The latest outrage of the Bush White House is the brutal attempt to kill the 40-year-old federal Medicaid program, the health program that is the final health and safety net for the unemployed, the disabled, the elderly and other low-income people.

As originally established, both Medicaid and Medicare were “entitlement” programs – programs under which people who met certain standards were entitled to their benefits. People living 65 years and beyond were told they would never have to worry about their health care because Medicare would provide for their needs.

For liberals and progressives, the struggle to force the 1964-65 Congress to fulfill its commitment to seniors and poor people was a watershed. Ever since the failure of Congress to enact a national health bill following World War II, the health status of the most vulnerable people was dramatically worsening, with statistics clearly indicating that something had to be done. And those facts, along with massive labor and political pressure, finally forced Congress and President Lyndon B. Johnson to act.

But, to get the powerful insurance lobby to drop its opposition, Congress agreed to allow insurance carriers to serve as third party administrators of both programs.

While Medicare is 100 percent financed by the federal government, the Medicaid program finacing is split 50-50 between state and federal government, with states playing a major role in its administration. For some states, like New York, the state’s share is split between state and local government.

In addition to its disastrous “welfare reform,” the Clinton administration pushed for the privatization of Medicaid programs, mostly through not-for-profit organizations. But even with these changes, both Medicare and Medicaid remained entitlement programs.

If Bush has his way that is about to change. Under his latest proposal, the federal share of Medicaid will be given the states in the form of “block grants.” That means governors can use the money in any way they wish.

In New York State the governor is cutting the state’s part of the Medicaid bill by $1.2 billion, with more than 40 percent of the cuts in Medicaid targeted at services such as nursing homes and home care – services primarily used by seniors. The special drug program for seniors will be cut.

Under the Bush plan, Gov. George Pataki could use the federal Medicaid money to backfill the cuts. He could promise to use it for Medicaid, but his promises mean nothing.

The Greater New York Hospital Association says the Pataki Medicaid cuts would severely hit teaching hospitals and so-called safety net hospitals, i.e., the public hospitals.

With two-thirds of all states proposing drastic Medicaid benefit cutbacks by increasing co-payments, restricting eligibility or just plain removing poor people from the Medicaid rolls, it is clear a national movement must be put together to fight back.

The link between the outrageous war budget and the cutbacks in domestic programs can become the trigger to bring together broad coalitions to defeat Bush. And, as the AFL-CIO Executive Council said recently, we cannot wait for the 2004 elections – the struggle must start today.

Saving Medicaid and Medicare is the next step in forcing Congress to enact a national health care program.

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