Caregivers Union Denounces Medicaid Cuts
On the Line interviewed Shaine Truscott, a Vice President for SEIU 775, which represents over 55,000 caregivers across Washington, Montana, and Alaska. We spoke about the attacks on Medicaid by the Trump administration and billionaire agenda, what it would mean for working people, and why we need to organize and fight back against them. The following interview has been edited for length and clarity.
Jeff Rosenberg (JR): The billionaires and the Trump administration have put a major target on medicaid cuts as part of the big billionaire bill they are pushing through Congress right now. Can you tell us what is happening with these attacks and how your union is understanding them?
Shaine Truscott (ST): 100% of our members rely on Medicaid funding, both through state and federal budgets, to do their jobs to take care of their clients who are elderly and disabled individuals living in our communities. And right now that funding for Medicaid for the work that they do for the care that we all rely on is under direct attack by Republicans in Congress so that they can give tax breaks to their billionaire friends.
JR: How are the politicians justifying these cuts and how are they going about making it harder for people to access healthcare?
ST: What Republicans in Congress will tell you is that they're trying to go after waste, fraud and abuse in the Medicaid system. We know that there isn't $715 billion worth of waste, fraud, and abuse in the most foundational and the most efficient health care insurance system that we have in this country – which is Medicaid.
Medicaid covers anyone from elderly people, poor people, children, working class people, even some veterans. And the system is incredibly efficient. We know that they are chipping away at this foundational health care system by putting up red tape barriers, making it harder for people to re-enroll, making it harder for people to get coverage in the first place by imposing work requirements, and reducing the overall funding that they spend on this system by kicking people off the rolls.
And on top of that, they're going after some of our most vulnerable populations. Trans and non-binary folks are going to see their gender affirming care eliminated if their care is federally funded right now. They are going after states that provide care to undocumented immigrants by imposing penalties and fines on those states.
And they are doing all of this not to create more efficiencies in government. We know that there's not much more efficiency to create in Medicaid. They're doing all of this so that they can extend tax breaks for billionaires. We are looking at folks who are in the top 0.1% of our country's wealth getting an extra $100,000 a year in tax breaks as a direct result of these cuts.
They will somehow say that they are making these cuts in order to protect care for the most vulnerable. We work with the people who are the most vulnerable, who are covered by Medicaid, and they are going to be hurt by this. What this system needs, what these folks need is more funding, not less. You cannot protect anyone by taking a $715 billion sledgehammer to Medicaid.
JR: What do you think will be the real consequences for working people if this goes through?
ST: This is where the gut-wrenching part of this attack comes into play, because it was not so long ago that we were living with that reality. People would regularly lose their homes, go without care, or even lose their lives because they couldn't afford insurance. That all changed with the Affordable Care Act, with Medicaid expansion. More people have been able to access life-saving care. The system has expanded and covers more people today, even if it is still far from perfect.
What these cuts are going to do is harm the most vulnerable folks among us. They're going to harm the elderly. They're going to harm the disabled. They're going to harm our children. They're going to harm working Americans. We're going to see folks dying. We’re going to see folks going without care, life-saving care. We’re going to see hospitals closed, particularly in rural parts of our country.
We’re going to see people, birthing parents, having to travel two hours in order to be able to deliver their baby. Can you imagine being in labor in a car for two hours trying to get to the nearest hospital that will help you deliver your baby? People are going to be hurt and they're going to die.
JR: The people who aren't going to be affected by this are those with more than enough money to access health care. Do you think that they even recognize what they are doing?
ST: I've been sitting with this question a lot because I can't even put myself in the mindset that you would have to be in in order to inflict such cruelty on people. I cannot fathom it. I just don't understand. And I don't think many Americans understand. Most Americans are against these cuts, regardless of who they voted for. When the cuts are explained to most Americans, we as a people are against these cuts.
I can't tell you what these out of touch billionaires are thinking. I can't imagine what level of existence that they're on, what their reality is, that they think that people deserve to die, that people deserve to have their care cuts, that people don't deserve the same access to care and to quality of life that they have. That's not the values that I was raised with. It's not the values that the caregivers and the members of our union were raised with. It's not the values that anyone I know was raised with.
So it's up to anyone's guess what they're thinking and how they justify this. Honestly, they should be ashamed.
JR: These cuts majorly undermine our entire healthcare system. How are these cuts anticipated to impact healthcare workers and the healthcare system?
ST: It's not just health care workers. It's all of us. Medicaid is a foundational health care system in our country in every single state. If you think that you're going to avoid the impacts of these cuts because you have private insurance through your employer – you're wrong.
You will absolutely feel the impact of these cuts because Medicaid funds so much of our health care system. If your local clinic that runs on 70% Medicaid dollars is no longer receiving those funds, what do you think is going to happen to that clinic? Where are you going to get your care? Healthcare workers will lose their livelihood, and the people that they serve will lose access to their ongoing care. It's the whole system that's going to be under strain.
These costs are going to be shifted to the states. In Washington state for instance – and many others – we are already underwater. We don't have enough money in the state budget to fund everything that we care about, to fund our schools, to fund parks, to fund our roads. And with more of a crunch on our state budgets resulting from major cuts to Medicaid and SNAP, if these cuts go through, we're going to see this bleed out in places that we can't even fathom right now.
The specific impact on health care workers is they're going to have to do more with less. This is something that we've always asked our health care workers to do. We already ask them to do it with very little pay, with very little respect, and with very little reward. The reality is that they are going to be doing the same level of work, but potentially with fewer hours that they're paid, potentially with less access to quality, affordable health care for themselves, potentially with less access to other benefits. We may lose access to our training to make sure that they understand and know how to do the work that they're supposed to be providing every day.
But you can't be a health care worker and deny care. In particular, it is impossible to be a caregiver for someone who you care for, who you love, sometimes in your home, sometimes it's your family member. You can't deny them care.
Many of our caregivers give care without pay. They're going to bear the brunt of the cuts economically, in their own budget. These costs that I talked about that are going to be shifted to the states are then going to be shifted to everyday working class people in the end.
JR: We know that these weren't a gift from the rich and powerful. Medicaid and Medicare were passed in 1965 after decades of organizing for and demanding them from the Civil Rights and Labor movements. What is the history behind how we won these programs? What does that tell us about what it's going to take to protect them?
ST: Working people have been raising demands for programs like this starting back in the 1930s when you had the labor movement rising up in major strikes and campaigns to organize new workers. This is also when they won massive entitlement programs like Social Security and Unemployment Insurance. Many of those programs were expanded as the Civil Rights movement demanded racial and economic justice for the most oppressed and exploited. That’s when we won Medicaid and Medicare.
Healthcare advocates have continued to organize since then. We saw these efforts culminate in 2009-2010, when activist groups all across this country demanded deep changes to an unjust healthcare system. We need to make sure that we have a health care system that works for working class Americans, that maintains our ability to see the doctors that we want to see, that ensures our prescription costs don’t get out of control, that my preventative care isn't going to cost me an arm and a leg to go see a doctor to do regular checkups.
We saw people – especially unions and healthcare advocacy groups – organize and demand this together across this country. We put pressure on our politicians and members of Congress. As a result, we were able to see the passage of the Affordable Care Act. Then the fight went to the states and we were able to expand our Medicaid programs in many of our states across this country. That’s how we got the exchange systems.
Your kid can stay on your insurance until they're 26. That wasn't the case before 2010. Preventative care often cost you an arm and a leg before 2010. If you had a pre-existing condition – let me tell you what, pregnancy was a pre-existing condition – you could legally get denied insurance. That's not the case anymore because we took action.
After we fought for all of this, we now see Republicans making the largest attacks on Medicaid that we have ever seen in our nation's history. Some of them are coming out of the woodwork who voted on this bill saying, “I didn't know what I was voting for.” It’s ridiculous. They jammed it through and Trump is calling on every single Republican lawmaker to not break from loyalty to him by voting against the bill.
This is a deeply unpopular set of cuts. It's unpopular with most Americans across the country. They did a poll a couple months ago, 90% of Americans believe that Medicaid is a benefit to their community. You can't get 90% of Americans to agree on anything these days. Even Republicans in Congress believe that Medicaid is a huge benefit to their districts. They need to answer to their people. They need to answer to the working class people in their districts who are going to be the most impacted by these cuts.
JR: Our healthcare system, even before these cuts, has been facing multiple crises – unaffordable and unaccessible care, hospital and clinic closures, and a shortage of healthcare workers due to intense burnout and churn. Far too many working people are still facing mounting medical debt and going bankrupt because of this. The majority of personal bankruptcies are due to medical debt.
We see our healthcare system in many ways continuing to crumble with all of these crises coming together. What does that tell you about our healthcare system that we’re seeing all these crises, even prior to these cuts?
ST: We have a profit driven healthcare system that is creating all kinds of problems for working class people. My opinion is that we have a healthcare system that operates not to benefit the people who are receiving the care, not to support the people who are providing the care, but that operates to create the most amount of profit for the folks who are in charge, for the insurance companies, for the hospital execs, for the folks who are running the show.
During the pandemic, we saw the results of this on full display. We saw underfunded hospitals and nursing homes struggling. We saw them bleeding out staff because they couldn't afford to pay folks enough to stay there through the trauma that was the pandemic.
What we saw was sort of unveiling of our already crumbling healthcare system. People who work in healthcare already know this every day, but now everyone could see. They know that they're overworked. They know that there's too much care to provide and not enough hours in the day, not enough staff to meet the need that exists.
What our healthcare system needs right now is not $715 billion ripped right out of it and given to billionaires. What it needs right now is investment and resources that show the health of working people is a real priority. We're not going to achieve that if we keep on bleeding these systems dry. If we keep on trying to just maximize the profit for the wealthiest few and maintain these systems, then we are giving up on public health. Those two things are incompatible.
JR: What's the message you want to send to Trump, Musk, and any of these billionaires and politicians pushing to cut Medicaid?
ST: The message I want to send to them is that the American people are going to see through this. When regular working class folks – especially folks who voted for Trump – start seeing their healthcare being taken away from them, start seeing their hospitals closing down around them, they're going to see the truth behind what's happening.
You cannot consistently attack the folks who supported you, the folks who voted for you, the folks who live in the country that you are supposed to be leading. You cannot consistently attack those folks and take away things that matter to them and expect that you're going to hold on to power. And you better believe it.
Our unions, our working class folks are going to be standing up against every single one of these attacks. We're going to be the bulwark against which all of these attacks run up against. And they are not going to stop hearing from us. Not even if they end up passing these cuts. We're going to be coming after them. We're going to be holding them accountable.
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