Marilyn” is a 40-year-old woman who has lived in Maine her entire life. She is a mother, a grandmother, a wife and an active member of her various communities. She is also a woman living with HIV. Because of the health care and the drugs Marilyn receives as a beneficiary of MaineCare (Maine’s Medicaid program), she is a healthy and productive community member, able to work, care for herself, her family and her friends. Without MaineCare, Marilyn could soon lose her hard-won health and become disabled, dependent and could even die.

In early 2005, Marilyn and many other Maine residents face a real threat to their health and their health care. President Bush has never met Marilyn but he has proposed to cut Medicaid, the health care program that Marilyn and more than 260,000 Maine residents depend on, by $60 billion over the next 10 years. On March 7, Congress begins its budget process. The decisions made by the House and Senate budget committees, decisions that are expected as early as the first week of the process, will determine the depth of the cuts to the Medicaid program and whether Marilyn and others like her will get the essential, life-saving health care they rely on.

The decisions made by Congress in March – whether or not to accept the president’s proposed cuts to Medicaid – could also leave Congress with no alternative but to cap portions of the program later in the year. Such caps would change the very nature of Medicaid, the country’s health care safety net, serving the neediest low-income Americans with guaranteed comprehensive coverage.

Cuts to Medicaid or caps on portions of the program would hit states hard. Many states, including Maine, are already limiting Medicaid benefits and eligibility and would be forced to find deeper cuts in their programs. In turn, many low-income Americans, including those living with HIV-AIDS, could lose some or all of their health care.

Some people have argued that Medicaid should be cut because spending is out of control. Nothing could be farther from the truth. In the past few years, per-person spending in the private insurance market grew at almost twice the rate of Medicaid, despite the fact that Medicaid serves a much needier population. Medicaid costs are going up because enrollment is increasing as more employers drop private insurance coverage and unemployment rises. Rather than cutting Medicaid, the president and Congress should be focusing on expanding access to the private insurance system.

With all this talk of state budgets and federal programs, it’s easy to lose sight of how Medicaid cuts could affect real-life Americans, but that’s what we’re concerned about: 53 million Americans for whom, like Marilyn, Medicaid coverage is a life and death issue.

And many others are concerned too. A range of voices – from governors and senators, consumer advocates and people living with life-threatening and chronic illnesses to medical and nonmedical providers of care – are fighting against the Administration’s proposal. Governors, who know well the importance of Medicaid to their states and their constituents, appear to be rejecting the President’s proposed cuts to this lifesaving program. They have already sent a letter to President Bush opposing harmful cuts to Medicaid.

All Democratic senators signed on to a letter urging no cuts and caps in Medicaid. Consumer groups from Families USA to the HIV Medicaid and Medicare Working Group have collected signatures on letters in opposition to cuts, urged constituents to make calls to their elected officials, and organized visits to elected officials to explain the importance of this program and the harmful effects of cuts and caps. People living with HIV and other chronic and life-threatening diseases have rallied, written letters, made calls, and visited their elected officials.

Medicaid serves more than 50 percent of people with AIDS, 90 percent of children with AIDS and currently 53 million vulnerable Americans. The President’s proposed cuts have elicited an outcry of opposition from everyone who understands the importance of this program. Sens. Olympia Snowe and Susan Collins have been effective advocates for people with Medicaid coverage and we encourage their continued leadership in opposing cuts to this program during the critical budget resolution process. Medicaid is a promise made by the American government to its most vulnerable citizens nearly 40 years ago. This Congress can’t be the one that reneges on that life-saving promise.

Laurie Eddy, MSN, FNP, is executive director of the Eastern Maine AIDS Network.