The Fourth of July is a day to celebrate our freedom, but now Americans have something much darker to commemorate. On July 4, Congressional Republicans passed the One Big Beautiful Bill. Included in the bill is a more than $1 trillion cut to Medicaid, America’s largest single source of health care coverage. The Trump administration’s rationale for the cuts is that Medicaid is a flawed and inefficient system in need of reform. They are not wrong, but their solution certainly is, and it dooms millions of Americans.
The United States is in the midst of a health insurance crisis. More than 26 million Americans cannot afford basic medical care. Medicaid, created for low-income and disabled Americans, sought to address a substantial portion of the uninsured population and is now under threat. Amid the political outcry, however, it is easy to forget that Medicaid was never perfect to begin with. As the majority of Americans who oppose the OBBB grapple with its effects, lawmakers cannot lose sight of the reform Medicaid needs. Righting the ship starts with repealing the GOP’s devastating cuts, but the fight only ends when Medicaid is accessible to all who need it.
Medicaid started as a federal program to provide health insurance to low-income mothers, children and people with disabilities. Instead of making Medicaid a federal program — like Medicare — the Johnson administration outsourced Medicaid to the states, allowing each to finance and administer its own system, leading to different requirements across states for determining who was eligible for government healthcare.
One of Medicaid’s greatest weaknesses started as one of its greatest reforms. By the 2008 election, health care was one of the biggest issues on the ballot. When former President Barack Obama took office, he set his sights on expanding health care to about 48 million uninsured Americans at the time. Passed in 2010, the Affordable Care Act — or Obamacare — attempted to expand coverage by expanding Medicaid eligibility to people making up to 138% of the poverty line. The federal government would reimburse each state in full, where it had only provided partial funding prior. For people above the poverty line but still struggling to get coverage, the ACA promised subsidies for private health insurance.
Before long, a legal challenge was in front of the U.S. Supreme Court. In National Federation of Independent Business v. Sebelius, the court ruled that states had the choice to expand their Medicaid programs. Forty-one states, including Washington D.C., did, but 10 others did not. This created a coverage gap. Many Americans in those 10 states, more than 1.5 million, found themselves too rich to be eligible for Medicaid requirements but too poor to afford private insurance. Unexpanded states now have an uninsured rate twice as high as expanded states. It’s hard enough to get health insurance in America — difficulty shouldn’t be based on where you live.
We don’t need a massive legislative undertaking to give Americans more health coverage. Instead, Americans can focus on correcting the coverage gap. Short-term reform means demanding that the remaining states expand their eligibility requirements to the optional federal poverty level. In doing so, we can guarantee that millions more Americans can access the healthcare they need and improve a system flawed since its creation.
Yet, faced with a system in desperate need of reform, the GOP revved their proverbial chainsaws this past July. Claiming massive waste and inefficiency in the program, the Republican spending bill contains about $1 trillion in cuts to Medicaid. The Trump administration insists the cuts aren’t actually cuts, and despite the Congressional Budget Office’s projection that more than 10 million people could lose their health insurance, GOP officials claim people will be able to keep their coverage. Maybe they’re lying. Or maybe they genuinely believe the sick and elderly can fulfill their work requirements by picking lettuce in California. It doesn’t really matter, because we’re still worse off.
The Trump administration is right to suggest Medicaid isn’t working the way it should — but their solution sends the program backward even more. A majority of adults on Medicaid are working honest jobs, not looking for handouts. Work requirements don’t lead to less fraud or waste — they just create more red tape. In truth, the greatest inefficiency of Medicaid is the fact that it is still inaccessible to more than a million Americans, unaccounted for by a system that has failed to prevent them from falling through the cracks.
July 4, 2025 marks 249 years since the signing of our Declaration of Independence, a document Republicans love to reference. Yet, that document says that before even liberty and the pursuit of happiness, Americans have the inalienable right to life. By stripping Americans of their ability to afford medical care, our elected officials have violated this sacred promise. Health insurance is broken in America, but breaking it further is not the answer. We must fix what the Trump administration has broken and come to the solution we’ve been missing all along. Medicaid is not a perfect system, but Americans don’t need less Medicaid; they need more.
Gunnar Hartman is an Opinion Columnist studying public policy. His column, “Cash and Constitutions,” focuses on the rise of authoritarianism and the role of money in politics. He can be reached at hartmang@umich.edu.
