Why Don’t Americans Rise Up Against Unpopular Policy Like Medicare Cuts Anymore?

Congress has passed one of the most draconian cut to social safety net programs in modern American history. President Donald Trump proudly signed the bill into law. As a result of the legislation, which opponents agree is deeply destructive, over 11 million Americans will lose their health care coverage. Many rural hospitals will likely have to close their doors, thereby widening the health care deserts. Millions will lose access to food stamps. Educational services for lower-income and disabled children will shrink.

The big political question is whether the Republicans will face serious political repercussions for what they have done to the American people, red and blue, all to pay for the extension of supply-side tax cuts and a massive expansion of immigration control enforcement. Fiscal conservatism has nothing to do with the decision, as the legislation is going to blow a hole on the debt that Americans will be paying for over generations.

In an earlier era, political logic would dictate that Republicans would pay a steep price. Taking so many concrete goods away from a wide range of citizens, including those who make up the core of a political coalition, has traditionally been considered a bad idea. But will that fallout happen by 2026? The central political question is whether the GOP will face electoral consequences or once again escape them. In an age of hyperpolarization and media fragmentation, outrage has a shorter shelf life, attention spans are fractured, and accountability is harder to achieve.

In 1989, though, a Democratic Congress was forced to repeal a major new health care benefit, along with the taxes that had been included to pay for it. How did this come to pass, and why wouldn’t such a reversal happen now?

Throughout the 1980s, health care experts became increasingly concerned about the costs that elderly Americans were facing as a result of catastrophic medical situations, such as strokes, spinal cord injuries, and heart attacks. Medicare, created in 1965, did not cover most of those conditions. Elderly Americans and their families were forced to find other ways to pay for treatment.

In 1988, the Democratic Congress, working with President Ronald Reagan, decided to do something about the problem. Secretary of Health and Human Services Otis Bowen, who had been the chair of an advisory council in 1984 that recommended a policy response, crafted much of the proposal. After regaining control of the Senate back from the GOP in 1986, Democrats mobilized to pass the Medicare Catastrophic Coverage Act. They added benefits such as premium protection to support lower-income beneficiaries. The historic bill passed with sizable margins and substantial bipartisan support. The vote was 328 to 72 in the House; 86 to 11 in the Senate.

The legislation expanded coverage in a number of critical areas, including hospitalization and skilled nursing, hospice stays, home health care, respite care, and strict caps on hospital and doctors’ bills. Congress also included a prescription drug benefit for the first time in the program’s history.

Reagan had insisted that the benefits be self-financing. In response, Congress included higher premiums for Medicare Part B (the section of Medicare that covered doctors’ visits), and then, to cover the remaining two-thirds, a progressive surtax that would increase depending on the income of the beneficiaries. For the highest brackets, the maximum amount would be $800 on individuals and $1600 for couples.

“This legislation will help remove a terrible threat from the lives of elderly and disabled Americans,” Reagan stated upon signing the bill, “the threat of an illness requiring acute care, one so devastating that it could wipe out the savings of an entire lifetime.” The president explained that “it will be paid for by those who are covered by its services.” Overall, from the perspective of the administration, the measure seemed historic and politically beneficial.

Following passage of the bill, the architects of the program lost control of the debate. Opposition quickly mounted as the press reported on more of the details in the bill. “It blew up,” former Massachusetts Democrat Rep. Brian Donnelly, who opposed the measure, explained. “A lot of people in the United States already had this coverage. Almost every retired union member had the coverage through negotiated benefits.”

Some frustration stemmed from the bill’s design. Congress, for instance, had not included long-term hospital care. But the provision that generated the most heat was the tax increase. Although most Americans would never feel much of the burden of the surtax, opponents spread false information that every elderly citizen would have to pay the $800 surtax, a significant amount for working and middle-class Americans.

As news from the pollsters started to circulate, congressional Democratic leaders like House Speaker Jim Wright and Sen. Bentsen didn’t do much to push back. They assumed that emotions would settle, as they often did, and the elderly would rationally realize the immense benefits they would be receiving and gain a realistic understanding of the tax obligations.

The proponents were wrong, as their opponents blitzed the public with negative information. The National Committee to Preserve Social Security and Medicare, a liberal group chaired by President Franklin Roosevelt’s son James, launched a major campaign calling to end the new program. The group sent out misleading flyers, warning that their 5 million members should oppose the “seniors-only income tax increase,” which suggested the $800 maximum on individuals, or even the $1600 (which was for couples), would in fact fall on everyone who was over 65.

When the Congressional Budget Office (CBO) reported that costs would be much higher than legislators had originally predicted, public concern about costs accelerated. On Feb. 6, 1989, Republican Rep. Al McCandless, who had always opposed the legislation, introduced a bill to repeal the entire measure.

As legislators returned to their districts for the summer recess in August 1989, they were yelled and screamed at by voters who feared a mass tax on the elderly. “They thought retired people were sitting around doing their ceramics and their little aerobics classes in senior centers and wouldn’t give any fight,” explained a retired airline pilot in Las Vegas named Daniel Hawley. “Well, they found out differently.”

While Reagan had signed the bill, congressional Democrats faced most of the blowback. One of the program’s designers, House Ways and Means Chairman Dan Rostenkowski, was accosted by a group of seniors in front of the press. Late in the summer, “Rosti” was in Chicago to speak to constituents at the Copernicus Center about the program. He arrived to find that almost 200 people were packed inside the building waiting to grill him. Taking the temperature of the room, the chairman said he preferred to speak to a smaller group in a private setting. They refused.

Feeling that the confrontations would be politically damaging, Rostenkowski left the building. The constituents booed him. Some of the elderly protesters followed him out of the building. “Liar!” and “Recall!” they screamed. The geriatric protesters surrounded his car, pounding on his windows, yelling insults about what he had done. “He’s supposed to represent the people, not himself,” one woman screamed at the closed car window. The crowd surrounded the car in order to block it.

Unsure of what to do, Rostenkowski opened the door and quickly departed, walking down the street as the protesters and media trailed him. The image was one for the ages. At one point, he walked into a gas station, where his car was waiting to speed him away.

California Rep. Pete Stark, who served on the Ways and Means Committee, concluded that the law had been too complex and opened the door to misinformation. “I don’t think there are 300 members of the House who could tell you extemporaneously what Medicare benefits are.” Proponents of the law also admitted that they made a tactical mistake by scheduling the premiums to go up before anyone received benefits.

On Oct. 4, the House voted to repeal the Medicare Catastrophic Coverage Act 360 to 66. The Senate voted to repeal the surtax and many of the benefits while keeping unlimited hospital coverage. The vote was 99 to 0. During conference committee, senators gave way to the House and accepted its more stringent decision. Most of the law was erased from the books. President George H.W. Bush signed the repeal into law in December. “Rarely has a government program that promised so much to so many,” noted the New York Times, “fallen apart so fast.” Senate Majority Leader George Mitchell warned: “By repealing the legislation, we have not repealed the problem. The problem is bad and getting worse.”

Given the state of contemporary politics, it might be that Republicans don’t suffer the same fate as Democrats in 1989—despite legislation that will have a much greater effect on the well-being of voters without providing any benefit in return.

Democrats face an even greater information challenge. Republicans have consistently enjoyed more success in the contemporary media environment. The rapid pace of news in the attention economy makes conditions very different in 2025 than the late ’80s. The ability for any single issue, no matter how dramatic, to hold national news space for very long has diminished. Moving from one story to another at dizzying speed, with more people tuned out altogether from any common source of information, provides some degree of insulation to a party from being held accountable for its decisions. If the public is not paying attention, which Trump is very good at ensuring, elected officials tend to worry much less. Media stunts like the protest against Rostenkowski can go viral, but the scroll moves on.

Like the problems with Medicare Catastrophic, the design of the budget bill will help Republicans. Congress delayed most of the Medicaid cuts until after the 2026 midterms. Assuming partisan discipline and media amnesia, there are a number of other reasons that Trump’s party might be able to weather this storm.

Since the 1980s, Republicans have been pounding away at the idea that government is a bad thing when it comes to social services and support. Though the right has been more than comfortable using government issues like defense and policing, when it comes to helping middle-class and working Americans, Republicans have unleashed a fierce rhetoric about the dangers of dependency, fraud, and abuse. Even when Republicans backed away from cuts, the ideas endured. Dependency, fraud, and bloated government became bipartisan concerns. Many Democrats, as the historian Gary Gerstle argued in The Rise and Fall of the New Deal Order, have adopted their own version of this ideology. “The era of big government is over,” President Bill Clinton famously declared in his 1996 State of the Union address with House Speaker Newt Gingrich watching from behind feeling content.

For all of these reasons, Republicans are feeling, with justification, that they might be able to get away with the bill and avoid the turmoil Rostenkowski felt as he fled from a geriatric crowd.

Until Democrats figure out a strategy to break through this political environment through effective voter mobilization and public communications, they will watch, helpless, as the GOP dismantles programs they have built, waiting for their opponents to pay a price. One day, if the wreckage is complete, Democrats may realize they fought the battles of 2025 with the instincts of 1989 and lost the house that FDR and LBJ built.