Trump Just Had a Princess Bride Moment

President-elect Trump’s latest statement on Congressional Republicans’ campaign to repeal the Affordable Care Act shows just how little he understands a debate that has life and death stakes for millions of Americans.

For months, Trump has been all over the map: One day he’s pledging to provide “insurance for everybody,” the next he’s considering a so-called “replacement” plan that would pull the rug out from under some 21 million seniors, people with disabilities, children, and workers.

But on Wednesday, he took his cluelessness and unpredictability to a new low when he declared, “Whether it’s Medicaid block grants or whatever it may be, we have to make sure that people are taken care of.”

As fans of the 1980s cult classic The Princess Bride, there is only one appropriate response:

There are few surer ways to guarantee that people will NOT be “taken care of” than converting Medicaid into a block grant—a technical term that in reality means massive cuts.

Converting Medicaid into a block grant would end the program’s promise of health insurance for all eligible individuals. It would also slash the federal funding that states receive to run their Medicaid programs, forcing them either to make up the difference with money from their own coffers, or (much more likely) to make huge cuts in the coverage they provide to their residents. Faced with inadequate resources, states could have little choice but to institute waiting lists for coverage or cap enrollment—leaving millions of Americans without the care they need.

In fact, an Urban Institute analysis of a past GOP proposal to block grant Medicaid estimates that an additional 14 million to 20 million Americans would lose coverage under a Medicaid block grant—that’s on top of the 30 million who would lose coverage under ACA repeal and elimination of Medicaid expansion.

This isn’t a new idea. Congressional Republicans—including Representative Tom Price, Trump’s pick to lead the Department of Health and Human Services—have long had Medicaid block grants on their wish list. But what’s still unclear, as Trump swings recklessly from promising universal coverage to considering slashing health care for people who can’t afford insurance, is whether the President-elect is actually changing his opinion or if he is just so ignorant on health care policy that he doesn’t understand what he’s saying.

In either case, we can be sure of one thing: Trump’s willingness to embrace life-threatening policies without even making an effort to understand them is:

At a Michigan campaign rally in August 2016, then-GOP presidential nominee Donald Trump tried to appeal to the African-American community with a hypothetical question: “What do you have to lose by trying something new like Trump?”

Now that his administration is taking shape, the answer is becoming very, very clear. His nominee for Attorney General has called the NAACP “un-American,” his nominee for the Secretary of Housing and Urban Development has referred to desegregation as “a failed socialist experiment,” and his chief strategist led the website credited with making blatant racism mainstream again. Now, with the nomination of Scott Pruitt to lead the Environmental Protection Agency (EPA), Trump is signaling an attack on public health—which has pronounced health hazards for communities of color.

Pruitt’s confirmation hearings begin on Wednesday, and his record is providing ample questions for the process. As Attorney General for Oklahoma, Pruitt has spent much of his career trying to dismantle the EPA. He led state attorneys general efforts to sue the EPA over its Clean Power Plan, which aims to reduce carbon pollution from dirty-fueled power plants. As Attorney General, he eliminated the office’s Environmental Protection Unit. He has received hundreds of thousands of dollars in political donations from oil and gas interests, and then repeated their calls to allow greater pollution—almost verbatim—to the very agency he is nominated to now serve. An investigation found him to be part of a secret, collaborate alliance between attorneys general and the energy industry. He also denies the science of climate change, despite global scientific agreement.

“Pruitt personifies environmental injustice,” according to Earl Hatley, Grand Riverkeeper and co-founder of the Oklahoma-based nonprofit Local Environmental Action Demanded Agency. Hatley expects Pruitt to provide the oil and gas industry exemptions from air and water protections—first by targeting the Clean Air Act, and then by remove fracking regulations. “Oklahoma is an oil state; it always has been,” says Hatley. “We’re trying to fight it, but with people like Pruitt, the pushback is really hard.”

Pruitt’s record of attacking public health, clean air, and safe drinking water safeguards should concern everyone, but African-American and Latino communities face some of the most serious health risks. Due in part to the enduring legacy of discriminatory housing policies, communities of color are more likely to have lead poisoning or contaminated water, be exposed to hazardous levels of air particle pollutants, and have their homes damaged during extreme weather. In 2007, nearly half of all people of color in the United States—an estimated 46 percent to 48 percent—lived within six miles of a hazardous waste facility.

Given these risks, it is vital for communities of color to have an EPA Administrator who embraces the environmental justice movement, which fights to give communities of color equal access to clean air and water. The EPA has been criticized for ignoring this movement in the past, but in recent years the agency launched a series of actions to support it—including the EJ 2020 Action Agenda, which includes defining priority areas and engaging in community-based work, and provides roadmaps for outreach and engagement with tribes and communities. The EPA also released a mapping tool that illustrates exactly which communities are most exposed to pollution.

This provides some hope to communities of color, but the EPA has much more work to do.

Marginalized communities are relying on the EPA now, more than ever, to protect their health

In the wake of the water crisis in Flint, Michigan—and multiple cities throughout the United States—marginalized communities are relying on the EPA now, more than ever, to protect their health from the hazards of water and air pollution. The EPA needs leadership that will protect Americans from pollution and climate change impacts, rather than destroy the EPA’s mission to give people clean air and water.

If there was any question about President-elect Trump’s interest in helping communities of color, he answered it himself. He had the option to nominate an EPA Administrator who pledged to support the agency’s mission to set and enforce air and water quality safeguards, work to reduce air and water pollution, and continue to incorporate environmental justice efforts throughout the agency. Instead, he selected a nominee who wants to attack decades of environmental progress, with no record of helping communities of color fight for environmental equality.

With Scott Pruitt as EPA Administrator, we have a lot to lose.

A November 2016 study by the U.S. Department of Agriculture examined the food shopping patterns of American households who currently receive nutrition assistance through the Supplemental Nutrition Assistance Program (SNAP) compared with those not receiving aid. Its central finding? “There were no major differences in the expenditure patterns of SNAP and non-SNAP households, no matter how the data were categorized.”

But you wouldn’t know that from reading the New York Times’ front-page story last Friday. The headline announced “In the Shopping Cart of a Food Stamp Household: Lots of Soda,” and the article was flanked by photos of a grocery cart overflowing with 2-liter bottles of soft drinks and a store aisle that is nothing but a wall of soda.

The actual conclusion of USDA’s study—“both food stamp recipients and other households generally made similar purchases”—is buried 15 paragraphs down from the sensationalized headline. The article did not initially link to or even name the study.

Soon after publication, several experts took to social media to highlight the study’s actual findings.

Joe Soss, a political scientist at the University of Minnesota, pointed out that the article’s main argument—that households receiving nutrition assistance spend vastly greater shares of their grocery budgets on soda compared with other households—is directly contradicted by the report’s actual finding. The difference was incredibly slight: 5 percent versus 4 percent of a household’s grocery spending. The Times also reported that a misleadingly high 9 percent of budgets were dedicated to soda, because the article conflated soda with “sweetened drinks” (which includes many juices).

Philip Cohen, a University of Maryland sociologist, noted that the article failed to mention the food item where USDA found the biggest difference in spending: baby food. (Shame on those struggling households for feeding their children.)

There is a broader problem with this kind of reporting

Beyond the article’s inaccuracies, there is a broader problem with this kind of reporting. It reinforces an “us versus them” narrative—as though “the poor” are a stagnant class of Americans permanently dependent on aid programs. The New York Times’ own past reporting has shown that this simply isn’t the case. Research by Mark Rank, which the paper featured in 2013, shows that four in five Americans will face at least a year of significant economic insecurity during their working years. And analysis by the White House Council on Economic Advisers finds that 70 percent of Americans will turn to a means-tested safety net program such as nutrition assistance at some point during their lives.

Most families who turn to income supports like SNAP do so only temporarily, and often during periods of crisis (such as loss of a job or a medical emergency). Since today’s low wages make it nearly impossible for families to save for these emergencies, which all of us inevitably face, benefits like SNAP provide critical support. These programs help put them back on their feet—and once they are, they stop their participation.

Americans’ high level of sugar consumption, and the related health consequences, is an important discussion to have. But using a false and divisive narrative that suggests that such consumption is chiefly the purview of people who need to turn to nutrition assistance plays directly into harmful stereotypes, and risks undermining a critical program that protects nearly 5 million Americans from poverty each year. These kinds of narratives have long served as the backbone of efforts to cut safety net benefits, like SNAP, which not only help struggling families in the short-term but also boost economic mobility in the long-term, while stabilizing the overall economy.

The current political climate makes this article particularly damaging and irresponsible. It provides cover for House Republicans, led by Speaker Ryan (R-WI) and President-elect Trump’s nominee for Health and Human Services, Rep. Tom Price (R-GA), who are poised to move forward with long-held plans to make deep cuts to nutrition assistance and other vital supports. It also enables misguided Republican governors who have long tried to limit what households receiving assistance can spend their SNAP benefits on. These so-called “junk food bans” may sound well-intentioned, but can end up ensnaring healthy, inexpensive staples like canned tuna, dried beans, and potato salad.

If the goal is to create a nutrition assistance program that will encourage healthier eating, cuts to SNAP are exactly the wrong approach. Research shows that increasing SNAP’s modest benefits leads to healthier eating. This comes as little surprise, given that healthy food is generally more expensive. But since SNAP’s modest benefits already run out before the end of the month for most households, it is a luxury that many families cannot afford.

Maybe the New York Times could look into that.

I recently read about a county in Kentucky that is typical of the kinds of depressed white communities that have dominated the news since Trump’s election. Owsley County is 83 percent white, mostly rural, and rigidly conservative.

On the surface, I don’t have much in common with its residents. I’m a black American. I’m pro-choice, pro-LGBT rights, and a feminist. I’m a lifelong progressive. According to multiple media outlets, Owsley’s residents see my beliefs as a direct threat. But we also have deep a bond.

Poverty.

The median household income in Owsley is just $19,146 per year. The unemployment rate is double the national average, the majority of children live below the poverty line, and in 2011 more than half the county’s residents received food stamps. When Medicaid was expanded under the Affordable Care Act, a whopping 66 percent of residents became eligible. And if you ask them about it, they express deep appreciation. Again and again.

“It’s been a godsend to me,” said a school custodian who suffered from a thyroid condition that practically immobilized her. Medicaid let her get treatment—and it paid for her cataract and carpal tunnel surgery.

Another resident lamented that without Medicaid, she couldn’t pay for the doctor’s visits to keep her hyperthyroidism in check. “If anything changed to make our insurance more expensive for us that would be a big problem,” she said.

Resident after resident in news article after news article acknowledged the price they would pay if these services disappeared. But in the past two years, the residents of Owsley overwhelmingly voted for a governor, and then for a president, who want to eliminate the Affordable Care Act.

Now that the heat of the election has passed, they are anxious. And I understand why.

I’m on Medicaid—a new recipient since the expansion. I have a feeling that several thousand poor white Kentuckians—like this black American—still suffer a twitch of anxiety when they hear the words “payment is due at the time of service,” at the doctor’s office. If you are uninsured and facing a health crisis, those are the scariest words you can hear.

I remember that feeling.

We languished in fear, and said prayers instead of visiting a physician.

I used to save the change from every purchase I made. I called it “health clinic money,” and I’d collect it for weeks so I could pay for my next $50 doctor’s visit. For more than a decade, my blood pressure readings were at heart attack levels. The doctors at my clinic wanted to see me every month, but I couldn’t always afford it. So I skipped my appointments.

In 2011, I learned my high blood pressure was due to kidney cancer. I was still uninsured, so getting the treatment that could save my life entailed a maze of forms that delayed my surgery for months. I eventually got help from a program in my state called “the Indigent Health Care Fund,” but the funding was spotty before Medicaid was expanded. When I applied, I was told the program was no longer accepting new clients—which happened often, once money for the year ran out—so I didn’t know my surgery had been given the green light until three weeks before it happened.

That’s what life was like for millions of us (and what it has remained like for Americans living in the states that stubbornly refused to expand Medicaid under the ACA). We languished in fear, and said prayers instead of visiting a physician. That’s inhumane. Free or low-cost health care for those who can’t afford it is a matter of basic decency.

If you don’t believe me, ask my friends in Owsley, Kentucky.

The incoming Republican Senate, House, and the new president are determined to repeal Obamacare, and it’s still a mystery when—or if—it will be replaced. Undoing Medicaid expansion and replacing it with a fee paying system will return millions to the days of saving their change before seeking help. Preventative care (the kind that could have caught my cancer earlier) or regular monthly appointments (the kind that could protect me from a cancer recurrence) will be curtailed or gone.

Instead, the poor everywhere will see the familiar front desk sign that reads “Payment is Due at the Time of Service.” And we’ll go home.

I wake up and sense the space heater just inches away—the only source of heat in the entire apartment. With just enough money to pay the rent, it’s a luxury if the utilities are on. My two small children roll over to watch me as I straighten out the toddler mattresses on the floor where the three of us sleep.

“Momma, I’m hungry.”

My chest tightens, a visceral reaction to these words, because I know I cannot feed them what they need.

“Okay, baby.”

I leave the bedroom, making sure to quickly close the door behind me, and I’m hit with an icy chill. Shivering from the lack of heat, I walk into the kitchen knowing exactly what I would—and would not—find there.

Pancakes it is.

While I’m preparing the last of the mix, I realize that there is only enough for one person. I split the pancakes between two little napkins while my own stomach growls ferociously. I walk back into the bedroom. The food is gone almost as soon as I hand it to them.

“I’m still hungry, Momma.”

But I already know. I tickle them in hopes that they forget the churning feeling within their little bellies. My heart breaks.

Getting them ready for the doctor is more ritualistic than the everyday grind. I’m careful to part their hair perfectly, placing the curls into well-groomed styles. Then I pull out two brand new outfits—Christmas gifts from Grandma—that I was saving for a doctor’s appointment or a food pantry visit (whichever came first). I did not qualify for the local food pantry this month, so the doctor’s visit it is. Once my children look as perfect as possible—as normal as possible—we set out in the Volkswagen my sister gifted us. The gas is just about gone.

I think about the $70 I lost by missing work that day.

It is hard to miss the luxury vehicles in the doctor’s office parking lot, or the families tossing half-eaten breakfast sandwiches and lattes into the trash. Once we’re inside I watch a woman at the front desk rummage through crisp dollar bills, searching for one small enough for her co-pay. I think about the $70 I lost by missing work that day.

I’m anxious for the visit to be quick and painless. I know that the doctor will ask questions that I would rather leave unanswered. My children move sluggishly beside me.

“Momma, I’m hungry.”

With weak arms, I lift my smallest child and hold her close while I check in at the desk. After telling the nurse my children’s names and appointment time, I hurry to find a seat—trembling from the weight of my two-year-old child.

The nurse comes to take their weights and measurements, then shows us into Examination Room Three. I change them into the office robes without messing up their hair, and fold their new outfits with precision. As the doctor approaches, I start to worry about what he would say about their progress—or lack thereof—on the growth scale. Are they underweight? Am I a bad mother because I do not have more to give?

The doctor enters the room.

He is always polite, clean, and empathetic. He cares about the children he sees daily, and wants them all to grow healthily. Yet he is ignorant to the realities that the families face—or at least, to the one that my family is facing.

“All seems great,” the doctor says. “Is everything alright at home?”

“I’m just tired and hungry.”

“Me, too! Be sure to eat breakfast next time,” he says, blithely.

As we leave to go home, I listen to the music of my dwindling gas tank. There are 69 cents on my debit card, $12 on my food stamp card, and a week left in the month. My kids have fallen asleep, and I am already thinking about what I will feed them when they wake—singing an all-too-familiar song of hunger.

Trump Just Had a Princess Bride Moment

What People of Color Stand to Lose if Scott Pruitt Is Confirmed for the EPA

In the Shopping Cart of a Food Stamp Household: Not What the New York Times Reported

Trump Voters and I Have One Thing in Common: We’re Scared of Losing Medicaid

42 Million Americans Experience Hunger Each Year. I’m One of Them.

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