Ben Zdencanovic, University of California, Los Angeles

The Medicaid system has emerged as an early target of the Trump administration’s campaign to slash federal spending. A joint federal and state program, Medicaid provides health insurance coverage for more than 72 million people, including low-income Americans and their children and people with disabilities. It also helps foot the bill for long-term care for older people.

In late February 2025, House Republicans advanced a budget proposal that would potentially cut US$880 billion from Medicaid over 10 years. President Donald Trump has backed that House budget despite repeatedly vowing on the campaign trail and during his team’s transition that Medicaid cuts were off the table.

Medicaid covers one-fifth of all Americans at an annual cost that coincidentally also totals about $880 billion, $600 billion of which is funded by the federal government. Economists and public health experts have argued that big Medicaid cuts would lead to fewer Americans getting the health care they need and further strain the low-income families’ finances.

As a historian of social policy, I recently led a team that produced the first comprehensive historical overview of Medi-Cal, California’s statewide Medicaid system. Like the broader Medicaid program, Medi-Cal emerged as a compromise after Democrats failed to achieve their goal of establishing universal health care in the 1930s and 1940s.

Instead, the United States developed its current fragmented health care system, with employer-provided health insurance covering most working-age adults, Medicare covering older Americans, and Medicaid as a safety net for at least some of those left out.

Health care reformers vs. the AMA

Medicaid’s history officially began in 1965, when President Lyndon B. Johnson signed the system into law, along with Medicare. But the seeds for this program were planted in the 1930s and 1940s. When President Franklin D. Roosevelt’s administration was implementing its New Deal agenda in the 1930s, many of his advisers hoped to include a national health insurance system as part of the planned Social Security program.

Those efforts failed after a heated debate. The 1935 Social Security Act created the old-age and unemployment insurance systems we have today, with no provisions for health care coverage.

Nevertheless, during and after World War II, liberals and labor unions backed a bill that would have added a health insurance program into Social Security.

Harry Truman assumed the presidency after Roosevelt’s death in 1945. He enthusiastically embraced that legislation, which evolved into the “Truman Plan.” The American Medical Association, a trade group representing most of the nation’s doctors, feared heightened regulation and government control over the medical profession. It lobbied against any form of public health insurance.

During the late 1940s, the AMA poured millions of dollars into a political advertising campaign to defeat Truman’s plan. Instead of mandatory government health insurance, the AMA supported voluntary, private health insurance plans. Private plans such as those offered by Kaiser Permanente had become increasingly popular in the 1940s in the absence of a universal system. Labor unions began to demand them in collective bargaining agreements.

The AMA insisted that these private, employer-provided plans were the “American way,” as opposed to the “compulsion” of a health insurance system operated by the federal government. They referred to universal health care as “socialized medicine” in widely distributed radio commercials and print ads.

In the anticommunist climate of the late 1940s, these tactics proved highly successful at eroding public support for government-provided health care. Efforts to create a system that would have provided everyone with health insurance were soundly defeated by 1950.

JFK and LBJ

Private health insurance plans grew more common throughout the 1950s.

Federal tax incentives, as well as a desire to maintain the loyalty of their professional and blue-collar workers alike, spurred companies and other employers to offer private health insurance as a standard benefit. Healthy, working-age, employed adults – most of whom were white men – increasingly gained private coverage. So did their families, in many cases.

Everyone else – people with low incomes, those who weren’t working and people over 65 – had few options for health care coverage. Then, as now, Americans without private health insurance tended to have more health problems than those who had it, meaning that they also needed more of the health care they struggled to afford.

But this also made them risky and unprofitable for private insurance companies, which typically charged them high premiums or more often declined to cover them at all.

Health care activists saw an opportunity. Veteran health care reformers such as Wilbur Cohen of the Social Security Administration, having lost the battle for universal coverage, envisioned a narrower program of government-funded health care for people over 65 and those with low incomes. Cohen and other reformers reasoned that if these populations could get coverage in a government-provided health insurance program, it might serve as a step toward an eventual universal health care system.

While President John F. Kennedy endorsed these plans, they would not be enacted until Johnson was sworn in following JFK’s assassination. In 1965, Johnson signed a landmark health care bill into law under the umbrella of his “Great Society” agenda, which also included antipoverty programs and civil rights legislation.

That law created Medicare and Medicaid.

From Reagan to Trump

As Medicaid enrollment grew throughout the 1970s and 1980s, conservatives increasingly conflated the program with the stigma of what they dismissed as unearned “welfare.” In the 1970s, California Gov. Ronald Reagan developed his national reputation as a leading figure in the conservative movement in part through his high-profile attempts to cut and privatize Medicaid services in his state.

Upon assuming the presidency in the early 1980s, Reagan slashed federal funding for Medicaid by 18%. The cuts resulted in some 600,000 people who depended on Medicaid suddenly losing their coverage, often with dire consequences.

Medicaid spending has since grown, but the program has been a source of partisan debate ever since.

In the 1990s and 2000s, Republicans attempted to change how Medicaid was funded. Instead of having the federal government match what states were spending at different levels that were based on what the states needed, they proposed a block grant system. That is, the federal government would have contributed a fixed amount to a state’s Medicaid budget, making it easier to constrain the program’s costs and potentially limiting how much health care it could fund.

These efforts failed, but Trump reintroduced that idea during his first term. And block grants are among the ideas House Republicans have floated since Trump’s second term began to achieve the spending cuts they seek.

The ACA’s expansion

The 2010 Affordable Care Act greatly expanded the Medicaid program by extending its coverage to adults with incomes at or below 138% of the federal poverty line. All but 10 states have joined the Medicaid expansion, which a U.S. Supreme Court ruling made optional.

As of 2023, Medicaid was the country’s largest source of public health insurance, making up 18% of health care expenditures and over half of all spending on long-term care. Medicaid covers nearly 4 in 10 children and 80% of children who live in poverty. Medicaid is a particularly crucial source of coverage for people of color and pregnant women. It also helps pay for low-income people who need skilled nursing and round-the-clock care to live in nursing homes.

In the absence of a universal health care system, Medicaid fills many of the gaps left by private insurance policies for millions of Americans. From Medi-Cal in California to Husky Health in Connecticut, Medicaid is a crucial pillar of the health care system. This makes the proposed House cuts easier said than done.

Ben Zdencanovic, Postdoctoral Associate in History and Policy, University of California, Los Angeles

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Martin Abel, Bowdoin College and Reed Johnson, Bowdoin College

People say they prefer a short story written by a human over one composed by artificial intelligence, yet most still invest the same amount of time and money reading both stories regardless of whether it is labeled as AI-generated.

That was the main finding of a study we conducted recently to test whether this preference of humans over AI in creative works actually translates into consumer behavior. Amid the coming avalanche of AI-generated work, it is a question of real livelihoods for the millions of people worldwide employed in creative industries.

To investigate, we asked OpenAI’s ChatGPT 4 to generate a short story in the style of the critically acclaimed fiction author Jason Brown. We then recruited a nationally representative sample of over 650 people and offered participants US$3.50 to read and assess the AI-generated story. Crucially, only half the participants were told that the story was written by AI, while the other half was misled into believing it was the work of Jason Brown.

After reading the first half of the AI-generated story, participants were asked to rate the quality of the work along various dimensions, such as whether they found it predictable, emotionally engaging, evocative and so on. We also measured participants’ willingness to pay in order to read to the end of the story in two ways: how much of their study compensation they’d be willing to give up, and how much time they’d agree to spend transcribing some text we gave them.

So, were there differences between the two groups? The short answer: yes. But a closer analysis reveals some startling results.

To begin with, the group that knew the story was AI-generated had a much more negative assessment of the work, rating it more harshly on dimensions like predictability, authenticity and how evocative it is. These results are largely in keeping with a nascent but growing body of research that shows bias against AI in areas like visual art, music and poetry.

Nonetheless, participants were ready to spend the same amount of money and time to finish reading the story whether or not it was labeled as AI. Participants also did not spend less time on average actually reading the AI-labeled story.

When asked afterward, almost 40% of participants said they would have paid less if the same story was written by AI versus a human, highlighting that many are not aware of the discrepancies between their subjective assessments and actual choices.

Why it matters

Our findings challenge past studies showing people favor human-produced works over AI-generated ones. At the very least, this research doesn’t appear to be a reliable indicator of people’s willingness to pay for human-created art.

The potential implications for the future of human-created work are profound, especially in market conditions in which AI-generated work can be orders of magnitude cheaper to produce.

Even though artificial intelligence is still in its infancy, AI-made books are already flooding the market, recently prompting the authors guild to instate its own labeling guidelines.

Our research raises questions whether these labels are effective in stemming the tide.

What’s next

Attitudes toward AI are still forming. Future research could investigate whether there will be a backlash against AI-generated creative works, especially if people witness mass layoffs. After all, similar shifts occurred in the wake of mass industrialization, such as the arts and crafts movement in the late 19th century, which emerged as a response to the growing automation of labor.

A related question is whether the market will segment, where some consumers will be willing to pay more based on the process of creation, while others may be interested only in the product.

Regardless of how these scenarios play out, our findings indicate that the road ahead for human creative labor might be more uphill than previous research suggested. At the very least, while consumers may hold beliefs about the intrinsic value of human labor, many seem unwilling to put their money where their beliefs are.

The Research Brief is a short take about interesting academic work.

Martin Abel, Assistant Professor of Economics, Bowdoin College and Reed Johnson, Senior Lecturer in Russian, East European and Eurasian Studies, Bowdoin College

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sun-Min Yu, UMass Amherst and Steve Granick, UMass Amherst

Your cells constantly generate and conduct electricity that runs through your body to perform various functions. One such example of this bioelectricity is the nerve signals that power thoughts in your brain. Others include the cardiac signals that control the beating of your heart, along with other signals that tell your muscles to contract.

As bioengineers, we became interested in the epithelial cells that make up human skin and the outer layer of people’s intestinal tissues. These cells aren’t known to be able to generate bioelectricity. Textbooks state that they primarily act as a barrier against pathogens and poisons; epithelial cells are thought to do their jobs passively, like how plastic wrapping protects food against spoilage.

To our surprise, however, we found that wounded epithelial cells can propagate electrical signals across dozens of cells that persist for several hours. In this newly published research, we were able to show that even epithelial cells use bioelectricity to coordinate with their neighbors when the emergency of an injury demands it. Understanding this unexpected twist in how the body operates may lead to improved treatments for wounds.

Discovering a new source of bioelectricity

Don’t laugh: Our interest in this topic began with a gut feeling. Think of how your skin heals itself after a scratch. Epithelial cells may look silent and calm, but they’re busy coordinating with each other to extrude damaged cells and replace them with new ones. We thought bioelectric signals might orchestrate this, so our intuition told us to search for them.

Almost all the vendors we contacted to obtain the instrument we needed to test our idea warned us not to try these experiments. Only one company agreed with reluctance. “Your experiment won’t work,” they insisted. If we made the attempt and found nothing worthwhile to study, they feared it would make their product look bad.

But we did our experiments anyway – with tantalizing results.

We grew a layer of epithelial cells on a chip patterned with what’s called a microelectrode array – dozens of tiny electric wires that measure where bioelectric signals appear, how strong the signals are and how fast they travel from spot to spot. Then, we used a laser to zap a wound in one location and searched for electric signals on a different part of the cell layer.

Several hours of recording confirmed our intuition: When faced with the emergency need to repair themselves, bioelectrical signals appear when epithelial cells need a quick way to communicate over long distances.

We found that wounded epithelial cells can send bioelectric signals to neighboring cells over distances more than 40 times their body length with voltages similar to those of neurons. The shapes of these voltage spikes are also like those of neurons except about 1,000 times slower, indicating they might be a more primitive form of intercellular communication over long distances.

Powering the bioelectric generator

But how do epithelial cells generate bioelectricity?

We hypothesized that calcium ions might play a key role. Calcium ions show up prominently in any good biology textbook’s list of major molecules that help cells function. Since calcium ions regulate the forces that contract cells, a function necessary to remove damaged cells after wounding, we hypothesized that calcium ions ought to be critical to bioelectricity.

To test our theory, we used a molecule called EDTA that tightly binds to calcium ions. When we added EDTA to the epithelial cells and so removed the calcium ions, we found that the voltage spikes were no longer present. This meant that calcium ions were likely necessary for epithelial cells to generate the bioelectric signals that guide wound healing.

We then blocked the ion channels that allow calcium and other positively charged ions to enter epithelial cells. As a result, the frequency and strength of the electrical signals that epithelial cells produce were reduced. These findings suggest that while calcium ions may play a particularly crucial role in allowing epithelial cells to produce bioelectricity, other molecules may also matter.

Further research can help identify those other ion channels and pathways that allow epithelial cells to generate bioelectricity.

Improving wound healing

Our discovery that epithelial cells can electrically speak up during a crisis without compromising their primary role as a barrier opens doors for new ways to treat wounds.

Previous work from other researchers had demonstrated that it’s possible to enhance wound healing in skin and intestinal tissues by electrically stimulating them. But these studies used electrical frequencies many times higher than what we’ve found epithelial cells naturally produce. We wonder whether reevaluating and refining optimal electric stimulation conditions may help improve biomedical devices for wound healing.

Further down the road of possibility, we wonder whether electrically stimulating individual cells might offer even more healing potential. Currently, researchers have been electrically stimulating the whole tissue to treat injury. If we could direct these electrical signals to go specifically to where a remedy is needed, would stimulating individual cells be even more effective at treating wounds?

Our hope is that these findings could become a classic case of curiosity-driven science that leads to useful discovery. While our dream may carry a high risk of failure, it also offers potentially high rewards.

Sun-Min Yu, Postdoctoral Research Fellow in Polymer Science and Engineering, UMass Amherst and Steve Granick, Professor of Polymer Science and Engineering, UMass Amherst

This article is republished from The Conversation under a Creative Commons license. Read the original article.