Such Medicaid cuts and hospital closures are but two manifestations of a far larger attack on American health and healthcare in what’s fast being transformed into a death-dealing nation. They are but harbingers of an even larger “unwinding” of our health as a nation. Before the pandemic and the most recent cuts, 87 million Americans were already uninsured or underinsured. We’re talking about people sharing heart-attack medicine because they can’t afford their own prescriptions, burying their children for lack of healthcare, and relying on emergency rooms rather than preventative care, while going bankrupt in the process.

It’s simple enough. All too many of us are skipping needed care. In 2022, more than one of every four adults (28 percent of us) reported delaying or going without some combination of medical care, prescription drugs, mental health care, or dental care simply because they lacked the ability to pay.

Meanwhile, medical debt is growing all too rapidly. A Census Bureau analysis of such debt found that, in 2021, 15 percent of all American households owed medical debt—or 20 million people (nearly one in 12 adults). Indeed, the SIPP (Survey of Income and Program Participation) survey suggests that, in total, Americans owe at least $220 billion in medical debt, the biggest source of bankruptcy in the nation.

And of course, as I’ve written before, this is all connected to another reality: that life expectancy is down for everyone, while the poor can expect to die, on average, 12 to 13 years earlier than rich people. Worse yet, the death-rate gap between rich and poor in this country has risen by a staggering 570 percent since 1980. As The Washington Post reported, “America is increasingly a country of haves and have-nots, measured not just by bank accounts and property values but also by vital signs and grave markers. Dying prematurely has become the most telling measure of the nation’s growing inequality.” Poor Health

In the face of all this, you might wonder how things could get any worse. Recently, Congress announced potential cuts to another crucial food and health program for the poor. The Special Supplemental Nutrition Program for Women, Infants, and Children (known as WIC) is at risk of a $1 billion shortfall, essentially guaranteeing harmful cuts to that lifeline for low-income families and children. If Congress refuses to fully fund the program, current funding levels simply won’t cover all eligible participants.

In fact, the $1 billion shortfall now slated to occur equals 1.5 months of benefits for all program beneficiaries or six months of benefits for all pregnant women and infants participating in WIC. House Republicans are currently refusing to approve the budget for this vital program that helps mothers and children up to age five access staples like fruit, vegetables, and infant formula, and connects them to healthcare resources.

In a statement to NBC News, Agriculture Secretary Tom Vilsack called WIC, “one of the most consequential, evidence-based public health programs available.” He implored Congress to fully fund the program, which provides “life-changing benefits and services” to its participants.

And Vilsack is anything but wrong when he speaks of the importance of that pro-poor, pro-health program. An abundance of research suggests the critical role that WIC plays in “supporting maternal health and child development. WIC participation during pregnancy is associated with lower risk of preterm birth, lower risk of low birth weight, and lower risk of infant mortality.” Children on WIC are more likely to consume a healthier diet, and this impact only grows the longer a child stays in the program, which also has a significant reach. As the Department of Agriculture reports, “Nearly 40 percent of America’s infants participate in WIC, which is available only to pregnant women, new mothers, infants, and children who meet income guidelines and are determined to be at nutritional risk by a health professional.” So Much More Is Needed

But as such programs are cut to the bone and more people experience a plethora of problems already plaguing the health of the nation, many are likely to give up entirely, assuming there’s nothing to be done and that it’s just too costly to address inequality and poor health. As someone who has been organizing among the poor for more than 30 years, however, I want to suggest that, as a nation, this just can’t be as “good” as it gets.

Across the span of my lifetime, there have been debates about how to address the larger health crisis in American society. When I was in high school, there was already debate about the effectiveness of establishing a national healthcare program, as President Bill Clinton and Hillary Clinton campaigned on expanding healthcare and actually proposed a new plan for it in 1993. At the time, I remember hearing criticism of the Canadian system of nationalized healthcare. People there, it was said, experienced long lines, way too much paperwork, and a lack of options for patients.

Today, considering the way our healthcare system is unwinding, I could almost laugh (however grimly) at what it would mean to have that Canadian system of years past. All too sadly, however, that country has followed the United States in cutting and privatizing its healthcare system.

Many consider the Affordable Care Act (ACA) one of the most important policies adopted under the presidency of Barack Obama, given that more than 20 million people gained health coverage through it and the ACA’s policies made it easier for eligible people to enroll in Medicaid. In particular, the ACA expanded Medicaid coverage to nearly all adults with incomes up to 138 percent of the Federal Poverty Level ($20,783 in 2024) and helped states with matching federal dollars expand Medicaid to more of their residents. Yet the ACA didn’t go nearly far enough. To date, 40 states and Washington, D.C., have adopted Medicaid expansion, while 10 states have not. Even in states with Medicaid expansion, too many of us are still not covered. And now we’re witnessing one of the greatest attacks on health and healthcare in decades (and just imagine what we’re likely to face if Donald Trump becomes our next president and/or the MAGA Republicans take Congress).

What this nation truly needs is a complete overhaul of its healthcare system. As a start, Medicaid needs to be expanded, extended, and built into a single-payer, universal healthcare plan. Workers need the right to living-wage jobs with generous benefits, including guaranteed paid family sick leave. Social welfare programs like the Supplemental Nutrition Assistance Program, WIC, and the Child Tax Credit need to be strengthened so that the abundance of this society is experienced by everyone. Household and medical debt would have to be cancelled, while drug-recovery programs would need to be fully funded. And parks and recreation centers, as well as grocery stores with quality, affordable food, would have to proliferate, starting in poor communities.

It’s not enough to protest the unwinding of pandemic Medicaid programs. Even that classic protest chant—“They say cut back, we say fight back!”—doesn’t go far enough. Instead, the 135 million poor and low-income Americans, and for that matter, the rest of us, must make healthcare and so much more into basic human rights.

Let me end then not with words of mine but with Becca Forsyth’s challenge to Americans in her Poor People’s Campaign testimony that day in Albany. “We must stop this raging storm of policy violence that is killing our friends and neighbors,” she said movingly. “It doesn’t have to be this way! We can wield our votes as powerful demands. The time for sitting on the sidelines is over. We have to move forward together like our lives depend on it…the lives of our children! Because they do!!”

How right she is!