Letters from an American - Hidden Cuts to Health Care

Episode Date: August 21, 2026

August 20, 2026Republicans are trying to hide the cuts they have made to health care in the US, Republicans are working to undo the progress made with the Affordable Care Act, The work requirement they have imposed on the ACA is really a paperwork requirement, Up to 15 million people are at risk of losing Medicaid coverage, In 1883 sociologist Wiliiam Graham Sumner published an influential book that concluded that citizens owe nothing to each other, Those succeeding in the industrializing economy agreed, The Trump administration appears to embrace the belief that the nation depends upon the survival of the fittest, Robert F Kennedy’s beliefs about vaccines seem to align with that idea, The US is experiencing a wave of foodborne illnesses, The administration cut back mandatory tracking of eight pathogens that had been covered by FoodNet before the administration cut six of them, The leadership positions at the CDC and FDA are vacant and need to be filled, Keeping government out of society undermined public health and safety in the past, Middle class Americans demanded regulation of the food and drug industry, ushering in reforms. Watch today's recording here: https://www.youtube.com/live/g9TUa1Rwd6U?si=T8_KKcHQZElhpnZ-Get full, free access to Letters from an American here: https://heathercoxrichardson.substack.com/subscribeYou can also find me:Bluesky: https://bsky.app/profile/hcrichardson.bsky.socialInstagram: https://www.instagram.com/heathercoxrichardson/?hl=enFacebook: https://www.facebook.com/heathercoxrichardson/YouTube: https://www.youtube.com/@heathercoxrichardson Get full access to Letters from an American at heathercoxrichardson.substack.com/subscribe

August 20, 26. On Saturday, August 15th, 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, or 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 corporations in their July. lie 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 health care 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 health care 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, 26, 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 a trillion dollars over the next 10 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 Zang and Gideon Luchin's 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. own an interest of more than 25% or who exercised 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 the 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, he 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 health care industry. This seems to explain why he has claimed, without evidence, that the Texas children who died of measles were malnourished, and that we 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 doctors' 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 illnesses, 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. Deirdre McPhillips of CNN reported that so far this year, the U.S. has reported about 10,500 cases of food-borne 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 some of the average. 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 jalapenos 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, or FoodNet, before the administration cut the surveillance down to just two, and fulfilling 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 re-free for sale the next day. And what was in sausage meat was a terrifying mystery. In the early 20th century, middle-class Americans demanded regulation of the food and drug industry, ushering in the reforms that we now call the progressive era. Letters from an American was written and read by Heather Cox Richardson. It was produced at Soundscape Productions, Dead in Massachusetts. Recorded with music composed by Michael Moss.