~~ recommended by emil karpo ~~
February 13, 2026
Brian Stukes/Getty Images/Caring Across Generations
Eight thousand candles lit on the National Mall by a coalition of caregiver groups to represent the close to eighty million Americans who depend on Medicaid, Washington, D.C., July 23, 2025
One year ago President Donald Trump promised to “love and cherish” Medicaid. Alas, his affection for the public insurance program was short-lived. The so-called One Big Beautiful Bill Act (OBBA) he signed into law on July 4—the most sweeping health care legislation since Barack Obama’s 2010 Affordable Care Act (ACA)—slashes about $1 trillion in federal health care spending, mostly from Medicaid, over the coming decade. The spending reductions fund tax cuts for the wealthy and a surge in spending on immigration enforcement.
As an ICU physician at a safety-net hospital system that largely serves publicly insured, low-income communities north of Boston, I may see some of the effects of the law’s cuts firsthand. Around half of our system’s gross patient revenue comes from Medicaid, which covers more than 70 million Americans. What these cuts will mean for hospitals like mine is uncertain: some providers could face severe financial strain or even closure if Medicaid revenues plunge. But for Medicaid enrollees themselves, there is little doubt that the cuts will translate into inadequate care, increased debt, doctor visits avoided, prescriptions left unfilled, and chronic diseases left unmanaged, resulting in health crises and even, in some cases, preventable deaths. I might see the latter parts of this sequence in the ICU, where an uninsured patient could, for instance, arrive short of breath, with a sputtering heart, swollen brain, or failing kidneys, because of years of untreated high blood pressure.
https://www.youtube.com/watch?
The Congressional Budget Office estimates that the OBBBA’s welter of cuts will increase the number of Americans without health coverage by some 10 million. For instance, a provision that makes enrollment into Medicaid more cumbersome will leave approximately 400,000 more people without coverage by 2034. Another that forces participants to undergo a reassessment of their eligibility every six months rather than annually will separate roughly 700,000 from health care. And one that restricts states’ ability to raise funds for Medicaid by taxing health care providers will leave 1.1 million more uninsured. But the law’s most punitive component—one rooted in the Elizabethan Poor Law tradition of separating the “deserving” from the “undeserving” poor—is the provision imposing work requirements that will compel nearly 20 million beneficiaries to regularly document time spent working (or a qualifying exemption). Precedents in Arkansas and Georgia show that such requirements mostly dump people from coverage by forcing them to clear onerous administrative hurdles—with significant cost to taxpayers, given the need for expensive new bureaucracies. All in all, a shockingly large number of Americans will find themselves affected: in a study published in the Annals of Internal Medicine last year, my colleagues David Himmelstein, Steffie Woolhandler, and I projected that, together, the Medicaid cuts included in a late version of the bill could lead to nearly two million patients losing their personal physician, 380,000 not getting mammograms, 1.2 million accruing additional medical debt, and 16,000 dying preventable deaths.
These cuts cannot be reversed fast enough. But whenever the political conditions shift, turning back the clock won’t suffice. Medicaid’s origins lie in a state-centric welfare model ideologically predicated on the same distinction between the “deserving” and the “undeserving” that underpins the Trump administration’s new work requirements. Since its inception, this model has constrained the program’s benefits and made it more vulnerable to attack from the political right. We need to restore Medicaid, and to improve it—but the best way to advance its mission in the long term would be to replace it with something better.
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