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As an emergency room nurse in a rural community, and a mom whose daughter has multiple disabilities, I am appalled by Congress’ passage of President Trump’s cruelly named “Big Beautiful Bill,” which will result in millions of people losing their Medicaid coverage. But we still have our voices — and our votes — and advocates around the country are working to reverse these cuts. There’s a role for everyone to play, especially during Congress’ August recess.
Despite a glimmer of hope, I remain disgusted that the majority of Republicans who voted in favor of this inhuman legislation showed their complete disregard for the most vulnerable people in our state and nation who rely on this vital program: low-income moms and their children, people with disabilities, seniors, and rural residents. While 1 in 5 people nationwide have Medicaid coverage, in Michigan 1 in 4 people stand to lose their insurance, which includes both health and dental care.
Particularly despicable is that the majority of Republicans who voted in favor of cutting Medicaid funding by $1 trillion did it so they could give massive tax breaks to billionaires. As if this was not horrible enough, many people don’t even realize yet that these cuts will impact them: The changes to Medicaid won’t kick in until after the 2026 midterm election. That’s when the funding cuts, along with new rules that will require some people to work to keep their Medicaid coverage, go into effect — while the super-rich can take advantage of the tax breaks immediately.
What the politicians didn’t account for is the pain and suffering people are feeling now, the uncertainty of not knowing what their future holds — will they, their children, and loved ones lose their Medicaid coverage? Will hospitals close because they can’t sustain the flood of people who will turn to them for care as we expect, particularly in rural communities? Will people who work at those hospitals lose their jobs? We can only hope people will make the emotional turmoil they are now feeling known at the ballot box in 2026.
Overburdening rural hospitals, delaying care
For 10 years, I have worked at Beacon Three Rivers Health in Three Rivers, a rural area about 45 minutes south of Kalamazoo. We’re a very low-income community, which means we already see lots of patients in the ER because they can’t afford to get care anywhere else. Legally, the ER can’t turn them away. With the Medicaid cuts and new work requirements — which will take away Medicaid coverage from between 200,000 and 300,000 Michiganders starting in 2027 – we’ll see more patients turning to the ER because they don’t have any other choice.
Our hospital will also see a sicker population overall. Not only will people delay care. They won’t be able to afford medication and preventive care such as annual physical exams and routine screenings for health issues that can be treated with early detection, all of which is currently covered by Medicaid.
This will further stretch resources and burden already overworked nurses, who are forced to work longer hours and see more patients than we think is safe. We want to give every single patient safe, quality care, and Medicaid cuts will mean we have to work even harder to do so.
According to the Michigan Department of Health & Human Services, nearly 40% of small-town and rural Michiganders are covered by Medicaid. When these people lose their coverage, that means fewer payments to hospitals. The loss of those funds could force hospitals to cut essential services to stay open — or even close altogether. For many rural areas, the hospital is the largest employer. The Medicaid cuts will endanger people’s health and possibly our local economy.
Work requirements will create barriers to coverage
The work requirements also don’t take into account real-life challenges. To qualify for Medicaid, people will have to prove at least twice a year that they can’t work or show that they did work, were in school, and/or volunteered a total of 80 hours a month, according to a Kaiser Family Foundation (KFF) report. Consider my 26-year-old daughter, who has cerebral palsy, mild developmental delays, and profound hearing loss. Despite all of her challenges, she works in a Walmart stockroom 36 hours a week and fortunately qualifies for the company’s health insurance. But it took a year to find a job that worked for her abilities. She also had to make sure the bus line reached her new job because she can’t drive.
The same report from KFF makes it clear just how burdensome these work requirements are. In just one example: Each state can set its own requirements for how far back it can track someone’s work record. It could be one or two months — or possibly more. If someone has a gap in their past work history, they could lose their Medicaid coverage. Although it remains unclear just how many Michiganders will be impacted by these work requirements, KFF points out that when work requirements were enacted in Arkansas, 18,000 people lost coverage, but work participation did not increase. Plus, KFF analysis shows most adult Medicaid recipients under age 65 are already working, and many don’t receive insurance from work.
When crafting this legislation, I am certain our elected officials didn’t think about how challenging it is for some people, especially people with disabilities, to get a job and find a way to get there. My daughter, who can get a ride from my husband or me if the bus isn’t running, is one of the lucky ones, but what about the millions more who can’t work? The work requirements will likely tie them up in red tape that could take months to sort out before they can qualify for coverage.
Families earning low incomes who also stand to lose coverage will have to make very hard choices about whether to seek treatment at all — and then how to pay for their medication and follow-up visits to stay healthy, even if they visit our ER. They will have to choose between getting care or buying groceries or putting gas in their car.
The political maneuvering to delay the Medicaid cuts from taking effect until after the 2026 midterms is an unspoken admission of guilt by our elected leaders for the pain and suffering they know their constituents will endure with the loss of this coverage. They fear they will pay the price for their actions at the ballot box — as they should.
But we can take action now, during the August recess. Some legislators are talking about voting “no” on the September budget bill if these cuts aren’t reversed, which is a start. Even if all funding isn’t fully restored, minimizing this big, terrible bill’s harmful impact on the health of our country is a step in the right direction.
Tell your members of Congress to vote “no” on any budget bill that doesn’t restore the cuts to Medicaid. Even if President Trump vetoes a budget with Medicaid funding restored, those who vote to protect billionaires’ tax cuts over the health of our country’s most vulnerable will be on record — again — as voting against their constituents’ best interests. And we won’t forget when it’s time to vote in the 2026 midterms.
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Brandy Shoup, R.N.
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