Senior woman having blood pressure checked, preventive care, Image via Shutterstock.

It’s hard to see it now but there was a time when the Republican Party made moves to expand healthcare coverage to U.S. citizens.

“Republicans once signed onto the gradualist approach to achieving the goal of universal coverage,” reporter Merrill Goozner tells the Washington Monthly. “In the early 1970s, President Richard Nixon proposed covering everyone through insurance industry-managed plans. In the 1990s, a Republican-controlled Congress authorized universal coverage for children. Even President Trump in 2017 vowed to replace Obama’s Affordable Care Act with a new plan that would provide ‘insurance for everyone.’”

But now, Goozner said “the U.S. is making a U-turn on the long road to health care for all, with the GOP not even pretending that universal coverage is a desirable national goal.”

Trump’s budget bill this year will drive an estimated 17 million people from the insurance rolls by 2034, according to KFF, with more than two-thirds of those losses arising from cuts to Medicaid. Half those cuts, said Goozner, also establish bureaucratic roadblocks for obtaining coverage and won’t be reversed even if the Democrats manage to force concessions from Republicans as part of shutdown negotiations. Now, Republicans may reduce healthcare coverage almost to what it was before the Affordable Care Act passed in 2010.

Calls for universal coverage extend back to the end of World Ward II, with President Harry Truman looking to copy the post-war coverage European nations were adopting, but the American Medical Association succeeded in imposing an employment-based insurance system. A decade-and-a-half later, Democrats and Lyndon B. Johnson Medicare and Medicaid for the old, disabled, and poor. In 1997, Bill Clinton managed to convince the Republican-led Congress to include a separate plan for uninsured children in the Balanced Budget Act.

“Yet now, under Trump and a supine Republican Congress, America is deliberately reducing the ranks of the insured,” said Goozner. “The process has already begun. Premiums for individual plans being sold on the exchanges for next year are soaring due to the expiration of enhanced subsidies, which will discourage many people from buying plans.”

Trump’s new Medicaid work requirements are postponed until after the 2026 mid-term elections “to hide their full effects from voters,” but Goozner said states have already been “given the green” light to begin enforcing twice-annual recertification requirements. Many Republican-run states are happy to oblige, and they’re also cutting their Medicaid spending in response to federal cutbacks for joint federal-state programs.

“Millions of low-wage workers will start losing their Medicaid coverage next year, not because they aren’t working, but because they become frustrated by the paperwork requirements set up by hostile bureaucrats beholden to their Republican overlords,” Goozner said.

At the same time, an annual KFF employer survey reveals the rates for employer-sponsored insurance plans are soaring at twice the inflation rate on average.

“No matter how the government shutdown is resolved, the health care affordability crisis, exacerbated by the historic GOP U-turn on universal coverage, will remain a salient issue during next year’s House and Senate campaigns,” Goozner said. “The only question is whether Democrats will be able to take advantage by offering a program that addresses voters’ number one concern when it comes to health care.”