As summer approaches, millions of Americans begin planning or taking trips to state and national parks, seeking to explore the wide range of outdoor recreational opportunities across the nation. A lot of them will head toward the nation’s wilderness areas – 110 million acres, mostly in the West, that are protected by the strictest federal conservation rules.

When Congress passed the Wilderness Act in 1964, it described wilderness areas as places that evoked mystery and wonder, “where the earth and its community of life are untrammeled by man, where man himself is a visitor who does not remain.” These are wild landscapes that present nature in its rawest form.

The law requires the federal government to protect these areas “for the permanent good of the whole people.” Wilderness areas are found in national parks, conservation land overseen by the U.S. Bureau of Land Management, national forests and U.S. Fish and Wildlife refuges.

In early May 2025, the U.S. House of Representatives began to consider allowing the sale of federal lands in six counties in Nevada and Utah, five of which contain wilderness areas. Ostensibly, these sales are to promote affordable housing, but the reality is that the proposal, introduced by U.S. Rep. Mark Amodei, a Nevada Republican, is a departure from the standard process of federal land exchanges that accommodate development in some places but protect wilderness in others.

Regardless of whether Americans visit their public lands or know when they have crossed a wilderness boundary, as environmental historians we believe that everyone still benefits from the existence and protection of these precious places.

This belief is an idea eloquently articulated and popularized 65 years ago by the noted Western writer Wallace Stegner. His eloquence helped launch the modern environmental movement and gave power to the idea that the nation’s public lands are a fundamental part of the United States’ national identity and a cornerstone of American freedom.

Humble origins

In 1958, Congress established the Outdoor Recreation Resources Review Commission to examine outdoor recreation in the U.S. in order to determine not only what Americans wanted from the outdoors, but to consider how those needs and desires might change decades into the future.

One of the commission’s members was David E. Pesonen, who worked at the Wildland Research Center at the University of California at Berkeley. He was asked to examine wilderness and its relationship to outdoor recreation. Pesonen later became a notable environmental lawyer and leader of the Sierra Club. But at the time, Pesonen had no idea what to say about wilderness.

However, he knew someone who did. Pesonen had been impressed by the wild landscapes of the American West in Stegner’s 1954 history “Beyond the Hundredth Meridian: John Wesley Powell and the Second Opening of the West.” So he wrote to Stegner, who at the time was at Stanford University, asking for help in articulating the wilderness idea.

Stegner’s response, which he said later was written in a single afternoon, was an off-the-cuff riff on why he cared about preserving wildlands. This letter became known as the Wilderness Letter and marked a turning point in American political and conservation history.

Pesonen shared the letter with the rest of the commission, which also shared it with newly installed Secretary of the Interior Stewart Udall. Udall found its prose to be so profound, he read it at the seventh Wilderness Conference in 1961 in San Francisco, a speech broadcast by KCBS, the local FM radio station. The Sierra Club published the letter in the record of the conference’s proceedings later that year.

But it was not until its publication in The Washington Post on June 17, 1962, that the letter reached a national audience and captured the imagination of generations of Americans.

An eloquent appeal

In the letter, Stegner connected the idea of wilderness to a fundamental part of American identity. He called wilderness “something that has helped form our character and that has certainly shaped our history as a people … the challenge against which our character as a people was formed … (and) the thing that has helped to make an American different from and, until we forget it in the roar of our industrial cities, more fortunate than other men.”

Without wild places, he argued, the U.S. would be just like every other overindustrialized place in the world.

In the letter, Stegner expressed little concern with how wilderness might support outdoor recreation on public lands. He didn’t care whether wilderness areas had once featured roads, trails, homesteads or even natural resource extraction. What he cared about was Americans’ freedom to protect and enjoy these places. Stegner recognized that the freedom to protect, to restrain ourselves from consuming, was just as important as the freedom to consume.

Perhaps most importantly, he wrote, wilderness was “an intangible and spiritual resource,” a place that gave the nation “our hope and our excitement,” landscapes that were “good for our spiritual health even if we never once in ten years set foot in it.”

Without it, Stegner lamented, “never again will Americans be free in their own country from the noise, the exhausts, the stinks of human and automotive waste.” To him, the nation’s natural cathedrals and the vaulted ceiling of the pure blue sky are Americans’ sacred spaces as much as the structures in which they worship on the weekends.

Stegner penned the letter during a national debate about the value of preserving wild places in the face of future development. “Something will have gone out of us as a people,” he wrote, “if we ever let the remaining wilderness be destroyed.” If not protected, Stegner believed these wildlands that had helped shape American identity would fall to what he viewed as the same exploitative forces of unrestrained capitalism that had industrialized the nation for the past century. Every generation since has an obligation to protect these wild places.

Stegner’s Wilderness Letter became a rallying cry to pass the Wilderness Act. The closing sentences of the letter are Stegner’s best: “We simply need that wild country available to us, even if we never do more than drive to its edge and look in. For it can be a means of reassuring ourselves of our sanity as creatures, a part of the geography of hope.”

This phrase, “the geography of hope,” is Stegner’s most famous line. It has become shorthand for what wilderness means: the wildlands that defined American character on the Western frontier, the wild spaces that Americans have had the freedom to protect, and the natural places that give Americans hope for the future of this planet.

America’s ‘best idea’

Stegner returned to themes outlined in the Wilderness Letter again two decades later in his essay “The Best Idea We Ever Had: An Overview,” published in Wilderness magazine in spring 1983.

Writing in response to the Reagan administration’s efforts to reduce protection of the National Park System, Stegner declared that the parks were “Absolutely American, absolutely democratic.” He said they reflect us as a nation, at our best rather than our worst, and without them, millions of Americans’ lives, his included, would have been poorer.

Public lands are more than just wilderness or national parks. They are places for work and play. They provide natural resources, wildlife habitat, clean air, clean water and recreational opportunities to small towns and sprawling metro areas alike. They are, as Stegner said, cures for cynicism and places of shared hope.

Stegner’s words still resonate as Americans head for their public lands and enjoy the beauty of the wild places protected by wilderness legislation this summer. With visitor numbers increasing annually and agency budgets at historic lows, we believe it is useful to remember how precious these places are for all Americans. And we agree with Stegner that wilderness, public lands writ large, are more valuable to Americans’ collective identity and expression of freedom than they are as real estate that can be sold or commodities that can be extracted.

Leisl Carr Childers, Associate Professor of History, Colorado State University and Michael Childers, Associate Professor of History, Colorado State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Republicans in Congress intend to cut about US$880 billion in federal health care spending.

One of their primary targets is Medicaid. That government program covers 82 million Americans with health insurance. Most of the people enrolled in the program are low income, have disabilities, or both.

Medicaid, jointly funded by the federal government and the states, is also the biggest funder in the U.S. of long-term care services, whether they are delivered in the patient’s home, another location where they spend part of their day or a nursing home. That makes it particularly important for older adults and those with disabilities. All states must meet the basic federal guidelines for Medicaid coverage. But 41 states have opted to take advantage of the Affordable Care Act provision that expanded eligibility to cover more people under the program.

We are gerontology researchers who study health and financial well-being in later life. We’ve been analyzing what the potential impacts of Medicaid cuts might be.

While the debate about how to reduce the budget focuses largely on dollars and cents, we believe that cutting federal spending on Medicaid would harm the health and well-being of millions of Americans by reducing their access to care. In our view, it’s also likely that any savings achieved in the short term would be smaller than the long-term increase in health care costs born by the federal government, the states and patients – including for many Americans who are 65 and older.

Weak track record

Wary of backlash from their constituents, Republicans have agreed on a strategy that would largely cut Medicaid spending in a roundabout way.

Previous efforts by the GOP in some states, such as imposing work requirements for some people to get Medicaid benefits, have not greatly reduced costs. That’s largely because there are relatively few people enrolled in the Medicaid program who are physically able to be employed and aren’t already in the workforce. Nor have past efforts to reduce fraud, waste and abuse led to significant savings.

According to widespread media reports, Republicans are considering changes that would cut the amount of money that the federal government reimburses states for what they spend on Medicaid.

In May 2025, the nonpartisan Congressional Budget Office estimated that 8.6 million Americans would lose their health insurance coverage should the GOP proposal become law.

Historically, states have dealt with budget cuts by reducing their payments to health care providers, limiting eligibility or restricting benefits. These reductions all particularly affected home- and community-based services that many disabled and older adults rely on.

About 3 in 4 of the people with Medicaid coverage who receive long-term care through the program get that care at home, in their communities or both, rather than residing in a nursing home. States save an estimated 26 cents for every dollar spent on those services delivered outside nursing homes.

Losing coverage can be harmful for your health

We recently analyzed data from a nationally representative study of approximately 6,000 people who had Medicaid coverage but lost it when they turned age 65 because their income exceeded 100% of the federal poverty level. In 2025, that cutoff is about $15,560 for a single person and $21,150 for a couple.

Medicaid income eligibility generally drops from 138% to 100% of the federal poverty level at age 65 once Medicare becomes a person’s primary health insurer.

The people who participated in the study had lost their Medicaid coverage upon turning 65 between 1998 and 2020. Our team followed the experiences of these participants over a 10-year period starting at age 65 to see how they fared compared with people who continue to be enrolled in Medicaid after their 65th birthday.

What we found was both surprising and disturbing.

Fewer activities of daily living

Over the decade following that milestone, the people who lost their Medicaid coverage had more chronic conditions and could perform fewer activities of daily living, such as bathing and getting dressed, without any assistance as compared with those who still had Medicaid coverage. In addition, they were twice as likely to experience depression and be in fair or poor health.

As people’s health worsened, they also went to the hospital more often and stayed there longer. They also used outpatient surgery services more frequently.

These services are particularly expensive for the health care system. Depending on the service, it may also be costly for patients. Unlike the comprehensive coverage of Medicaid, the Medicare program fully covers only inpatient hospitalizations, short-term nursing facility care, hospice, some short-term home care, annual wellness visits, vaccines and some basic preventive care. Beyond that, Medicare requires the payment of premiums to help with uncovered services that can also include deductibles and copays.

This arrangement can lead to significant out-of-pocket costs that make health care hard for low-income older adults to afford unless they have both Medicare and Medicaid coverage.

We also found that older people who lost Medicaid coverage were less likely to see their primary care physician for routine and follow-up care, despite being enrolled in Medicare. This explains in part why they are going to the hospital more often, likely avoiding routine health care that may incur out-of-pocket costs and eventually utilizing Medicare-covered hospital care when needed.

In short, we found that exiting the Medicaid program upon turning 65 actually leads to an increase in the use of some of the most expensive health care services, such as inpatient hospitalization and outpatient surgery. So although Medicaid may no longer pay for these costs, the rest of the health care system does.

Just under 90% of older adults enrolled in Medicare have some kind of supplemental coverage that helps them pay for services that the program doesn’t cover. For 16% of the people with Medicare coverage, Medicaid covers those additional health care costs. The rest of that nearly 90% obtain supplemental coverage from private insurance companies or are enrolled in a Medicare Advantage plan that’s run by a private company instead of the government.

However, 11% of Americans covered by Medicare don’t have any additional coverage. It is likely that those who lost Medicaid benefits at age 65 may not be able to afford any other supplemental coverage options and fall into this group.

People who lose Medicaid coverage may die sooner

One of our more troubling findings was that people who lost Medicaid coverage at age 65 were 14% more likely to die within the next 10 years than were those who kept their coverage in addition to gaining Medicare coverage. This was true even though the people who lost their Medicaid access tended to start out in better health.

Roughly 12 million Americans are enrolled in both Medicare and Medicaid today. Much is at stake for them and other low-income people as Congress considers making major changes to the program to cut federal spending on it.

For some Americans, it’s a matter of life and death. For others, it’s a matter of healthy versus unhealthy aging that leads to costlier health care not just for themselves but for the U.S. as a whole.

Jane Tavares, Senior Research Fellow and Lecturer of Gerontology, UMass Boston and Marc Cohen, Professor of Gerontology, UMass Boston

This article is republished from The Conversation under a Creative Commons license. Read the original article.