, including
vitamins.
And it would help to explain the effort to change the
vaccine schedule for children by separating the MMR vaccine into single-disease
vaccines. Rather than two shots, requiring two doctor’s visits, the vaccine
series would require six. Experts say such a change will mean poorer children
will not get the whole vaccine series, putting them and their communities at
risk.
If overall health can fight off germs and illness, then
measures like the pasteurization of milk and the tracking of foodborne
illnesses are unnecessary.
The U.S. is experiencing a particularly bad wave of
foodborne illness. It’s driven both by hot weather that nurtures food
contamination and by federal funding cuts that scaled back the ability of
federal agencies to conduct food inspections and provide grants to state and
local health departments that used to be able to trace outbreaks quickly.
Deidre McPhillips of CNN reported that so far this year,
the U.S. has reported about 10,500 cases of foodborne illness. Between 2021 and
2025, the annual average was about 1,500 cases. At least 9,481 people in 17
states have fallen ill with cyclosporiasis carried by lettuce from Taylor
Farms, and thousands more cases are being investigated. It’s the largest
cyclospora outbreak in U.S. history, spurred by cuts of more than 40% to food
safety detection systems.
It’s not just lettuce. Frozen organic blueberries sold in
Alabama, Florida, Georgia, Kentucky, North Carolina, South Carolina, Tennessee,
and Virginia have been recalled for E. coli; fresh jalapeños from Taylor Farms
have been recalled for salmonella; 1.5 million dozen eggs sold in Texas,
Oklahoma, Louisiana, Arkansas, Mississippi, and New Mexico have also been
recalled for salmonella.
Anna Skinner of Newsweek notes that
while the focus has been on produce, in fact, FDA records show what she calls
“a steady stream of recalls” that includes “prepared foods, salad dressings,
soups, bakery items and ready-to-eat products,” potentially contaminated with
salmonella, Listeria, or foreign materials, including pieces of metal.
As former U.S. surgeon general Dr. Jerome Adams wrote
in USA Today, “You cannot effectively focus on chronic
diseases while you’re being repeatedly overwhelmed by acute infectious
outbreaks.”
He called for restoring the mandatory tracking of all eight
pathogens that were covered by the Foodborne Diseases Active Surveillance
Network (FoodNet) before the administration cut the surveillance down to just
two, and for filling the leadership positions at the Centers for Disease
Control and Prevention and the Food and Drug Administration that are currently
vacant. He called for inspectors to prioritize high-risk foods and imports and
for the Department of Health and Human Services to reaffirm that vaccines are
safe and effective.
In the 1890s, the determination of those like William
Graham Sumner to keep government out of society in order to promote
individualism had undermined public health and safety. Producers adulterated
tuberculosis-carrying milk with chalk and formaldehyde, decorated candy with
lead paint, and scooped melted ice cream off the bottom of the vat to refreeze
for sale the next day, and what was in sausage meat was a terrifying mystery.
In the early twentieth century, middle-class Americans
demanded regulation of the food and drug industry, ushering in the reforms that
we now call the Progressive Era.
—Heather Cox Richardson
