In a hard-hitting New York Times op-ed on Friday, senior New York Democratic Rep. Steve Israel put all of Washington on notice. He is fed up with campaign fundraising. He joins Sen. Barbara Mikulski, D-Md., this year and Sen. Tim Johnson, D-S.D., last year in retiring from Congress. They’ve had enough of shaking down America’s superrich.

Corporate lobbyists and wealthy activists dictate much of American politics today. In the 2012 presidential race, 0.01 percent of Americans contributed almost 30 percent of the money spent in that entire election cycle. Corporations spend billions of dollars annually on lobbying. America’s big spenders exert tremendous influence over elected leaders and have dramatically different priorities from everyday citizens.

Nowhere is that clearer than in the political battle over the Affordable Care Act’s Medicaid expansion, which exemplifies how very wealthy political donors impair access to health care.

The law raised the income threshold for low-income Americans to qualify for Medicaid. Households with income up to 138 percent of the federal poverty line are eligible. However, the Supreme Court ruled this provision optional for states. For states that expand Medicaid, the federal government picks up all costs to cover additional Medicaid populations until 2017. States pick up 5 and then 10 percent of the tab thereafter.

Twenty states have failed to expand Medicaid, leaving 3.1 million Americans uninsured. With a new executive order in Louisiana, the number will fall to 19 states, and an additional 200,000 Americans will eventually become insured.

Medicaid expansion is vital. If it were expanded in every state, it could have prevented 7,115 to 17,104 unnecessary deaths and 240,700 racked-up catastrophic medical bills each year.

Expansion also saves money. With it, states could spend far less on uncompensated emergency care. If Pennsylvania alone expanded Medicaid coverage, Rand Corp. economist Carter Price found that it could add $3 billion to the state’s GDP and create 35,000 jobs.

Yet expansion is being held up because of politics. New research shows that Charles Koch and David Koch’s advocacy group Americans for Prosperity is having great success blocking state Medicaid expansion. The organization’s 34 state chapters currently spend large sums to build its grass-roots advocacy and place political ads. It’s paying off in Florida, where Gov. Rick Scott has all but retreated on his openness to expand Medicaid to cover 567,000 low-income Floridians.

This trend is unfortunate, because there’s fertile ground for Medicaid expansion nationwide. New research suggests if public health activists could better mobilize, they could pressure lawmakers to expand Medicaid. Citizen advocates can trump the austerity-first agendas of billionaire-financed interest groups. They simply have to organize better.

The priorities of rich donors are out of line with voters. Brian Schaffner’s analysis from the 2014 cooperative congressional election study shows a large gap in opinion about Medicaid expansion between the average GOP supporters and the richest among them. Sixty-two percent of nondonor Republicans surveyed said they would refuse the Medicaid expansion, compared with 77 percent of donors who gave much more than $1,000.

Opposition to Medicaid Expansion

Medicaid expansion aside, the political influence of the extremely rich undercuts American health care.

A study of wealthy Americans by political scientists Benjamin Page, Larry Bartels and Jason Seawright finds that while average Americans favor national health insurance, which would be publicly financed on the basis of one’s ability to pay, only 32 percent of the wealthy surveyed said they support the policy, compared with 61 percent of all Americans. When asked if average Americans were willing to “pay more taxes in order to provide health coverage for everyone,” 41 percent of the rich said yes, compared with 59 percent of the general public.

Views on Health Care

Donations from the wealthy and corporate contributions for lobbyists have also resulted in attacks on Medicare, the half-century-old national health insurance program for seniors and people with special needs. Raising Medicare’s eligibility age from 65 to 67 is a frequency cited idea among the current crop of Republican presidential candidates, even though it would dramatically curb health access for seniors. It’s not crazy to expect House Speaker Paul Ryan to sneak it into this year’s budget. President Barack Obama even offered it as part of a large budget deal in 2011.

This policy would force people off their health coverage, particularly in states that have not expanded Medicaid. An estimated 435,000 seniors would lose coverage by 2021 if the eligibility age were raised. If the eligibility age had been raised in 2014, seniors would have had to pay $3.7 billion more in out-of-pocket costs that year, preventing many of them from obtaining necessary treatments.

Most troubling is that this proposal would increase overall health care spending. Medicare is much better at controlling costs than private insurance, and it has lower administrative costs. Individuals kicked off Medicare likely would get private coverage, and their health care bills would add to overall U.S. health care spending. Thus any Medicare savings achieved by increasing the eligibility age would be canceled out. The Center for American Progress found that raising Medicare’s eligibility age would cost individuals, businesses and states twice as much as the federal savings suggested by the reform.

Though a large majority of Americans opposes raising the retirement age, it remains a fixture in health and federal budget discussions. Why? Because the policy has a powerful big money constituency in Washington. Most trade associations share the interests of their wealthy members: recklessly shrinking federal spending in the name of balancing the budget and eliminating tax obligations, no matter the consequences to the economy and public health.

Trade associations have outsize lobbying muscle. According to a seven-month analysis in 2014 by the Center for Public Integrity, nearly 85 percent of corporate donations for lobbying flowed to trade associations. For every dollar spent on lobbying on behalf of labor unions or citizen interests, corporations and their associations spend $34. Of the 100 organizations that spend the most on lobbying, 95 consistently represent business.

Lobbying to gut Medicare and Social Security is a long-standing problem. Since 1998, the top three health care industry groups have spent three times as much on lobbying as AARP. The Business Roundtable and the U.S. Chamber of Commerce are the biggest spenders year after year. Both advocate raising the Medicare eligibility age.

There are ways to improve and save Medicare that align with citizens’ interests. We could lower the Medicare age to boost its solvency and achieve better health outcomes. We could save Medicare billions of dollars by allowing it to negotiate the price of prescription drugs. We don’t have to slash benefits and curb access for our hard-working seniors.

As candidates parade around the nation rattling their cups at $40,000-a-plate fundraising dinners, the health of American democracy worsens. When industry-sponsored evening banquets blanket the first 100 days of the next president, we will all suffer.

Many solutions can address the concentrated role big money plays in our politics. Public funding of campaigns is one way to renew the people’s faith in our elections because it would create a more level playing field, allowing a wider range of candidates to compete. At a minimum, we should empower voters by mandating disclosure of all contributions.

The very rich’s austerity agendas are literally killing people. It’s imperative we take the required steps to restore confidence in our democracy.

Originally published by Al Jazeera America