People making 20k a year don't have to make choices like food or medicine. Medicaid covers them at 100% without any premiums or co-pays/ co-percentages or pre-authorization. It's the the middle class that worries about budgeting every day. Those working less and earning less are covered at 100% for nothing. Likewise, food stamps cover their food and are similarly paid for by but not available to the working middle class, which is constantly squeezed with bleeding heart stories about how the poor suffer and middle class doesn't pay their own way.