WASHINGTON (AP) \u2014 On this day in 1965, President Lyndon B. Johnson signed legislation into law that launched Medicaid, creating a U.S. health care safety net for millions of low-income Americans in what would become one of the crowning achievements of his domestic legacy.<\/p>\n
A year earlier, he did the same for food stamps, drawing on President John F. Kennedy\u2019s first executive order for the development of \u201ca positive food and nutrition program for all Americans.\u201d<\/p>\n
This summer, with the stroke of a pen, President Donald Trump began to chisel them back.<\/p>\n
The Republican Party\u2019s big tax and spending bill delivered not just $4.5 trillion in tax breaks for Americans but some of the most substantial changes to the landmark safety net programs in their history. The trade-off will cut more than $1 trillion over a decade from federal health care and food assistance, largely by imposing work requirements on those receiving aid and by shifting certain federal costs onto the states.<\/p>\n
WATCH: Who will be affected by Trump administration\u2019s Medicaid, SNAP work requirements<\/a><\/p>\n While Republicans in Congress argue the trims are needed to rightsize the federal programs that have grown over the decades and to prevent rising federal deficits, they are also moving toward a long-sought GOP goal of shrinking the federal government and the services it provides.<\/p>\n \u201cWe\u2019re making the first changes to the welfare state in generations,\u201d House Speaker Mike Johnson said in a recent podcast interview.<\/p>\n As the tax breaks and spending cuts law begins to take shape, it is unleashing a new era of uncertainty for the safety net programs that millions of people in communities across the nation have grown to depend on, with political ramifications to come.<\/p>\n Big safety net changes ahead<\/p>\n Polling shows most U.S. adults don\u2019t think the government is overspending on the programs. Americans broadly support increasing or maintaining existing levels of funding for popular safety net programs, including Social Security and Medicare, according to the poll from The Associated Press-NORC Center for Public Affairs Research.<\/p>\n WATCH: How proposed cuts to Medicaid could affect rural hospitals<\/a><\/p>\n Local governments are scrambling to figure out how they will comply with the new landscape, calculating whether they will need to raise their own taxes to cover costs, trim budgets elsewhere or cut back the aid provided to Americans.<\/p>\n \u201cThe cuts are really big, they are really broad and they are deeply damaging,\u201d said Sharon Parrott, president of the Center for Budget and Policy Priorities, a research institute in Washington.<\/p>\n \u201cThe consequences are millions of people losing health care coverage,\u201d she said. \u201cMillions of people losing food assistance. And the net result of that is higher poverty, more hardship.\u201d<\/p>\n At the same time, certain people who receive aid, including parents of teenagers and older Americans up to age 64, will have to prepare to work, engage in classes or do community service for 80 hours a month to meet new requirements.<\/p>\n All told, the nonpartisan Congressional Budget Office estimates 10 million more people will end up without health insurance. Some 3 million fewer people will participate in the Supplemental Nutritional Assistance Program, known as SNAP.<\/p>\n \u201cPeople are really concerned what this means for their fiscal health,\u201d said Mark Ritacco, chief governmental affairs officer at the National Association of Counties, which held its annual conference the week after Trump signed the bill into law.<\/p>\n The organization had pushed senators to delay the start dates for some Medicaid changes, and it hopes that further conversations with lawmakers in Congress can prevent some of them from ever taking hold. At its conference, questions swirled.<\/p>\n \u201cWe\u2019re talking about Medicaid and SNAP \u2014 these are people\u2019s lives and livelihoods,\u201d Ritacco said.<\/p>\n GOP bill trims back health care and food aid<\/p>\n Republicans insist the law is adhering to Trump\u2019s vow not to touch Medicaid as the changes root out waste, fraud and abuse. A memo from the House GOP\u2019s campaign arm encourages lawmakers to focus on the popularity of its new work requirements and restrictions on benefits for certain immigrants.<\/p>\n \u201cThose safety nets are meant for a small population of people \u2014 the elderly, disabled, young pregnant women who are single,\u201d the House speaker said on \u201cThe Benny Show.\u201d<\/p>\n He said the years since the Affordable Care Act, or Obamacare, came into law, \u201ceverybody got on the wagon.\u201d<\/p>\n \u201cAll these young, able-bodied, young men who don\u2019t have dependents, riding the wagon,\u201d the speaker said.<\/p>\n Medicaid then and now<\/p>\n When President Johnson established Medicaid alongside Medicare \u2014 the health care program for seniors \u2014 as part of the Social Security Amendments of 1965, it was meant for low-income families as well as the disabled.<\/p>\n And it quickly took off. Almost every state signed on to participate in Medicaid by 1970, according to the KFF, an organization focused on health policy. It soon went beyond covering its core population to include pregnant women, school-age children and not just the very poor but also those with incomes just over the federal poverty limit, which is now about $15,650 annually for a single person and $26,650 for a family of three.<\/p>\n