America’s health care system is imperfect. Too many people lack coverage; health care is too difficult to afford; and access to care is inequitable. But, for 60 years, a key source of health care coverage for 1 in 5 Americans—Medicaid—has made tremendous strides toward addressing these challenges. Now, that progress is under unprecedented attack.
Earlier this month, President Donald Trump signed congressional Republicans’ One Big “Beautiful” Bill Act (OBBBA) into law, greenlighting the largest cuts to Medicaid in the program’s history. Ten million Americans—including disabled people, veterans, and parents—will lose their coverage as a result of the law, with the bulk of those losses coming from the Medicaid program. For those who are able to stay on Medicaid—especially seniors and people with disabilities—vital benefits will be at risk of being cut as states grapple with onerous new limits on their ability to fund their Medicaid programs.
The consequences will be catastrophic. Hospitals, particularly those in rural communities that disproportionately rely on Medicaid, will be forced to close their doors as uncompensated care costs soar—impacting not just people with Medicaid but also entire communities. Health care costs will become an even larger burden for millions of Medicaid recipients who will have to pay new out-of-pocket costs for the first time in order to receive care. And people with complex medical needs, like those struggling with addiction or with chronic diseases like asthma, will have a harder time accessing treatment.
This is why everyday Americans such as Nancy Baker Curtis of Iowa—whose son Charlie is permanently disabled—are speaking out. In June, Nancy publicly pleaded with her senator, Joni Ernst (R-IA), to oppose these devastating cuts out of fear they could force Iowan policymakers to limit coverage of the feeding tubes, physical therapy, and educational supports Charlie receives via Medicaid. Congressional Republicans, including Sen. Ernst, heard these pleas and voted for the bill anyway. Now, rather than work to blunt the impacts of the bill, lawmakers such as Sen. Josh Hawley (R-MO) are shamelessly lying about what it does. In a recent press conference with local reporters, Hawley claimed the bill won’t cut Medicaid in Missouri for the remainder of this decade. That’s verifiably false.
But, if we’re to speak truthfully about what’s happening six decades after Medicaid was signed into law, we must emphasize that it doesn’t have to be this way. Outside of my role at CAP, like Nancy, I know firsthand that the program can help deliver exceptional care and lower costs. My brother James is developmentally disabled and resides in a Medicaid group home. The program was and continues to be a lifeline for him, for my parents, and for me as his future guardian. Because of Medicaid, James is able to receive care and support while living a full life with family and friends in his community, with a degree of integrity and independence that Medicaid-funded services provide. Medicaid reforms can expand access to this kind of coverage and be used to combat inequities in access to care.
As a policy expert, I know Medicaid can work this way, because that’s exactly what this country did under President Barack Obama by expanding Medicaid under the Affordable Care Act (ACA). It’s what President Bill Clinton did by expanding Medicaid to cover more poor children. And it’s what President Joe Biden, working with Democratic and Republican governors, achieved by expanding Medicaid coverage to a full year for postpartum moms thanks to the American Rescue Plan.
Each of these policy interventions improved the financial security of the American people and bolstered public health by making it easier for people to see a doctor and receive care. That’s exactly what policymakers should be doing more of. Unfortunately, some are hellbent on doing the exact opposite—all to give $1 trillion in tax breaks to the top 1 percent. It doesn’t have to be this way.