As congressional Republicans work on a massive bill that enacts much of President Donald Trump’s agenda, one of the biggest points of contention is potential cuts to Medicaid, the joint federal and state program that has provided health insurance for low-income Americans since 1965. Today, it provides coverage for 20% of Americans—72 million people.

The original budget passed by House Republicans called for steep spending cuts which experts said were nearly impossible without slashing Medicaid spending. While Trump has repeatedly vowed that Medicaid cuts are off the table, House Republicans have continued to debate potential cuts.

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There is broad consensus among economists and public health experts that large cuts to Medicaid—which House hardliners seem to be demanding as their price to enact Trump’s tax cuts and extensions—will have dire consequences for healthcare outcomes and the finances of low-income families.

But to fully comprehend what slashing Medicaid spending would mean for the millions of people who depend on it, Americans need to understand the creation and evolution of the program, its relationship to the broader healthcare and political landscape, and the human cost of prior budgetary rollbacks.   

The history of Medi-Cal, California’s Medicaid program and the largest and most expansive such program in the country, provides this crucial background. It shows how Medicaid is the byproduct of battles among grassroots activists, policymakers, corporate employers, trade associations, physicians, insurance companies, and labor unions. Despite its many flaws and limitations, the system that emerged from these fights is a triumph of social care within a notoriously fractured, privatized, and stratified national healthcare system.

Medi-Cal’s history illuminates why Medicaid is worth not only saving but strengthening—and it warns that past efforts to roll back Medicaid funding have resulted in disastrous human costs.

Medi-Cal, and Medicaid more broadly, emerged out of larger struggles over healthcare in the 1930s and 1940s. Despite intense lobbying........

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