On Thursday, House Republicans voted to enact a spending bill that will strip close to one trillion dollars from federal Medicaid funding across a decade—an attack expected to cause tens of thousands of preventable deaths each year, disproportionately among the one in three disabled people on Medicaid in the US. The cuts will, among other reductions in treatment, limit Medicaid’s home and community based-services, endanger rural hospitals, and kick millions of users off Medicaid altogether, especially those unable to secure exemptions to the bill’s new work requirements. “It’s a devastating day for disabled people to witness members of Congress, people who are elected to serve the people, be willing to strip healthcare away from 17 million Americans,” said Maria Town, CEO and president of the American Association of People with Disabilities, “and endanger disabled people’s ability to live, work and thrive in our communities.” Republicans in Congress have played down or denied the impact of the cuts—which Town calls an out-and-out lie: “Many disabled people [whose insurance is] covered via Medicaid expansion…are going to lose access to their health care.” Nicole Jorwic, chief program officer at the nonprofit Caring Across Generations, is shocked that the bill’s open funding of tax cuts for the ultra-rich through gutting Medicaid still allowed it to pass. “That narrative was a clear one—taking care away from people to pay for tax cuts was an even stronger message than in 2017, when we did win” a fight against the rollback of the Affordable Care Act, she said. Little Lobbyists CEO Elena Hung, who has been fighting alongside other families in Washington, DC, to try and prevent the cuts, described the vote as a “punch in the gut.” “It’s just an absolute moral failure,” Hung said. “At the end of the day, this Congress lacks the courage to do the right thing.” For people like Hung, their kids’ future hangs in the balance. “Medicaid is the only way that children like mine are able to live at home and be in their communities and not be forced into a medical facility or institution,” Hung said. “It is literally lifesaving for children like mine.” Cuts to Medicaid are not the only devastating attack on the social safety net in the budget bill that just passed the House: It also includes $230 billion in cuts to SNAP over the next decade. “There are many disabled people who receive SNAP,” Town said. “In fact, I believe four out of all five households that receive SNAP benefits have a family member with a disability in them.” For the disability advocates I spoke with, Thursday was a difficult day without a clear plan for tomorrow. “While there is sure to be devastation and unfortunately, lives lost, and we need to be able to mourn for that,” Jorwic said, “what the disability community has always shown is that we can come together and imagine something that other people can’t see as possible.” “We have to have hope to continue to fight,” Hung said. “When I think about families like mine, families with kids with complex medical needs and disabilities, there isn’t a choice to give up.”

The GOP’s “Big Beautiful Bill,” which cleared the Senate Tuesday afternoon and is returning to the House, is generally terrible for families. But women and babies who live in areas that voted overwhelmingly for Donald Trump are likely to suffer some of its most sweeping and damaging effects. The historically brutal Medicaid cuts—a staggering $930 billion slashed from the program over the next decade—could force as many as 144 rural hospitals around the US to close their labor-and-delivery units or drastically scale back services, a new analysis by the National Partnership for Women & Families projects. That could have potentially catastrophic consequences for maternal and infant health. “When somebody is in labor or having a pregnancy-related emergency, every second counts,” says Rolonda Donelson, who wrote the National Partnership analysis. “And with these hospital closures, people are going to have to travel further and further to get the help that they need.” Medicaid is one of the most important safety nets for low-income women during pregnancy and the postpartum period, paying for 41 percent of births in the US—about 1.5 million babies a year. The program plays a particularly vital role in rural areas, covering the costs of 47 percent of births in those communities in 2023. Even with Medicaid support, the maternal mortality rate among rural women is almost twice as high as in urban areas; unsurprisingly, infant mortality is significantly higher as well.  Medicaid is likewise a critical safety net for the country’s 1,800 rural hospitals, helping defray the cost of caring for some 16 million rural residents who would otherwise be uninsured. Without Medicaid payments, many rural hospitals—which tend to be smaller and less profitable than their urban counterparts—would be at serious risk of going under. As it is, almost 150 rural hospitals stopped inpatient services or shut down completely from 2005 to 2023, the federal government says. The GOP megabill puts another 338 rural hospitals at risk, University of North Carolina researchers warned in a letter in June. As rural hospitals have struggled to stay open, labor-and-delivery departments have been among the services at greatest risk of being slashed. That’s because reimbursements by both private insurance and Medicaid are often too low to cover the costs of obstetric services, and rural hospitals don’t make enough money from other types of services to offset those losses. Since 2020, more than 100 rural hospitals have shuttered their maternity units or announced plans to close, according to the Center for Healthcare Quality & Payment Reform, a national think tank; only 42 percent of rural hospitals still offer labor-and-delivery services, while in 11 states, fewer than one-third do. Thus, vast parts of rural America are already maternity care deserts, forcing pregnant patients to travel further for prenatal care, deterring them from seeking immediate medical treatment when they suffer complications that might be life-threatening, and making them less likely to receive follow-up care after giving birth. > “When somebody is in labor or having a pregnancy-related emergency, every > second counts, and with these hospital closures, people are going to have to > travel further and further to get the help that they need.” The GOP cuts and changes to Medicaid and the Affordable Care Act will make that situation much worse, leading to 17 million people becoming uninsured, Donelson estimates. “This will disproportionately impact women because they are more likely to have Medicaid health insurance,” she adds. More than 60 percent of the rural labor-and-delivery units at risk are in red and purple states that went for Trump in 2024. Trump won rural voters by 40 points last November, a Pew analysis found. As my Mother Jones colleague, Michael Mechanic has reported, when ordinary Republicans are informed about how the budget megabill—a package of tax and spending cuts that would add an estimated $3.3 trillion to the deficit—would affect the after-tax incomes of American families, they hate it. “Apparently even Trump’s die-hard fans are appalled when they are shown how the bill’s provisions will affect the finances of the nation’s richest and poorest households,” Mechanic wrote, “not that they’d ever hear it on Fox News.” While the proposed cuts to Medicaid will be devastating for all rural hospitals, those in states that expanded Medicaid under the Affordable Care Act will be hardest hit, Donelson says. The GOP bill “really just shifts a lot of these costs from the federal government onto states that already [are struggling] to afford this,” making it “that much more expensive to cover those in the Medicaid expansion population,” she says. According to the National Partnership’s analysis, the states facing the greatest threats to rural maternity care are Kentucky and California, each with 13 rural obstetric departments at risk of closure; New Mexico, which has 11; and Louisiana, where ten obstetric units are at risk. Unlike many other Southern states, Kentucky and Louisiana are both Medicaid-expansion states. As Sharona Hoffman, co-director of Case Western Reserve University’s Law-Medicine Center, told my colleague Julia Métraux, Republicans’ new cuts seem intended to roll back Medicaid expansion. “The goal, I think, is to get states to say, ‘Well, we’re not getting the federal money support, and so we’re going to roll back or undo our expansion of Medicaid,’” Hoffman said. In total, 41 states could lose labor-and-delivery units in their rural hospitals because of GOP Medicaid cuts, Donelson says. The only reason some other states—including Arkansas and Alabama—won’t see cuts is because these states “already have limited maternal health services,” she says. The cutbacks and closures won’t just affect patients; they will also have a profoundly destructive impact on rural jobs and economies, where hospitals typically serve as one of the biggest employers in their communities. According to the National Partnership analysis, more than 80 percent of people working in hospitals in non-metro areas are women. The Trump/GOP mega-bill also includes many other provisions that will disproportionately affect women and children, from defunding Planned Parenthood to gutting spending on food stamps. Reproductive justice groups lost no time in excoriating the Senate after today’s vote. “For the past six months, people in all 50 states have been grappling with the chaos unleashed by the Trump administration’s cuts, freezes, and destruction of critical federal programs—and now Congressional Republicans are pouring gasoline on the fire,” Jennifer Driver, senior director of reproductive rights at State Innovation Exchange, said in a statement. “Instead of helping people make ends meet by lowering costs, Senate Republicans are choosing cruelty over solutions.”  “The Senate’s version of the bill is just as dangerous and devastating as the one passed by the House and attacks our communities’ health, dignity, and futures,” echoed Lupe M. Rodríguez, executive director of the National Latina Institute for Reproductive Justice. “Let it be very clear, instead of helping people stay healthy and safe, it puts our communities at risk only to serve the interests of the billionaires.”

At a time when Planned Parenthood, the nation’s largest provider of reproductive health care, faces unprecedented threats to its very survival on multiple fronts, the Supreme Court added another one on Thursday. In a 6-3 decision, the court ruled that if states decide to unilaterally cut off Medicaid funding to a healthcare provider—in this case Planned Parenthood—patients cannot sue to stop them. Justice Neil Gorsuch authored the decision in the case, known as Medina v. Planned Parenthood South Atlantic. In his opinion, he wrote that the Medicaid provision that protects patients’ ability to choose their doctor lacks the “rights-creating language” needed for patients to bring federal lawsuits when a state restricts their choice. In a dissent, Justice Ketanji Brown Jackson wrote that the decision would gut the landmark Reconstruction-era civil rights law giving ordinary citizens the ability to sue in federal court when their rights are violated. “South Carolina asks us to hollow out that provision so that the State can evade liability for violating the rights of its Medicaid recipients to choose their own doctors,” she wrote. The case began in 2018, when South Carolina Republican Gov. Henry McMaster disqualified the regional Planned Parenthood affiliate from receiving Medicaid reimbursements for the extensive non-abortion services it offers, such as birth control, sexually transmitted infection treatment, and screening for cervical and breast cancer. (Medicaid already doesn’t cover abortion, except in cases of rape, incest, or when the patient’s life is in danger. Nonetheless, many conservative states impose restrictions on their Medicaid programs that make it nearly impossible to access the procedure even under those circumstances.) As I reported in April, there was no dispute that McMaster’s decision was motivated by anti-abortion politics, rather than genuine concerns over patient safety or medical qualifications: > Everyone seemed to agree that in 2018, when [McMaster] suddenly declared that > the state would no longer consider Planned Parenthood South Atlantic a > “qualified provider” for Medicaid purposes, it had nothing to do with medicine > and everything to do with politics. “The payment of taxpayer funds to abortion > clinics, for any purpose, results in the subsidy of abortion and the denial of > the right to life,” McMaster reasoned in his executive order, as he > effectively cut access to birth control and basic health screenings for his > state’s poorest residents in an attempt to financially punish Planned > Parenthood. > > > > Congress amended the federal Medicaid law in 1967 to ensure that patients > would have the “free choice” to see any “qualified” provider who takes > Medicaid. The whole point of that provision was to stop states from > artificially restricting patients’ options. So, in response to McMaster’s > order, Planned Parenthood South Atlantic and one of its Medicaid patients, > Julie Edwards, sued the state, arguing that it had violated patients’ right to > choose their provider. By the time the case reached the Supreme Court, it had become a technical dispute over whether patients like Edwards even had the right to file such lawsuits, or if the federal government was alone in enforcing the free-choice-of-provider provision. During oral argument, Justice Sonia Sotomayor pointed out that the federal government’s only power to enforce the provision would be to pull Medicaid funding from noncompliant states—an extremely unlikely scenario. As a result, with today’s decision, the Court has removed one of the only practical ways to stop a state from punishing doctors it doesn’t like by kicking them out of Medicaid program. “Today’s decision is a direct attack on reproductive health care, and it is a dangerous green light for politicians to target any providers they don’t like,” said Jennifer Driver, Senior Director of Reproductive Rights at State Innovation Exchange, in a statement. “By allowing South Carolina politicians to block people enrolled in Medicaid from accessing care at Planned Parenthood, the Court has opened the door for extremist lawmakers across the country to do the same.” The ruling is a victory for the powerful conservative Christian legal group, Alliance Defending Freedom, which represented the state of South Carolina in an increasingly common arrangement. ADF has long worked to obliterate abortion rights and is one of the forces behind the fall of Roe v. Wade and legal attacks on the abortion pill, as well as major anti-LGBTQ laws and Supreme Court cases. Thursday’s decision could pave the way for states beyond South Carolina to block Medicaid reimbursements to Planned Parenthood—or any other disfavored medical provider. As a result, it threatens access to care for Medicaid patients who rely on Planned Parenthood. Meanwhile, Congress is considering separate moves to “defund” Planned Parenthood—and gut Medicaid entirely. Trump’s proposed budget, currently under consideration in the Senate, would block Medicaid reimbursements to nonprofits that offer reproductive health care if they also provide abortion. That policy change could force nearly 200 of Planned Parenthood’s approximately 600 health centers to close, the organization says. It’s part of the GOP’s proposed $723 billion in cuts to Medicaid—cuts projected to leave nearly 11 million people without health insurance, according to the Congressional Budget Office. The Trump administration is also attacking another federal funding stream for Planned Parenthood and similar clinics. Title X provides grants to health centers so they can offer free or reduced-cost family planning services to low-income and uninsured people. As of last year, 49 percent of patient visits at Planned Parenthood health centers were paid for by Medicaid or Title X funding. In April, Trump announced it would withhold tens of millions in Title X grants to Planned Parenthood, affecting 297 clinics in 34 states and Washington, DC. And his budget proposes eliminating Title X entirely. “They know so much of our patient base is on Medicaid or needs Title X to pay for their care,” Planned Parenthood of Michigan chief external affairs officer Ashlea Phenicie told NBC News in early June. “They know that cutting this off will allow them to cut off access to abortion and they are willing to make that trade.”

Tucked into Donald Trump’s “Big, Beautiful” spending bill—which passed in the House last month, and promises major cuts to Medicaid—is a provision to spend $46.5 billion in taxpayer dollars on building his long-promised wall along the US-Mexico border. The White House says that the funding will provide an additional 701 miles of primary wall and 900 miles of river barriers—but given how the construction of the wall played out in Trump’s first term, those numbers are wildly optimistic. During his 2016 presidential campaign, Trump promised to build 1000 miles of border wall for $8 to $12 billion—and said Mexico would pay for it. As a first-term president, he asked Congress for $5.7 billion towards the wall; it allocated $1.3 billion in border security funding instead, and Trump ended up invoking emergency powers to transfer funds from elsewhere in government to the project. As reported by ProPublica and the Texas Tribune, costs quickly ballooned: by the end of Trump’s first term, only 47 miles of previously unwalled land received new barriers—at a public cost of about $15 billion. An appeals court ruled in October 2020 that Trump’s use of emergency powers to divert billions in military funds to border wall construction was unlawful. Mexico, of course, did not pay for it.   This time, the bill that includes the massive wall spending narrowly passed the House in a 215-214 vote that saw two Republicans join all Democrats in voting no, with three others voting present or missing the vote altogether. Trump’s bill has faced criticism from Republicans, with Sen. Rand Paul (R-Ky.) specifically calling for cuts to its border wall spending. The non-partisan Congressional Budget Office found on Tuesday that the House bill would increase deficits by $2.8 trillion over the next decade.  To balance out the wall funding, other Senate Republicans have called for further cuts to Medicaid—despite the House bill already cutting hundreds of billions in Medicaid funding, which one analysis from the Annals of Internal Medicine found would increase the number of uninsured people by 7.6 million, and the number of annual deaths by more than 16 thousand. The cuts have been condemned by the medical community, including in a recent statement by the American Hospital Association. Senate Minority Leader Chuck Schumer (D-N.Y.) blasted the Senate GOP’s version of the bill, saying that its “cuts to Medicaid are deeper and more devastating than even the Republican House’s disaster of a bill.” An AP-NORC poll released Monday found that the vast majority of Americans do not want to see Medicaid cut, with only 18 percent of US adults saying the program has too much funding.  The bill itself is also unpopular among the American people: A Quinnipiac poll last week found that 53 percent of voters opposed it, with just 27 percent in support and 20 percent not offering an opinion. A Washington Post/Ipsos poll released Tuesday found that 42 percent of Americans were not in favor of the bill, with 23 percent supporting—and that fully 52 percent of Americans are specifically against spending $50 billion to complete the border wall.  But—as with tariffs and attempts to cut agency funding without congressional approval—the administration is evidently willing to put Americans’ concerns aside when spending their money.  

Last week, Max, a trans man in North Carolina in his twenties—and my childhood friend—got top surgery. “I didn’t cry when I saw the results because it just looks like how I feel it should,” Max wrote in an email. He cried later, he said—when he realized he’d been able to “build a body I feel fully at home in.” Three days after Max’s surgery, Donald Trump’s “Big, Beautiful Bill,” a massive package of GOP tax and spending legislation, passed the House with a last-minute amendment that would ban Medicaid and Affordable Care Act marketplace plans from covering transgender health care like Max’s surgery and hormone replacement therapy. Approximately 185,000 trans adults, or about one in twelve in the US, are on Medicaid, according to the University of California, Los Angeles’ Williams Institute. Max could only afford his surgery because it was covered in part by Medicaid. Medicaid also provided his hormone replacement therapy—prohibitively expensive without insurance—and the rest of his health coverage for the last several years, while he’s juggled school with full-time work. The “Big, Beautiful Bill” has yet to pass in the Senate, and Democratic senators are working to use the Byrd Rule, which limits “extraneous” provisions to the budget, to remove its amendment against gender-affirming care. > “I want more than anything for other trans people to have the options I did.” If the bill passes with that amendment intact, said Jennifer C. Pizer, chief legal officer at LGBTQ civil rights nonprofit Lambda Legal, “There will be litigation, because the harms are quite serious and it legitimizes the range of other cruel and unjustifiable treatments of transgender people.” The provision against gender-affirming care, Pizer pointed out, wouldn’t force all states to follow suit; she cited California’s use of state funds to cover domestic partners’ health insurance before federal law recognized same-sex relationships. States protective of transgender rights may take similar steps. But for those with a history of anti-LGBTQ legislation, there’s less hope: ten states already exclude coverage for such care in their Medicaid plans for all ages. And the Trump administration, Pizer noted, has unlawfully pulled federal funding from programs it opposes—a “battering ram” it may use against states taking action to fund transgender healthcare. That, together with the administration’s other attacks, has trans people on Medicaid fearful even in states with strong LGBTQ rights protections. Ory and Caleb, both from Oregon, spoke positively about the state’s Medicaid program. Caleb described the care it provides as vastly improving their mental health; Ory called it “lifesaving.” But both have started to make backup plans to stock up on testosterone out of fear of losing access. An Oregon law prohibits insurance carriers from denying medically necessary gender-affirming treatment, putting it in direct conflict with the new federal provision should it pass. It’s not clear how such tensions between federal and state authority will be resolved, Pizer said. Alex joined Medicaid after the death of her partner compelled her to move close to where she grew up in Illinois. She started HRT on the day of Trump’s election. “I did not really plan it that way,” she said. “Let me tell you, that was not fun.” Still, Alex has loved HRT: “It no longer felt like my body was fighting itself,” she said. “It feels internally aligned in a way I did not know it could previously.” Alex called her senators for the first time to urge them to vote against the budget bill. Its authors “can pry my estrogen from my cold, dead hands,” she said, “and I’m not going anywhere anytime soon. Fuck those motherfuckers.” Max, in North Carolina, was hit viscerally by the latest attempt to slash the care he was relying on. “It was a rollercoaster of emotions,” he said, from euphoria and recovery following his surgery to grief following the news. > “They can pry my estrogen from my cold, dead hands.” The bill’s last-minute modifications to strip trans health coverage were made in a “cowardly way,” Max said—at night, with no cameras present—in “a pathetic attempt to avoid backlash, basically admitting that this is a terrible idea.” “Trans people are vulnerable, but we are not weak,” said Alex. “We will always stick up for one another. We have always existed, and we always will exist, and there’s nothing that anybody could do to stop that, no matter how hard they try.” Still recovering from surgery, Max writes, “I’m living the dreams of the little boy I used to be.” His wish? “I want more than anything for other trans people to have the options I did.”

House Republicans whose seats are not safe in the 2026 midterm elections voted early on Thursday morning to advance the largest cuts to Medicaid in history, endangering health care for millions of the poorest Americans. Several cast these votes after making promises to protect the Great Society program that provides health care to millions. Democrats are already hoping the vote will cause them to lose re-election next year. “When the votes are ultimately cast on that first Tuesday in November,” House Minority Leader Hakeem Jeffries said, “this day may very well turn out to be the day that House Republicans lost control of the United States House of Representatives.” > “Anyone saying the GOP is cutting Medicaid is lying,” > Rep. Luna falsely posted. The first months of the Trump administration have been dominated by its authoritarian impulses and corrupt money-grabbing, from disappearing people to El Salvador to his on-again-off-again trade war to the president collecting millions through his personal crypto currency. But the bill Republicans just passed is classic GOP: Cut vital benefits for the poor to line the pockets of the rich. The bill places work requirements on Medicaid recipients, which is expected to cost millions of people their health insurance. Pushing people off the Medicaid rolls is the point, because it is how the GOP found some of the savings it would use to offset tax cuts for the wealthy. (The bill also funds the tax cuts by increasing the deficit by trillions of dollars.) The work requirements are slated to go into effect by the end of 2026. Notably, that deadline is a few weeks after the 2026 midterm elections, an obvious attempt to shield House members from any political fallout. Still, Democrats will surely attempt to use elected Republicans’ own past statements they would preserve Medicaid against them as they try to take back control of Congress. Rep. David Valadao (R-Calif.), for example, posted less than a month ago “I won’t support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.” In 2023, the Hill recently reported, “48.7 percent of Valadao’s constituents… were covered by Medicaid.” But this morning he voted for the bill. His colleague, Rep. Kent Calvert (R-Calif.), likewise assured constituents “I am committed to protecting Medicaid benefits for Americans who rely on the program, including children, mothers, and the disabled.” He also voted yes. From Arizona, GOP Rep. Juan Ciscomani supported the bill, despite having promised that “from day one in Congress” he was “committed to ensuring access to Medicaid to those who need it.” That’s the opposite of what work requirements do, as it is not always possible for people to find jobs necessary to keep their Medicaid, and those with jobs often lose it because of onerous reporting requirements. Or take Rep. Anna Paulina Luna (R-Fla.) who posted bluntly in March, that “Anyone saying the GOP is cutting Medicaid is lying.” The bill now goes to the Senate. If it passes there without major modification and Trump signs it into law, as appears very likely, then Republicans will have succeeded in slashing both Medicaid and food support through SNAP at the same time the president’s economic policies are threatening to put the US economy into a recession. It’s an opportunity for Democrats—if they can convince voters that the president and congressional Republicans are to blame for the coming carnage.

Within the first few minutes of Tuesday’s House Committee on Energy and Commerce hearing on planned Republican Medicaid cuts—which would render more than 8 million Americans uninsured—a contingent of protesters entered the room in Washington, DC’s Rayburn Building where members of Congress had gathered. The protesters, shouting “No cuts to Medicaid!” represented groups including the disability rights protest organization ADAPT. Twenty-five demonstrators were arrested and removed from the building. The committee’s proposal for extensive cuts to federal health funding, including sweeping Medicaid cuts, are estimated by the nonpartisan Congressional Budget Office to likely “reduce the number of people with health insurance by at least 8.6 million” nationwide. The legislation would also enact more than $700 billion dollars in health-related cuts, in addition to also promoting work requirements for people on Medicaid—which tends only to serve as a means of of kicking them off, even though federal data shows that a majority of adults on Medicaid already work full- or part-time. After the initial protests, committee Chair Rep. Brett Guthrie (R-Ky.), who released the legislation on Sunday evening—Mother’s Day—threatened the protesters with arrest for disrupting the hearing, calling the outcry illegal and “a criminal offense.” The Energy and Commerce Committee’s ranking Democrat, Rep. Frank Pallone (D-N.J.), asked the Capitol Police to avoid making arrests, especially given the subject at hand. “People feel very strongly because they know they’re losing their health care, and [because of] the cruelty that comes from the Republican proposal,” Pallone said. Pallone went unheeded. The Hill reported that more than two dozen protesters were arrested for civil disobedience, including wheelchair users. One protester, while being escorted out of the room by the police, shouted, “You will kill me,” according to the Independent’s Eric Garcia. It wasn’t just people in the room who were loudly protesting against Medicaid cuts—other protesters demanding that Medicaid cuts be halted filled the hallway. > BREAKING: Chaos at the Rayburn Building. A Congressional hearing just stopped > cold as protesters flooded the halls to fight Medicaid cuts. Capitol Police > are warning of arrests. The situation is developing… #NoCutsToMedicaid > pic.twitter.com/cRAfsppI4U > > — CALL TO ACTIVISM (@CalltoActivism) May 13, 2025 Back in 2017, civil disobedience coordinated by ADAPT helped halt the GOP’s plan to destroy the Affordable Care Act: As activist Colleen Flanagan told the 19th’s Sara Luterman, “We risked injury. We put our bodies on the line to demand that they save our health care.” Now, it’s a wait-and-see game to determine whether a similar fightback by disabled people can help stop destructive cuts to Medicaid.

On Sunday, House Energy and Commerce Committee Chair Brett Guthrie (R-Ky.) released budget reconciliation text that outlined extensive cuts to Medicaid planned by the Republican Party—which the nonpartisan Congressional Budget Office promptly estimated “would reduce the number of people with health insurance by at least 8.6 million” nationwide. At least $715 billion would be cut from health programs, according to the CBO analysis, but it is unclear how much would be cut directly from Medicaid. Optional services under Medicaid—including physical therapy, hospice, and respiratory care for people on ventilators—would likely face cuts in many states. “This bill confirms what we’ve been saying all along, Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s health care,” Frank Pallone Jr. (D-N.J.), the ranking Democrat on the Energy and Commerce Committee, said in a press release Sunday. “Let’s be clear, Republican leadership released this bill under cover of night because they don’t want people to know their true intentions.” Not all Republicans are on board with the cuts, which appear to be driving fissures within the party. In a New York Times op-ed on Monday, Sen. Josh Hawley (R-Mo.) wrote the following, echoing the types of stories that both Democratic and Republican legislators have shared to try to stop Congress and President Donald Trump from slashing Medicaid: > If Congress cuts funding for Medicaid benefits, Missouri workers and their > children will lose their health care. And hospitals will close. It’s that > simple. And that pattern will replicate in states across the country. > > > One of my constituents, a married mother of five, contacted me to explain why > Medicaid is vital to her 8-year-old daughter, who depends on a feeding tube to > survive. Formula, pump rentals, feeding extensions and other treatments cost > $1,500 a month; prescriptions nearly double that cost. These expenses aren’t > covered by private insurance. The mother wrote to me, “Without Medicaid, we > would lose everything — our home, our vehicles, and eventually, our daughter.” States are also not in the position to replace slashed federal funding and maintain their Medicaid services, as we wrote in January coverage of potential cuts to Medicaid-funded Home and Community-Based Services: > Given that federal Medicaid funds already make up, on average, one-third of > state budgets, [Caring Across Generations chief of advocacy] Nicole Jorwic > believes that state governments coughing up the extra cost “is never going to > happen.” She notes that health funding is a popular target even in blue states > like Maryland, where a $3 billion state funding shortfall has put hundreds of > millions of dollars in funding for its human services department funds—where > Medicaid is housed—on the chopping block. The proposed cuts would also prohibit Medicaid funding for Planned Parenthood for the next decade, which accounts for more than a third of the organization’s budget. Those cuts would affect the provision of services such as pap smears, cancer screenings, and birth control, since Medicaid already does not fund most abortions due to the Hyde Amendment. But abortion opponents and hardline Republicans are pushing to defund the organization regardless as punishment for its abortion services and its historic support for the Democratic party. On a call with reporters Monday afternoon, Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, said that Planned Parenthood health centers provide those services to more than two million people annually, and that the majority of the clinics are located in “medically underserved areas, rural areas or areas with health professional shortages.” More than half of its patients use Medicaid and other public insurance programs, she added. “If patients can’t get care at Planned Parenthood health centers, many will have nowhere to go,” McGill Johnson said, characterizing the proposal as a “targeted attack” and “an attempt to defund a political opponent.” But the idea appears broadly unpopular. A January poll conducted by the nonpartisan research firm PerryUndem found that nearly three-quarters of respondents—73 percent—oppose defunding Planned Parenthood for services such as birth control, wellness exams, and cancer screenings. Last week, NOTUS reported that some moderate Republicans told House Speaker Mike Johnson (R-La.) they would oppose defunding Planned Parenthood. “The fact is that numerous organizations provide critical health care services for women outside of the issue of abortion, and to cut off funding for those services in any way creates a challenge,” one House Republican told NOTUS. Additionally, the budget reconciliation text aims to weaken the ability the federal government’s ability to negotiate drug costs for Medicare users—a major move put forward by the Biden White House to make medication more affordable for aging and disabled people in the United States, who regularly pay some of the world’s highest drug costs.

At a 24-hour vigil to protect Medicaid on the National Mall in Washington, DC, Rep. Jamie Raskin (D-Md.) was to the point: to protect democracy, Medicaid has to be protected, too. The vigil, which kicked off Wednesday at 1 p.m. ET, is hosted by the advocacy group Caring Across Generations and will be livestreamed until it ends Thursday; beyond Raskin, the event featured speakers including Reps. Pramila Jayapal (D-Wash.) and Nancy Pelosi (D-Calif.) alongside disability advocates and Medicaid users, in response to a series of White House attacks and cuts on health services spearheaded by President Donald Trump, his advisor Elon Musk, and Robert F. Kennedy Jr., Secretary of the Department of Health and Human Services. “Sometimes,” Raskin said, “people say to me, ‘Well, is it more important to go and fight for democracy and judicial independence and the right to vote, or is it more important to go and fight for Medicaid and Social Security?’ That’s a false choice. It’s all the same.” The United States, Raskin said, needs to represent everyone—not just people like Trump and Musk. Since February, Republicans in Congress, at Trump’s prompting, have been pushing a federal budget that would entail up to $88 billion in annual cuts to Medicaid’s $600 billion budget, which supports some 72 million users. While President Trump has repeatedly promised not to cut Medicaid directly, the budget proposals before Congress won’t be possible without drastic cuts to the social safety net. “What they’re doing with the budget is to destroy community,” Pelosi said. “Community has a word—unity—in it, and that is what we have to be: completely unified in our fight for Medicaid, for Medicare, for Social Security, for SNAP.” > “We will be out here as long as it takes!” Maria Town of > @aapd-disability.bsky.social highlights that Medicaid allowed her to have > physical therapy and her mom to have respite care. > > [image or embed] > > — Autistic Self Advocacy Network (ASAN) (@autisticadvocacy.org) May 7, 2025 at > 10:53 AM For disabled people who rely on Medicaid, those cuts would almost certainly mean a reduction of services, including funding for home care workers—if it doesn’t lead to their being kicked off the service altogether. Raskin cited one Maryland constituent who had shared with him that Medicaid was what made it possible for him to live independently and work. “This is a matter of life and death for millions of people across the country,” Raskin said. “So the question is, what kind of America are we going to be? Are we going to be in America for dictators and plutocrats and theocrats and autocrats, or are we going to be an America for all the people?” The vigil, Raskin said, helped to demonstrate that Americans were “not going to allow” Donald Trump to sign a widely harmful budget into law. “It is through American democracy that we’ve created Medicaid, that we’ve created Social Security, that we’ve created Medicare,” Raskin said. “We are not going to allow them to tear it down.”

For millions of disabled people, essential health devices known as durable medical equipment, or DME—think of CPAP machines or in-home dialysis equipment—help them both remain at home and stay alive. Donald Trump’s recent wave of tariffs, extremely broad in both the imports and countries they target, are still at a new 10 percent baseline in many cases—but they’re likely to raise the costs of medical devices, putting people’s ability to afford it (and providers’ ability to supply it) in jeopardy. That’s especially true for people who are low-income, including disabled people on Medicaid, or on fixed incomes, like many retirees on Medicare. DME can include oxygen equipment, suction pumps, some diabetes supplies, and mobility devices like wheelchairs—all indispensable to the day-to-day lives of people who use them. Although states are compelled to cover such devices through Medicaid, they have flexibility in how far that coverage extends: like how often equipment will be replaced, how many items will be sent during a given time period, and how much the co-pay. That’s particularly true of Medicare, which isn’t required to cover as many of the costs associated with letting disabled people remain in their homes. If tariffs drive up the cost of a piece of home medical gear, and if states don’t agree to quickly negotiate, people under Medicaid could be sent fewer supplies in a period, or may face greater co-pays. For Medicaid users, even a cost increase that an insurer or provider would treat as marginal—say, around $50 more per month for medical equipment—can be devastating.  Research from data analytics and consulting firm GlobalData found that around 75 percent of US-marketed medical devices are, at least in part, manufactured abroad. It also found that respiratory devices—one of the most common medical device imports, and very much not optional for those who rely on them—are likely to be one of the more seriously impacted products. Unlike with some consumer products, says Andrew Thompson, a director on GlobalData’s medical devices team, “the demand doesn’t go away” for medical devices. Given that China is a major supplier of medical devices and is the target of massive US tariffs in Trump’s escalating trade war with the country, Thompson said firms may be incentivized to look at even cheaper factories in other countries. “The FDA inspects and approves the factories where these devices are made, in the US and overseas,” he said. If a company switches from China to Vietnam, Thompson says, “you have to go for the approvals again”—and due to thousands of layoffs at the FDA, that process is likely to take even longer. The US instituting a 10 percent tariff should not, on its own, be a major problem when it comes to supply chains and costs, Thompson told me; the United Kingdom does the same. What causes issues, he says, is the “moment of uncertainty.” To anticipate the potential impact of further tariff-driven caps to DME, Harvard University assistant professor of health policy and management Ari Ne’eman looks to the past. “Some state Medicaid agencies in the 1990s put in place a prescription drug cap that really limited the extent to which people with disabilities enrolled in Medicaid could access prescription medications,” Ne’eman says. “One of the things we saw come out of that was people were forced into nursing homes in order to be able to bypass the prescription drug cap and get the medication they needed.” Around a quarter of American adults with diabetes below the age of 65 are on Medicaid. Outside of medicine like insulin, durable medical equipment that people with diabetes need includes blood glucose meters, test strips, syringes and continuous glucose monitors.  Washington state chapter #Insulin4All organizer Kevin Wren is worried about having to ration continuous glucose monitors; he also sources his insulin pumps from China, where exporters are still coming to grips with a wide variety of tariffs that can stack in unpredictable ways. “If you ration this thing [CGM] at the top, then you’re really making it much harder to manage an already difficult disease,” Wren said, who is on Medicaid; he has already been without his CGM sensors for some stretches because he had been through three in less than a month. The tariff saga and its impact on disabled people cannot be separated from the administration’s brutal cuts to Medicaid, said Allie Gardner, a senior policy analyst at the Center on Budget and Policy Priorities. Both houses of Congress passed a budget reconciliation bill in April that will result in up to $880 billion in cuts to Medicaid over the next decade. According to a KFF brief, these cuts “would represent 29 percent of state-financed Medicaid spending per resident.”  “All of that is likely going to have put pressure on states to make difficult decisions about reassessing eligibility benefits and reimbursement rates, all of which would directly affect people’s coverage and access to care,” Gardner said. In addition, Ne’eman says, “anytime you’re taking hundreds of billions of dollars away from Medicaid, disabled people will be impacted.” If states are prioritizing keeping their eligibility levels the same, Gardner says, “they could increase out-of-pocket costs”—a reality that is already on the table for DME in some states, if tariffs raise the cost of medical devices.  If people do die as a consequence of tariff-driven cost increases and supply issues with medical equipment, then their deaths, Wren is concerned, will be written off as expected. “The full impact won’t be captured,” Wren said. “It’s really the most vulnerable of the most vulnerable Medicaid patients who need technologies to live.”