Historians cite a relatively modest number of Americans as key figures in the struggle to provide decent health coverage to all. Any accounting of these “health care heroes” would certainly feature President Lyndon Baines Johnson who signed the Social Security Amendments into law 60 years ago giving birth to Medicare and Medicaid. Perhaps less well known but just as instrumental was Wilbur J. Cohen, a former adviser to the Social Security commissioner who was one of the principal architects of that legislation.

More recently, Barack Obama’s expansion of Medicaid under the Affordable Care Act is believed to have helped decrease mortality rates, particularly among low-income adults who might otherwise have been unable to pay for a cancer screening or for medical help with a substance use disorder or a mental health affliction. That puts the 44th U.S. president high on that heroes list, too.

Could the next entry into this distinguished pantheon be Donald John Trump?

That would have seemed unlikely a year ago when Trump and many of his fellow Republicans spoke openly about weakening or repealing the ACA. But the ranks seem now divided. While many GOP members of Congress seek deep cuts to Medicaid to help pay for President Trump’s tax cuts, Trump himself is reportedly opposed. Even as Elon Musk and his Department of Government Efficiency targeted federal health care spending in recent weeks, Trump pledged not to cut Medicare, Medicaid and Social Security. Trump not Musk, is the decider.

Medicare and Social Security are obvious choices for drawing such a line. Both are exceptionally important to seniors, an important voting bloc. It’s why retiree benefits are sometimes referred to as the “third rail” of politics — meaning its untouchable like the high-voltage rail on subway lines. Medicaid? That’s a program benefitting lower-income, politically inactive Americans. But with the ACA expansion, the joint state-federally-funded program now assists some 70 million including 40% of all children and 60% of all nursing home residents, an arresting voting bloc.

Denying vital health care to that sizable number– particularly to fund finance tax breaks for billionaires—could be politically ruinous. President Trump gets that. Red state Republicans who may be less concerned about the hardships — and the reverse-Robin Hood nature of the arrangement — may not. Or at least they are more interested in paying for those tax cuts along with bolstering border security and defense spending.

Maryland has more than a passing interest in the outcome of this intraparty dispute. It is not only home to Medicaid (or more precisely, the Centers for Medicare & Medicaid Services in Woodlawn) but lawmakers fear a proposed $880 billion cut to the program which now is available to households earning within 138% of the poverty line might open a $16 billion hole in the state budget over the next decade.

Considering how Gov. Wes Moore and state lawmakers struggled this year to close a $3.2 billion budget deficit, one can only imagine the painful choices ahead. It might also leave more than 400,000 Marylanders without health insurance.

It’s one thing to ask Americans to make reasonable sacrifices. President Trump spoke recently about how many dolls parents can afford to give their children as presents while toy prices rise under his tariffs (“Maybe the children will have two dolls instead of 20,” he suggested during a cabinet meeting last Wednesday). But it’s quite another to tell millions they can’t get health care. And mostly because you want to pay for war ordnance or perhaps a new makeup studio in the Pentagon or marching bands.

That leaves Maryland’s top elected leaders in a curious position: On this issue, Gov. Wes Moore and others need to take Trump’s side. Oh, standing up for Medicaid should be easy. Acknowledging that they have an ally in the White House? Not quite so comfortable a fit for Maryland Democrats who have generally been excoriating this administration’s first 100 days from tariffs to deportations.

How about divorcing politics from policy on this occasion when lives are at stake? Would it be too much for U.S. Rep. Andy Harris, the state’s lone Republican in Congress, to join the Trump chorus, particularly as a medical professional who must understand this reality? So far, the Freedom Caucus chair is claiming it isn’t a cut at all.

The words of Mahatma Gandhi are worth pondering: “The true measure of any society can be found in how it treats its most vulnerable citizens.”