Trump's Beautiful Bill is Ugly when it comes to Health Care

The One Big Beautiful Bill Act, as the Republicans have named the reconciliation legislation that they are about to approve, will lay waste to a considerable part of the American healthcare system. It will do this by cutting more than a trillion dollars of healthcare spending. Most Americans are not prepared for this because most Americans have no idea that it is about to happen. As I pointed out in a post two days ago, polling by Priorities USA posted on X by Sam Stein shows that "Nearly half (48%) of Americans haven’t heard anything about the ‘Big, Beautiful Bill’" and "Only 8% of all Americans name Medicaid cuts as a detail of the bill they have heard about."

Americans can be forgiven for their ignorance on this topic. Just about everyone shares blame for failing to inform them. Republican officials have outright lied about what they are doing, insisting that they are only eliminating "waste, fraud, and abuse" and not actually taking healthcare away from their constituents. The media has all but ignored the cuts, with cable news channels often focused on the Sean Combs/Diddy trial rather than the legislation being debated at the same time. Even Democrats have devoted their time to criticizing Zohran Mamdani, the Democratic nominee for Mayor of New York City. Just yesterday, while Capitol Hill was fixated on debate over the One Big Beautiful Bill, Democratic Representative Tom Suozzi took to the pages of the Wall Street Journal, not to criticize the bill — in fact, he didn't even mention it — but to criticize Mamdani.

Even cult leader, convicted felon, and failed President Donald Trump appears to be unaware that the reconciliation bill — something that he has been twisting Republican arms to get passed — has Medicaid cuts. According to NOTUS:

But Trump still doesn’t seem to have a firm grasp about what his signature legislative achievement does. According to three sources with direct knowledge of the comments, the president told Republicans at this meeting that there are three things Congress shouldn’t touch if they want to win elections: Medicaid, Medicare and Social Security.

"But we’re touching Medicaid in this bill," one member responded to Trump, according to the three sources.

It is not surprising that Trump is uninformed. Republicans have been doing everything within their power to obscure their actions. Even today, the White House website has a "Myth vs Facts" document that denies that Americans will be kicked off Medicaid. This is flat out wrong. According to KFF, 11.8 million Americans will lose health insurance as a result of the OBBB Act, with "most of the drops in health insurance coverage resulting from the Senate version of the bill would come from Medicaid cuts." While Trump may be unaware of the Medicaid cuts, those voting to approve them are fully aware. Alaskan Senator Lisa Murkowski traded her vote in favor of the Act for an exception for Alaska from the Medicaid cuts (as well as cuts to SNAP funding). She was willing to let other states suffer the loss of funding, but not her state. After Democrats intervened, the Senate Parliamentarian ruled that the Medicaid concession could not be included as part of reconciliation and, therefore, Alaskans will get to experience the same healthcare cuts as the rest of us.

One of the reasons that Americans may not be as concerned about the Medicaid cuts as they probably should be is that most probably don't know how widely Medicaid is used. Many who currently rely on Medicaid may not even know it. In most states, Medicaid is not even called Medicaid. Here in the District of Columbia, it is called "Healthy Families". In Virginia, it is called Cardinal Care, and in Maryland its name is "Medical Assistance". Individuals currently enrolled in those programs are probably going through life oblivious to the dangers their healthcare faces from the Republican legislation.

The American Prospect recently published what to me was an eye-opening article about Medicaid. The article argues that "Medicaid is not a marginal welfare benefit. It’s infrastructure. It’s the connective tissue of the U.S. health care system. Its footprint is wide, but its visibility is low." The article goes on to say:

Many beneficiaries don’t realize that the programs they rely on—like home health services for an aging parent, behavioral health access, or school-based mental health support—are funded through Medicaid. Many don’t know that Medicaid pays for 41 percent of all births, and supports over 30 percent of all behavioral health funding. Many are unaware that it is the largest payer for long-term care.

While the impact of Medicaid cuts is primarily felt by individuals through loss of coverage, the result can affect an entire community. As the Prospect article points out, hospitals suffer from the loss of Medicaid funding. "According to a report from the Center for Healthcare Quality and Payment Reform, over 25 percent of rural hospitals are at risk of closure nationwide, and in 11 states, that number rises to 50 percent." These are primarily in areas that voted for Trump. The Republicans supporting the OBBB Act were almost universally voting to take healthcare away from their own constituents. They have tried to soften that blow by including a fund for rural hospitals. But the $50 billion allocated will not go nearly far enough. Hospitals will close.

Just today, local news outlets in Nebraska are reporting on the closure of Curtis Medical Center in Curtis, Nebraska, a town of about 900 people. It is the only health care provider in the community. The hospital's CEO was quoted as saying, "Unfortunately, the current financial environment, driven by anticipated federal budget cuts to Medicaid, has made it impossible for us to continue operating all of our services, many of which have faced significant financial challenges for years". The article notes that "The Nebraska Hospital Association has been pushing back against Medicaid cuts in the ‘One Big Beautiful Bill’ being considered in Congress." Nebraska Public Media quoted the executive director for the Nebraska Rural Health Association as saying, "We currently have six hospitals that we feel are in a critical financial state...We would likely see the closures within a year to two years of once [the bill is] fully enacted." The $50 billion for rural hospitals may be able to paper over these problems for the short term, but the underlying issues will remain the same. Moreover, the fund will do nothing for urban and suburban hospitals, which will also come under financial pressure.

The funding complexities of Medicaid and other healthcare programs are complex and, frankly, boring. For a media addicted to attracting clicks, it is probably not a very promising topic. Yet, the failure to educate the public about the cuts being made to healthcare by Trump's bill is going to lead to widespread rude awakenings. It is understandable that Republicans are trying to hide what they are doing. Trump probably has the believable excuse of ignorance. But Democrats have almost entirely missed the boat (Alexandria Ocasio-Cortez, who has consistently beaten the drum about this, is an exception). Sadly, demonstrating the state of today's Democratic Party, we will probably be hearing far too much about these cuts in coming days as Democrats base fundraising appeals on them. Democrats seem to be far more interested in raising money off of legislative losses than achieving legislative wins.