Charts Unwritten

It’s only mid-September, but I’m already exhausted.

Not the kind of tired that sleep cures, but the kind that settles heavy in your chest when you realize just how quickly things can unravel—and how hard it is to put them back together.

In the first two weeks of this month, we’ve seen a cascade of healthcare policy changes that will shape how people live, how they suffer, and in some cases, whether they survive. Medicaid cuts are underway. Vaccine mandates are being rolled back in multiple states. LGBTQ+ health protections are being quietly erased. Clinics are closing, and trauma survivors are being told to wait weeks for mental health care and that’s if they’re lucky enough to have any access at all.

For those of us on the front lines—whether as clinicians, advocates, case managers, or community workers—this isn’t just policy. It’s personal. I see it on every shift: the survivor who hesitates to report because their not sure they’ll be believed. The teen who calls a hotline that no longer exists. The asylum seeker who fears that asking for care might jeopardize their status. These are the human costs of legislative neglect.

But what’s happening now is more than neglect. It’s intentional disinvestment.

And it’s happening fast.

Healthcare, by Whiplash

In just one week, we saw new bills introduced that would defund school-based health centers, restrict gender-affirming care, and criminalize certain reproductive services. At the same time, several COVID-era expansions of Medicaid eligibility began to sunset, leaving thousands—if not millions—at risk of losing coverage.

I’ve worked in public health long enough to know that nothing in medicine exists in isolation. A policy shift in Washington can—and will—ripple into a survivor’s exam room in Brooklyn, a rural ER in Alabama, or a mental health crisis in Arizona. And when the federal government retreats, it’s the states—and often the cities—that are left to pick up the pieces.

However, there maybe hope as some are trying. States like California and New York have introduced counter-legislation to protect abortion access, increase mental health funding, and create pathways to care for LGBTQ+ communities. Others are forming regional coalitions to share data, pool emergency resources, and keep critical care systems afloat.

These efforts matter. They’re saving lives.

But they are also patchwork solutions to systemic failure. And they often rely on the unpaid or underpaid labor of advocates, social workers, and burned-out medical professionals—people like me.

The Cost of “Keeping It Together”

Recently, I sat in on two forensic evaluations and three advocacy intakes. I supported one asylum seeker who was retraumatized by the process, another who couldn’t find a primary care doctor who accepted Medicaid, and a survivor who chose not to report because she didn’t want to “deal with the system.” And honestly, I can’t blame them.

I’ve spoken with public health colleagues who are leaving the field altogether—because they’re tired of being told to “do more with less.” All the while politicians cut the very programs that might have supported them and patients in need.

This isn’t just burnout. It’s moral injury.

When States Step Up—And When They Don’t

Some state governments are trying to shield their residents from federal-level rollbacks. They’re expanding insurance options, funding community-based clinics, and creating culturally competent, trauma-informed care pathways. In places like Massachusetts and Washington, you can feel the infrastructure trying to hold firm.

But in others, silence is the policy. And silence kills.

When survivors can’t access emergency contraception because pharmacies fear retaliation, that’s not just a legal issue—it’s a failure of the entire system. When LGBTQ+ youth lose access to affirming care, we are watching public health collapse in real time. And when the burden falls on individual doctors, volunteers, or case managers to make up for that failure, it becomes both unsustainable and unjust.

Where Do We Go From Here?

This isn’t just about politics. It’s about survival. About whether people will be able to get a rape kit, refill their insulin, or find someone to talk to when they’re spiraling.

We need more than resistance—we need reconstruction. We need states to do more than protect what’s being taken away. We need them to build what was never provided in the first place: care that is affordable, affirming, trauma-informed, and consistent.

And we need decision-makers to understand that this moment isn’t theoretical. It’s showing up in ERs, exam rooms, community centers, and shelters—right now.

I’m Still Showing Up—But I’m Tired

I’m not writing this to sound hopeless. I’m writing it because I’m tired of pretending things are fine when they’re not. I’m writing it for the other advocates and clinicians who are sitting in exam rooms holding someone’s hand while the rest of the system falls apart around them.

We shouldn’t have to keep piecing together a broken system with trauma tape and good intentions. We deserve better. Our patients deserve better.

And if the federal government won’t act, I hope more states will have the courage to lead.

Before we all burn out.

Before we all give up.

Before another September ends like this.

— Advocate in Scrubs