Our money or our lives? Congress somehow votes for neither.
H.R.1, a.k.a. the "One Big Beautiful Bill Act," is headed for President Trump's desk for Sharpie™️ sign-off.
Spice warning. I’m not in the mood to hold back. I even made a meme (see below). The point here is not only to educate (though that is goal #1), but also to motivate everyone reading this to stay in this fight. Thanks for being here with me. Your support makes this doable.
Oh, and Happy 4th of July! I hope you eat some seedless watermelon. Thanks #science!
House passes “One Big Beautiful Bill Act.” It’s about to get ugly.
A mugger asks his victim, “Your money or your life?” Facing this self-imposed choice, Congressional Republicans somehow chose neither yesterday. H.R.1—known as the One Big Beautiful Bill Act now heads to President Trump’s desk for approval. In the end, the bill will add approximately $3.4 trillion to our federal deficits over the next 10 years while cutting health insurance, food stamps, and other benefits to millions of Americans in order to pay for tax breaks that mostly benefit wealthy people. Apparently healthcare for poor and working class Americans is not beautiful.
Naturally, the tax cuts go into effect almost immediately—soon enough to buy off some voters whose taxes would otherwise go up modestly, including a whopping $150 in savings for payers in the lowest quintile tax bracket if the 2017 tax cuts were to expire. But the slashed programs, cuts that will cause over 11 million people to lose health insurance via Medicaid, don’t go into effect for a while. Medicaid and food stamp funding cuts don’t start until 2028. Here’s a table with a rundown on the roll-in from The New York Times:
It’s a cynical trick but it also tips their hand. Members of Congress who voted for this package know that the hurt this bill will cause is real. They’re just hoping nobody will remember who did this, a few election cycles from now.
Celebrating some profiles in cowardice.
Three Zero cheers for Senator Josh Hawley (R-MO) in particular. In May, Hawley wrote an intelligent essay for The New York Times, in which he argued that cutting Medicaid was an awful idea.
Here’s a quote from that piece:
“Mr. Trump has promised working-class tax cuts and protection for working-class social insurance, such as Medicaid. But now a noisy contingent of corporatist Republicans — call it the party’s Wall Street wing — is urging Congress to ignore all that and get back to the old-time religion: corporate giveaways, preferences for capital and deep cuts to social insurance.
This wing of the party wants Republicans to build our big, beautiful bill around slashing health insurance for the working poor. But that argument is both morally wrong and politically suicidal.” —Senator Josh Hawley.
This is why when I discussed the issue with Senator Elizabeth Warren, she said “I can work with him. He's my guy.”
Welp, fast-forward to this week. Hawley voted in favor of these very cuts.
Here’s a list of quotations from other Congressional Republicans that would seem to have suggested that they knew cutting Medicaid would be a very, very bad thing.
Now, some Republicans are doing the Who me?” thing. Others are literally dancing in the halls of Congress—in public, mind you.
If I never read another article about how Democrats failed to understand working class voter concerns in the 2024 election, it won’t be a minute too soon.
Open tab: “They Savaged Their Party’s Bill. Then They Voted for It.” The New York Times.
Two more thoughts that are bothering me at this hour…
I’m not loving how all of this portends for the next big fight: HHS appropriations. If Congressional Republicans were willing to self-immolate on this monstrosity of a bill—cuts that will directly hurt their own constituents in the relative near term—I’m pessimistic that they will saddle up for a fight to save US medical research, basic science, and other public health investments across HHS, efforts that generally take far longer to vest.
The MAHA movement has collectively been doing La Macarena in celebration of RFK Jr.’s rhetoric on banning food dyes since his confirmation as HHS Secretary in February. But even if this were to have any measurable impact on pediatric health (questionable), it would be a rounding error compared to the damage that the One Big Beautiful Bill Act will cause to them by way of cut to healthcare and nutritional supplement programs (i.e. school lunches, food stamps). As Dr. Kevin Klatt writes in his Substack, “The bill contains significant cuts to SNAP and Medicaid (something that impacts not only healthcare but automatic enrollment in free lunch for kids), trading our social safety net for food/nutrition over the next decade to offset tax cuts for the wealthy.” However, Klatt has empathy for nutrition community. “For anyone who might be wondering why folks in the nutrition community might have been blinded by opportunity and sought to work with MAHA, I empathize. From any vantage point that you view nutrition, people have felt starved/neglected for a while.”
Highlights from the press releases.
After the House passed the bill today, my inbox began filling up with press releases from organizations in the healthcare space. Here are four highlights:
Children’s Defense Fund “Deeply Disturbed and Disappointed” by H.R. 1 Passage.
Following the House passing the “Big Beautiful Bill,” youth advocacy organization condemns bill as a disservice to children and families across the nation.
On Thursday, the United States House of Representatives passed a budget reconciliation package that includes massive tax cuts for corporations and the wealthy.
“Children’s Defense Fund believes all young people deserve to grow up with dignity, hope, and joy. That is why, for more than 50 years, we have committed to a vision of children and families across this nation thriving. And that is why, today, we are deeply disturbed and disappointed by the passage of H.R. 1.
“The bill has been called ‘big’ and ‘beautiful,’ but it is big only in its audacious harms to everyday people. It is bad and brutal in its gutting of essential programs children and families rely on for their day-to-day needs.
“A budget is a statement of our values—a moral document that reveals who we choose to protect and who we leave behind. This package values the rich, wealthy, and corporations. And it devalues children and youth by making historic cuts to Medicaid, the Children's Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP). It devalues the families of 17 million children by deeming them ‘ineligible’ and ‘undeserving’ of the vital Child Tax Credit (CTC).
“In this moment, we are reminded that poverty is a policy choice. That every child who goes without basic health care, a filling and nutritious meal, and a safe place to sleep bears the burden of choices made on Capitol Hill. We urge you to remember that the strength of a nation is measured by how it treats its children and youth. And when future generations ask what we did to protect them, we must be able to say we acted with courage—not convenience or political expediency.
“Our work toward a nation where marginalized children flourish, leaders prioritize their well-being, and communities wield the power to ensure they thrive remains resolute. But we must begin by acknowledging the harm and charting a better path forward.”
The American Hospital Association Statement on House Passage of One Big Beautiful Bill Act.
“Today is an extremely disappointing and very difficult day for health care in America. Despite months of clearly demonstrating the implications that these Medicaid proposals will have on the patients and communities we serve, especially the most vulnerable populations, Congress has enacted cuts of nearly a trillion dollars to the Medicaid program. No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage –- cannot be simply dismissed as waste, fraud, and abuse. The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.
The AHA remains committed to working with all stakeholders to mitigate the impact of these cuts wherever possible. Our goal is to help ensure hospitals can remain open for their communities, and people can get the care they need when they need it. Our nation’s health and economic future depend on it.”— Rick Pollack, President & CEO, American Hospital Association.
American Medical Association: Reconciliation bill passage a “harmful day for patients and health care”
“Today is a sad and unnecessarily harmful day for patients and health care across the country, and its impact will reverberate for years. Care will be less accessible and patients may simply forego seeing their physician because the lifelines of Medicaid and CHIP are severed.
“This is bad for my patients in Flint, Michigan, and it is devastating for the estimated 11.8 million people who will have no health insurance coverage as a result of this bill.”
“The American Medical Association’s mission is promoting the art and science of medicine and the betterment of public health. This bill moves us in the wrong direction. It will make it harder to access care and make patients sicker. It will make it more likely that acute, treatable illnesses will turn into life-threatening or costly chronic conditions. That is disappointing, maddening, and unacceptable.” —Bobby Mukkamala, MD, President, American Medical Association.
American Nursing Association: Patients, Nurses, Hospitals and Our Health System Count on Medicaid
As Congress considers proposals that would significantly reduce federal support for Medicaid, the American Nurses Association is urging lawmakers to reflect not only on the policy implications but also on the real-world consequences for patients, providers, and communities across the country.
“Today, the Senate passed HR1, which, if it becomes law, will have devastating consequences for patients, nurses, and healthcare overall, particularly for those in rural and medically underserved areas. Patients and nurses deserve better,” said Jennifer Mensik Kennedy, president of the ANA. "Medicaid is not just a budget line item—it is the backbone of care for millions of Americans, including seniors in nursing homes, children with complex medical needs, and working families in rural and underserved areas. It is also a critical pillar of the nursing workforce. Cuts to Medicaid would result in hospital and clinic closures, especially in rural areas, and would force nurses to shoulder even heavier workloads, leading to burnout, attrition, and ultimately, worse patient outcomes."
These are not abstract warnings. Nurses across the country are already reporting the strain: higher patient ratios, reduced resources, and the moral injury of being unable to provide the care their patients deserve. Medicaid accounts for 19% of hospital revenues nationwide. Reductions in funding will ripple through the entire health care system, threatening both access and quality of care.
Elected members of Congress should consider the political lessons of the past. In 2018, more than 20 Republican House members who voted to repeal the Affordable Care Act lost their seats. While many factors contributed to those outcomes, the public’s concern over health care access—particularly Medicaid—was a decisive issue in many districts. This is an important reminder that voters care deeply about health care, and they are paying attention. Constituents, especially nurses in the communities and their patients, are relying on our elected officials to do the right thing and to protect Medicaid.”
All of this will come as a rude awakening to many Americans. Around 20% of the country is on Medicaid. But because some local/state names for Medicaid programs are different, many don’t even realize that fact (“I’m on Medi-Cal, not Medicaid.”) Anyone thinking that will soon find out that programs like Medi-Cal are Medicaid. Or at least they will in a few years, when those cuts actually go live.
What are your reactions to all of this? Please share your thoughts in the Comments section.
That’s all for now. Thanks for reading and supporting science, facts, and the actual American way!
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
It's horrifying. And the way it's being done...we both got emails from SS this morning saying that the SSA is celebrating the passage of this legislation. It is completely inappropriate to get a blatantly political email from the SSA. There should be an outcry about this alone, but then there is so much to rage against one doesn't know where to start sometimes. We are in very dark times. And the worst part of it is that there is a huge part of the populace who has no idea what's coming and will defend things they don't fully understand.
As always, your words are meaningful and support the clear, sad facts. But the best part of this for me is the "meme" you created. It is my understanding that we DO answer eventually for the impact of every thought and deed we put out into the universe. And it undoubtedly takes far longer--on "the Other Side"-- than a night of insane destructive voting to overcome and help those affected by our violations of the Laws. The ripple effect of this shameless selfishness and cruelty on children and families worldwide is only the beginnings of generations of unnecessary misery. We must stay in the fight!