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In 1974 the Chicago Tribune exposed Linda Taylor’s crime of running game on the system. This sista, known to pass as a white woman occasionally, drove a Cadillac, wore fur coats and stole money from taxpayers to the tune of 150 thousand dollars by claiming to need welfare. She would be found guilty of this and was a known con artist. Ronald Reagan, in his presidential bid in 1976, made it a point to talk about this woman who abused the system. His speech elicited an audible gasp from the audience as he declared that under his presidency this type of fraud and abuse of taxpayers’ money would not happen again. He would move into the White House as Linda Taylor, whom journalists called “The Welfare Queen” served her time in a federal prison. While we don’t study her legacy in the annals of Black history, her crime of welfare abuse has become ingrained in the politics of American poverty.

However, since the ending of slavery, America has struggled with who should take care of the poor, the widows from wars, and the disabled. In 1965, LB Johnson established Medicaid as an extension of social security. This was a federal and state program to provide healthcare coverage for low-income individuals and families. This Minority Health Month, the nation is bracing as the current administration makes moves to cut federal funding for healthcare and programs that millions of Americans need.

During the fight for civil rights, the campaign for better healthcare was a unifying battle cry that yielded the famous quote by Dr. Martin Luther King, “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhumane.”

Our young people today must understand that The Civil Rights Movement was not just about the integration of schools, and equal treatment on buses and lunch counters, but a fight for health equity for Black people and poor people– including white and rural people. Medicaid is the largest healthcare provider in the United States, covering nearly half of all children, over 40 percent of births (including almost 50 percent of births in rural communities), low-income elderly, and disabled individuals. What’s more, Medicaid acts as the safety net low-wage working adults need when their jobs do not offer affordable coverage, and the primary insurer for their children. Medicaid even covers foster children, and The Affordable Healthcare Act ensures that adults who grew up in the foster system, between the ages of 18 to 26, continue to get healthcare from the state through their Medicaid program.

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The Question of Free Care for All 

For some, welfare benefits including Medicaid have always been synonymous with freeloading. The thought is that “those folks” get healthcare for free while others have to pay for it. Growing up in Houston, I remember going to Kroger with my mother, and standing behind people with their basket of groceries and pulling out food stamps to pay. We didn’t have food stamps, but I didn’t think anything of it. Yet sometimes, my mom had to choose what to keep and what to put back if we did not have enough money. I hated that. There I was ducking, diving and weaving through the line to put the groceries back we could not afford. The walk to the car was void of all eye contact out the store and into the car. I really questioned the notion of “freecare” for some and not others when I  purchased my first healthcare coverage as an adult. My first hospital bill was a real eye opener. One illness can destroy a person’s financial stability. This is frightening.

Today, as looming cuts to Medicaid and Social Security put the country on edge, the politics of The Welfare Queen has resurfaced again. This time this derogatory term isn’t just about “lazy Black women” who want to stay “dependent on the government”. Ordinary everyday people like you and me, collectively, are the new “Welfare Queen.”

The Dichotomy of How Social Welfare is Viewed

In the 90s, the stories of shiftless nonworking, often Black women living off welfare became central to media reporting. President Bill Clinton, in 1996, signed the Welfare to Work Act to move poor people off government assistance and onto a path out of poverty. Today, the belief that working families do not need healthcare benefits or subsidies for insurance are still buying into the politics of the undeserving.

A new analysis from the KFF (Kaiser Family Foundation) reports that most people with Medicaid coverage do work. In 2023, 44 percent of Medicaid enrollees under the age of 65 were employed full-time. An additional 20 percent were working part-time. And 1 out of 7 children in America receive their care through state-issued Medicaid programs. Some 70 million Americans are Medicaid recipients encompassing every ethnic background. Yet the division remains: it’s “those people” who are the ones taking from the government. The Welfare Queen rhetoric is back and politicians claim that American people only want to defraud the federal government by feigning illnesses like ESRD, cancer, HIV, schizophrenia, and Down syndrome. In the words of John Legend, “We’re just ordinary people”. The Trump administration’s proposed cuts help drive home the reality that our humanity is more tied together than not, because these cuts will affect us all.

The potential $880 billion in federal Medicaid cuts from the House passed a budget resolution to states’ tax revenues and education spending. An analysis by the KFF found that the proposed reductions would be equal to 29 percent of state-financed Medicaid spending per resident. States could opt to raise taxes to offset federal Medicaid reductions since proposed federal cuts represent 6 percent of state taxes per resident. States could also make cuts to other programs such as education, the largest source of expenditures from state funds (with proposed federal cuts at 19 percent), to offset federal Medicaid reductions.

Either way, it seems like a no-win scenario: healthcare, education… some aspect of American social systems as we know it, will be impacted. I think about the words of my colleague, Dr. Daniel Dawes, Dean of Meharry Global School of Public Health, and author of The Political Determinants of Health, “Things are very challenging right now for us all, especially in higher education and at HBCUs…”

To help me put this in perspective, I reached out to my trusted health industry-leading colleagues to get their feedback.

Dr. Kendra: What is your role in healthcare?

Dr. Collins: I am the Chief Medical Officer of CountyCare which is a government-sponsored Medicaid Health Plan in Cook County. We are affiliated with the Cook County Health and Hospital System. 

Dr. Kendra: What challenges do you know people will have based on your expertise in healthcare with the proposed changes in funding?

Dr. Collins: During this time, there will be many challenges for healthcare. Coverage under Medicaid is at risk; this includes loss of members under the Affordable Care Act (ACA), funding for health-related social needs and Gender Affirming Care. The data shows that Medicaid increases economic security for low-income households by making health care affordable and improving the quality of care for many who would be uninsured. With Medicaid our members are able to receive lifesaving and innovative care along with preventative care. For Illinois, we are preparing to implement the 1115 Waiver which will cover health-related social needs 

Dr. Collins brings to light how the entire healthcare system must figure out ways to cover their patients and ensure they do not leave vulnerable populations behind. The loss of federal dollars to the states will affect hospital systems. Hospital systems in rural areas that have increased services over the last twenty years are now in jeopardy. Programs for mental health, maternal health, and preventive medicine are in jeopardy.

Dr. Kendra: What does this mean for mental health?

Dr. Bailey: The budget cuts are concerning for mental health professionals here in Louisiana. They will potentially have a deleterious impact on the well-being of our patients. There is some concern over the possibility of cuts to Medicaid and how that could reduce the availability or affordability of psychiatric medications to lower-income individuals. The cuts to SAMHSA are particularly upsetting. Given the current state of the addiction and substance use crisis in America (and Louisiana), losing access to services like the helpline and other services designed to treat addiction and prevent relapse could cause significant harm. There are concerns about cuts to the Medicaid Expansion program, of which 90% is funded by the Federal government. Louisiana has a significant population living in rural areas and this program is a crucial resource in maintaining hospitals in these areas.

Dr. Kendra: What role do you have in healthcare?

Dr. Veal: I consult with healthcare systems and community-based organizations to develop and implement innovative, systemic health improvements.

Dr. Kendra: What challenges do you know people will have based on your expertise in healthcare with the proposed changes in funding?

Dr. Veal: There are a myriad of challenges, but the top three I am currently immersed in are critical ones impacting consumers

• Affordability: Persistent year over year healthcare costs will continue as healthcare entities pass on reimbursement reductions and to consumers. Government funding and staffing reductions will inevitability have a trickle down effect on state and local governments, and the surrounding community ecosystem (retailers, restaurants, etc.)with more layoffs and fewer consumers with health insurance or other. Consumer choices to deal with the disruption will increase Emergency room utilization and avoidable hospitalizations will likely increase.

• Access: as reimbursement declines, particularly in areas already impacted by clinician, physician and nursing shortages, access to care will be even more problematic for consumers.  

• Elimination: Elimination of federal grant funding supporting interventions for infectious diseases and chronic diseases will certainly impact the underserved, underinsured and uninsured the most.  Many of these provide a lifeline for intervention in certain rural and urban areas that these populations will not have access to otherwise.

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What’s At Stake

The potential cuts are scary for those of us who remember when patients would sit in the emergency room for days waiting to be helped. It is frightening to me to think of children dying from asthma attacks or a ruptured appendix because working families have to choose between delaying critical care and putting food on the table. Adult men and women will not be able to afford preventive cancer screening. My local pharmacist shared with me the increases in drug prices for medication for hypertension and antibiotics. As a physician, these are the harsh realities. We are losing the gains in the healthcare system with these cuts in federal aid, grants, and research.

When I hear political arguments about solving “fraud” and “waste” by defunding state healthcare programs that depend on federal dollars, like children’s health insurance programs (CHIPS) and education in school, I think about Linda Taylor and the creation of the Welfare Queen. She may have died but the policy of demonizing all of us who rely on these federal dollars for health and social services has returned.

What To Do?

• Learn about the facts about Medicaid and Medicare from trusted sources like the American Hospital Association

• Act locally by supporting grassroots organizations that help individuals and families at the community level with things like HIV/AIDS prevention, mental health, and chronic disease support.

• Join their newsletters, participate in an event, follow them on social media, and share their content with your family.

Use Your Voice

Use your political voice, your community voice, your American voice. This is the time to exercise your civic duty and stand up for civil rights. Work with your local politicians on both city and state levels. Organize a group as small as three, and as large as a community or church congregation to call their offices and demand a better outcome.

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