By skyforbes 
Someone has to choose. You?
The Republican freight train that’s determined to cut Medicaid and food support to the poor to give tax breaks to the wealthy appears to be a new kind of trolley car moral dilemma. Do we divert the train from the track leading to higher taxes for the 1% and run over poor people in line for medical care and food?
We know the wealthy recipients of the tax cuts, because we see the crowd of older white men clustered around the president (an even older white man) on TV all the time. And in the owner’s boxes of major sports teams. And on the Hollywood wealth-porn stories as they show off new yachts and island homes/fortresses.
But we don’t see the people on the other track, the ones depending on Medicaid or supplemental food programs to survive. They’re all around, but we ignore them.
Dan Rather, in his Substack, pointed out that “more than 600,000 Iowans are enrolled in Medicaid. That’s almost 20 percent of the state, including 2 in 5 children. Fifty percent of nursing home residents receive Medicaid.” Rather took aim at Iowa Senator Joni Ernst (Republican) after she addressed constituent concerns about cuts causing deaths by saying, “We’re all going to die.” I hope the Senator wasn’t referring to the 40% of children depending on help to avoid starvation, since Medicaid eligibility almost always means supplemental food help as well.
The population of Iowa in 2024 ended up at 3.241 million, so 600,000 is a decent chunk of that total, over 18%. Why are so many Iowans poor? One reason may be the minimum wage is stuck at $7.25, the rate set in by the federal government in July 2009. Do you know anything that hasn’t doubled in price in the last 15 years?
Texas has also kept the minimum wage at the federal rate of $7.25, as have all the other Confederate states (even though Faux News pretends racial prejudice no longer exists). In my Lone Star State home, Medicaid reported enrollment at around 4,420,000 in May 2025, out of a population of about 32,291,000. In this case, nearly 14% of the population, so slightly lower than in Iowa. But the higher population means more children rely on the program. About 61% of the total are kids, a higher percentage than Iowa, or around 2,696,200.
On the other side of the age scale, if we apply the accepted rate of Medicaid supported nursing home residents, we find an estimate 51,000–58,000 Texas residents in the program. Of course, there are many more nursing homes in the large cities, including two of the largest concentrations in Houston and Dallas. Rural residents who qualify for Medicaid support may not have facilities in their area as rural services continue to dwindle.
If Medicaid cuts by “We all die” Senator Ernst and the rest of the Republican go into effect, how many will die sooner than they should? According to Truthout, about 51,000 by 2034, if 13.7 million people lose insurance (Medicaid or subsidized Affordable Care Act users). After the CBO calculated that amount, the number losing coverage rose, based on new information after the tally, but they haven’t recalculated that result.
Look at the low-wage earners you see in your daily life at the grocery store, fast food place, pushing a mop, delivering food to your table or door, greeting you in hotels, or taking care of your grandmother in the nursing home.
You know these people. Is it worth letting them die for billionaires you’ll never meet?
Maybe you can discuss this new trolley car dilemma with Grandma while you settle her into your guest room after Medicaid stops paying for her nursing home.