(Image: Lauren Walker / Truthout; Adapted: Tom Harris)

Several years ago, 62-year-old Michael Kaufman, a disabled resident of Bovina, New York, accidently drilled through one of his fingers. He quickly went to the closest Emergency Room where the wound was treated and bandaged. He thought this was all that he needed to do; unfortunately, the next morning, he noticed red streaks traveling up his arm — a sign of possible blood poisoning — so he returned to the local ER where medical staff immediately inserted an IV of antibiotics and suggested that he go to a bigger hospital 50 miles away to see a hand specialist, which he did.

Shortly thereafter, the bills started to arrive, and Kaufman found himself saddled with $600 in charges: a $200 co-pay for each of the three ER visits. Lest you think Kaufman was uninsured, he was not. He was — and still is — on Medicare, a federally supported health insurance plan provided to the 56 million Americans who receive Social Security Disability or Retirement benefits. Kaufman relies on this insurance to pay for the majority of his medical needs.

“I worked for 40 years and had at least a few years of middle-income earnings,” Kaufman told Truthout. “I cared about my work and was hoping to do more of it, but life sets limits. Things happen. I had to leave work much earlier than I planned, but at least there was a backstop. I’ve been on Disability since 2012 and right now I probably spend an hour or two a week dealing with charges, bills. There’s a lot of turnover in medical offices, and records disappear. It’s gotten harder and harder to deal with the stress of it. So much depends on having a good memory and keeping good records, but memory diminishes with age.”

Despite his obvious frustration with the current health care system, Kaufman makes two things clear: He values Medicare and is adamant about protecting it. He also wants to see it expanded, not cut. “Medicare is a step in the right direction but it is inadequate,” he continues. Part A covers only hospitalization. Part B covers only 80 percent of other costs, including outpatient care. “If you don’t go to the doctor often, this might not come to much, but if you go a lot, the 20 percent adds up really fast,” he says.

What’s more, Kaufman stresses that recipients pay for their Part B coverage — the program operates without a cent of support from federal tax revenues and is instead funded exclusively by employee and employer contributions. The standard Part B premium is presently $134 a month [although the cost is means tested and can run up to $389.80 a month for high earners] while the average enrollment fee for Part D, Medicare’s prescription drug plan, is $35.63. There are also hefty hospital deductibles: $1,288 for the first 60 days, and between $322 and $644 a day for each additional 24 hours.

These are significant sums, Kaufman says. Still, when he hears Republican lawmakers denounce Medicare and propose reducing benefits, he becomes livid and cites a statistic he saw on the website of the National Committee to Preserve Social Security and Medicare. Already, he reports, 45 percent of retirees spend more than one-third of their Social Security benefits on health care, from co-pays for care, to premiums, deductibles and out-of-pocket fees for services — such as going to the eye doctor, dentist or audiologist — that are not provided. “We should be on the offensive, pushing for something better,” he says. “What we need is a single payer or socialized health care system.”

Republican-Initiated Cuts Likely

Needless to say, the Trump administration seems disinclined to consider either of these options and although we do not yet know exactly what the Republican-controlled Congress has in mind, they have indicated that the repeal of the Affordable Care Act (ACA) and changes to Medicare, Medicaid and Social Security are high on their agenda. “It’s a sequencing thing,” says Alex Lawson, executive director of Social Security Works. “They’ll first go after Medicaid, then Medicare, and then Social Security.”

Let’s start with Medicaid, a health insurance program meant to benefit the poorest US residents. After passage of the Affordable Care Act, 31 states and the District of Columbia expanded Medicaid eligibility — some locales allowed people with incomes up to 200 percent of the federal poverty guidelines to gain access to coverage. This has provided health insurance to 20 million previously uninsured people, including many children, and increased the total number of people on Medicaid to 74 million. Newly installed head of Health and Human Services, Tom Price, has proposed rescinding their coverage by repealing the ACA, a move that will save the feds an estimated $500 billion a year. In its place, Price wants Medicaid to become part of a block grant program, a proposal that advocates for seniors and people with disabilities say will be a disaster. David Certner, legislative counsel to AARP, notes that block grants are typically small, so that in the event of an economic downturn or emergency health crisis, states will be left scrambling for revenue to fund necessary services.

Max Richtman, CEO and president of the National Committee to Preserve Social Security and Medicare, notes that it’s not a coincidence that the Trump administration has targeted Medicaid first, since most recipients are youth or people with low incomes. “There is not a strong constituency protecting it,” he says.

This is worrisome to Joshua Grey, a disabled 58-year-old New York City resident. Grey contends with post-traumatic stress disorder and chronic depression; he is also HIV positive. But thanks to a patchwork of care provided by Medicaid, Medicare and the AIDS Drug Assistance Program (ADAP), he is able to get Truvada, an effective, but exorbitantly expensive, HIV medication. “I receive $1,300 and change each month from Social Security and pay $840 in rent. Every three months I’m required to pay $518 toward my drug costs, and then Medicaid picks up the balance of $1,600 a month so I can get the Truvada,” Grey explains.

Like Michael Kaufman, Grey finds the layers of bureaucracy frustrating, but knows that he has no choice but to cope. “As it is now, everything is tenuous,” he continues. “There is not much of a margin. I walk on eggshells since my money is really limited. I describe my life as a quilt that is not well sewn and can easily fray. If there are cuts to any of the programs I rely on, I will literally starve.”

Thousands of recipients echo Grey’s fears. Some rely on Medicaid alone, while 10 million, like Grey, are dually eligible for both Medicaid and Medicare. They, of course, are the most vulnerable group, should cuts be enacted.

Massive Cuts Threatened

Republican Sam Johnson of Texas has proposed raising the eligibility age for Medicare from 65 to 67, a shift that could leave 1.9 million 65-and-66-year-olds uninsured unless they qualify for Medicaid, are still working and have job-related coverage, have a spouse who can get a policy for the entire family, or have the funds to purchase a private insurance plan.

“Before we won Medicare in 1965, elderly people had to go out and try to buy health insurance policies on their own,” says Max Richtman. “It didn’t work because the companies did not want to sell affordable policies to older people. Now the Republicans are proposing giving seniors a voucher — we call it coupon care — to help them defray the cost of buying a health insurance plan. The message is ‘good luck, you’re on your own.’ People will fall through the cracks.”

At its core, he continues, the proposed change rests on a fundamental belief that the federal government should be solely concerned with trade, commerce and national security and should pay no mind to people’s need for such basics as food, shelter, economic security, education or clean water and air.

This message has a champion in House Speaker Paul Ryan (R-WI) who calls both Medicare and Social Security “liabilities” and “empty promises.” As is readily apparent, Ryan’s characterizations are music to Trump supporters’ ears. Additionally, a proposal to raise the Social Security retirement age to 69 is also being bandied about and is being cheered on by Ryan and company. If the plan goes through, it will have a particularly harsh impact on the 10,000 Baby Boomers who turn 65 each and every day. The poorest of them, typically people of color and/or LGBTQ people, will suffer most.

“Ending Social Security and Medicare are Paul Ryan’s reasons for living,” says Alex Lawson of Social Security Works. “Under the cover of chaos caused by Trump, Ryan has the ability to ram deeply unpopular policies, including the destruction of Medicare and Medicaid, through Congress.”

Aren’t the elected officials who support these cuts worried about being defeated in the next election? I ask. “Ryan and a lot of other Congress members are already auditioning for their next job,” Lawson replies. “They’ll cash out from Congress and go on to make millions because the insurance companies will rush to hire them. Why? Precisely because they destroyed Medicaid and Medicare. Plus, the crueler the policy is, the more invitations they get to appear on Fox News.”

Resistance Is Brewing

As the threat of vanishing health care becomes ever more dire, large numbers of people are mobilizing around the country to both protect the Affordable Care Act and advocate for a single-payer system. And, while collective resistance is brewing, tens of thousands of people are finding alternative avenues for a quieter, but nonetheless effective, form of individually driven resistance.

Pat Mitchell, for one, is an Alabama-based retiree and Medicare recipient who uses a website called canadadrugs.com to purchase her medication. “My co-pay in the US for a 90-day supply of the drug I need to take would be $1,568,” she told Truthout. “Using the canadadrugs website, the same supply costs $324. This is the only medicine I can tolerate, and I’ve been getting it from Canada for the past seven or eight years. The US does not try to negotiate prices for medicine. It’s wrong. I have friends who take half a pill a day or take their meds every other day due to the prohibitive costs. I can’t do this. If I don’t take my medication as prescribed, I have flare ups and end up in the hospital.”

While Mitchell is grateful to our northern neighbor for making her treatment affordable, she is also supportive of efforts to expand Medicare, protect Medicaid and improve Social Security benefits for the disabled and elderly. Furthermore, she hopes that Trump can be pushed to make good on his campaign promise to protect Social Security and Medicare benefits.

“Trump very clearly understands the popularity of these programs to people, many of whom voted for him,” AARP’s David Certner says. “As far as we can tell, he has not changed his mind on this, but that can change. We know that the House and Senate will begin the budget reconciliation process sometime this month. Policy changes can’t be made during reconciliation; only spending provisions can be altered, but they need only 50 votes to take effect.”

Vigilance Is Key

“Medicare is the part of our health system that works,” Alex Lawson of Social Security Works stresses. “We not only have to protect it, we have to expand it. We can start by lowering the age of general eligibility from 65 to 62. We should also allow Medicare to negotiate with Pharma over drug prices. We should be putting patents, not patients, at risk.”

Lawson knows that making headway on these demands will require hard work and a concerted campaign to counter a now-ascendant right wing that hates the idea of government-supported social welfare programs. A well-coordinated 82-year campaign against Social Security and a 52-year campaign against Medicare — coordinated primarily by Pete Peterson’s Committee for a Responsible Federal Budget, the Koch brothers and the Heritage Foundation — has impacted Congress and is believed by many Americans, he told Truthout. “The message that the market is the solution has been repeated over and over again. It’s part of a straight-up marketing campaign that has gotten a fair amount of traction thanks to the endless repetition. It’s now up to us to repeatedly call it what it is — a total lie.”