On July 3, 2025, the Senate passed a sweeping reconciliation package branded by some as “The One Big Beautiful Bill.” While the headlines tout economic vision, the reality for millions is bleak: the bill is projected to add $3.3 trillion to the national deficit while stripping away at the health care coverage from nearly 12 million Americans, with that number rising to 17 million if ACA subsidies expire (Reuters, KFF).
This isn’t just political accounting: it’s a blueprint for deeper inequity and a dangerous disinvestment in care.
The reconciliation bill proposes to cut $1.02 trillion from Medicaid and CHIP over the next ten years. However, these are programs that serve more than 70 million low-income Americans across all 50 states, D.C., and U.S. territories thus these cuts threaten critical care for the most vulnerable: elderly, disabled, BIPOC communities and rural populations who often have nowhere else to turn (KFF).
As someone who volunteers with survivors of violence and trauma in emergency departments, I’ve seen how fragile the access to care already is especially for marginalized individuals, much less for entire communities on public insurance. We’re already suffering long wait times, inaccessible facilities, and overstretched, burned-out medical staff and yet this bill will only exacerbate those issues.
Rural Hospitals are Being Left to Die
Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly adults who have an income up to 133% of federal poverty level [FPL] (CBPP) and this has been a lifeline for those who depend on rural hospitals. However, without it, hundreds will face closure. On June 30th, Senator Edward Markey released a list of over 300 rural hospitals at risk of shutting down or reducing services under this bill’s cuts (Sen. Markey’s Letter).
In areas where the nearest OB-GYN or trauma center may be 90 miles away, a hospital closure isn’t just inconvenient: it’s life-threatening. For survivors of assault, for disabled patients in need of specialized care, or for anyone in labor in a town without a maternity ward, the stakes have now become a matter of life or death.
Increasing Education Inequity and Disparities
Although the effects this bill will have on patients have been widely discussed, it goes without saying that it also hurts those training to become providers.
Graduate health education is already expensive, exclusionary, and full of hidden costs from application fees to licensing, exams, travel, and materials. But for first-generation and non-traditional students, especially those from marginalized backgrounds, the financial weight is especially heavy (ResearchGate, Penn GSE).
Yet this bill does nothing to alleviate that. Instead, it threatens loan programs and graduate education funding — even as we face national shortages in primary care and mental health providers (KFF HPSA Map). As of July 1st, 2026 the bill will enforce a lifetime cap of borrowing $100,000 for graduate students as well as $200,000 cap for medical and law school students (Economic Times). According to the AAMC, the average cost of attending medical school exceeds $275,000 — far above the proposed $200,000 federal borrowing cap. This gap will force many students into high-interest private loans, thus worsening the existing disparities in who can afford to pursue medicine.
If we want more providers in rural towns, in labor and delivery, in emergency medicine, or in family care: we have to make it possible for us to get there. Instead cuts like these tell patients that their pain is too expensive to treat. While telling those of us preparing to care for them that we’re on our own financially. Instead of bridging the gap we are widening it.
Overall this bill will be accelerating a dangerous cycle:
- Cuts to Medicaid → Hospitals lose funding
- Hospitals close → Care becomes harder to access
- Patients delay care → Outcomes worsen
- Need rises → But clinician pipeline shrinks
- System collapses where it’s needed most
We aren’t just bleeding healthcare coverage: we’re hemorrhaging care capacity.
If we’re serious about health justice and not just health coverage we must:
- Restore Medicaid and CHIP protections
- Reinvest in rural and safety-net hospitals
- Protect graduate medical education to ensure a diverse, accessible health workforce
Forget the big, beautiful bill. What we need is a humble honest investment: in people not in politics.
—Advocate in Scrubs
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