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An attack on the working class
More than a month after President Trump signed the “One Big Beautiful Bill Act” (OBBBA) into law on July 4th, the repercussions are still being unraveled and studied. Cuts to Medicaid and the healthcare system have clearly had a devastating impact on working and immigrant communities, leaving policymakers and stakeholders hustling to figure out how to counter the fallout.
A panel of experts representing different areas of the American medical system tried to answer this question at an August 1 roundtable hosted by American Community Media (ACoM).
Medicaid turns 60 this year, and with impending changes, it becomes more important to understand what this entails and how Medicaid will serve us.
“Sixty years ago, working-class communities had to choose between food and medicine, sometimes even health and education for their children. This was the gap Medicaid aimed to fill,” explained Dr. Ilan Shapiro Strygler, a pediatrician, Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services. “For more than half a century, Medicaid has not just been a source of health insurance, but a lifeline.”
He pointed out that emergency rooms served as the primary source of healthcare to typical Medicaid recipients. Working-class people are already forced to deprioritize their health and only go to the hospital when in need of urgent medical care.
This new bill will have a cascading effect, resulting in fewer ER visits and medicine refills, which will in turn increase complications and deaths, a large proportion from preventable and manageable diseases like diabetes, asthma, and allergies etc.
“To be clear, there will be a negative economic impact as well,” added Dr. Shapiro. “Slashing staff budgets, reducing the number of doctors and nurses, and withholding necessary funding to rural hospitals will affect the entire communities’ health and economies. Only when people are healthy and feel safe can they work and contribute to society.”
Compounding the stress of immigration crackdowns
Both Dr.Shapiro and Cary Sanders, Senior Policy Director, California Pan-Ethnic Health Network, reiterated the negative effects of the ICE raids they have observed at their healthcare centers.
“The pervasive fear has led to a lack of trust in the medical system,” noted Dr. Shapiro. “ In this political climate and ongoing immigration crackdown, the lack of trust has translated to fewer healthcare visits as immigrants are actively avoiding hospitals and doctors. They are now in survival mode, and that means that preventative health and getting the right prescriptions for chronic illnesses have taken a back seat.”
Sanders added that historically, Medicaid was implemented not just as a healthcare assistance program but also as an anti-poverty program, resulting from the Civil Rights Movement that created the necessary pathways for the advancement of poor and immigrant communities.
The OBBBA requirements for 80-hour work reporting and increased paperwork will restrict access to the Affordable Care Act (ACA) for all working communities, affecting immigrants who are lawfully present, asylum seekers, and refugees. It will be a devastating blow to people of color, especially women, elderly folks, and individuals with one or more disabilities, said Sanders.
She suggested that one of the important ways to counter this blow to healthcare justice will be to seek financial assistance through “Charity Care” policies that most hospitals will provide. An alternate source of healthcare could be community clinics and non-profit hospitals, which accept more charity care applications.
For advanced medical needs and financial assistance with surgeries, Dr. Shapiro suggested the National Association of Community Health Centers (NACHC) which has focused on providing healthcare for medically underserved and uninsured patients since 1971.
“Everything Is Connected”
“Everyone is going to see a minimum of 75% increase to their premium, perhaps even a doubling, as an effect of this disastrous bill,” said Anthony Wright, the Executive Director at Families USA. “This bill handed out trillions of tax cuts to billionaires but neglected to extend tax credits to the rest of us.”
He added that September 30th would be the last chance to fund the extension. “We have one month to let members of Congress hear from their constituents. After all, no one wants to see an increase of hundreds of dollars to their premiums or travel even further to access healthcare.”
Wright stressed that state governments will need to counter the effects of the OBBBA by streamlining application processes, increasing the scope and quality of telehealth services, and ensuring that private medical data is not shared with ICE.
“The cascading effects of this bill is going to hit us hard. Jobs will be lost, rural clinics will be at risk, and preventable deaths will go up,” he concluded. “Communities are going to hurt in a multitude of ways. After all, everything is connected.”
This article was written with support from the American Community Media Fellowship Program.