As the former chair of the Association of State Medicaid Directors, I have seen decades of efforts by Congress to either expand or contract the Medicaid program. Originally, Medicaid eligibility was tied in most cases to eligibility for cash assistance. That excluded many people living below the poverty level who did not meet the family composition rules for case assistance that targeted families with dependent children and people with disabilities.

That limited scope of medical assistance may have made sense in the early years following the establishment of Medicaid in 1965 when private health insurance coverage was widespread, but as the economy evolved, fewer and fewer working people were able to rely on employers that provided health insurance, especially those at the lower end of the income scale.

Welfare reform in the 1990s severed that link between cash assistance and medical assistance and began the process of converting Medicaid into a public health insurance model for poor people, regardless of their household or disability situation. The Affordable Care Act made the revolutionary step of establishing a base income level of 138% of the federal poverty level as a baseline for coverage, including single adults in states that accepted the opportunity to expand coverage.

In the 14 years since the passage of the Affordable Care Act, providers across the board, including hospitals, doctors, clinics and therapists, have re-engineered their business models based on the increase in the eligible population and the ability of the states to leverage their own spending to 90% federal match to offer new and innovative programs. COVID was one startling experience that demonstrated the importance of Medicaid coverage in funding the treatments that saved lives during the pandemic.

The budget proposed by the House would savage Medicaid funding to the tune of $1 billion. In rural areas already suffering from a shortage of providers, hospitals will close, and therapists will be hard to find. Families without coverage will increasingly fall into Medicaid bankruptcy. States will be forced to reduce coverage, leaving us increasingly vulnerable to the next pandemic.

This does not have to happen. We can take a stand that programs like Medicaid and Medicare are necessary to finance care for those who are not able to pay for care themselves — the aged, the disabled, children, pregnant women, and the working poor. We are still a great country. We do not have to accept that the poor and the sick must be abandoned to their fate for the sake of a tax cut for the wealthy.

Health care in this country may not yet be viewed as a right, but at least we listen to our better angels that are calling on us to look out for the welfare of our neighbors.

David Parrella lives in Buckland.