A Republican budget bill moving swiftly through the Senate would strip health coverage from 16 million Americans while delivering over $1.1 trillion in tax breaks to the nation’s wealthiest households, according to a report released by Sen. Bernie Sanders, ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee. The legislation, dubbed the “One Big Beautiful Bill Act,” would, by Sanders’ calculation, kick 19 people off health insurance for every millionaire household that receives a tax break.
“This report makes it abundantly clear that the reconciliation bill that Republicans are attempting to ram through the Senate this week would be a death sentence for working-class and low-income Americans throughout the country,” Sanders said. “Not only would this disastrous and deeply immoral bill throw 16 million people off of their health care and lead to over 50,000 unnecessary deaths every year, it would create a national health care emergency in America. It would devastate rural hospitals, community health centers and nursing homes throughout in our country and cause a massive spike in uninsured rates in red states and blue states alike. That’s not Bernie Sanders talking. That is precisely what doctors, health care providers and hospitals have told us.”
Healthcare providers from across the country submitted more than 750 responses to the HELP Committee detailing the consequences of the proposed cuts. Their testimony painted a bleak picture: overwhelmed hospitals, preventable deaths, shuttered rural clinics, and a bureaucratic maze that would deny care even to eligible patients.
“If Medicaid is cut, my patients will die,” said Dr. Helen Pope of Louisiana. “I realize I am being dramatic. It is a dramatic situation. They are humans who are doing their best. Please don’t allow them to suffer more.”
The report includes data showing that the uninsured rate would nearly double in many states, with especially sharp increases projected for Massachusetts (from 2.5 percent to 5.6 percent), Washington (from 6.2% to 11.0 percent), Florida (from 10.4 percent to 18.8 percent), and New York (from 4.7 percent to 8.8 percent) .
Doctors and healthcare systems warn the bill would lead to cascading effects across the healthcare sector. “Plainly said, children will die as a result of these cuts,” said Dr. Farhan Malik, a pediatric critical care specialist in Florida. “Hospitals will cut back on ICU doctors, doctors will leave because of salary cuts, critical ancillary services will be reduced, more medical students will avoid going into pediatric residencies.”
Research from the Yale School of Public Health and the University of Pennsylvania’s Leonard Davis Institute of Health Economics estimates the bill would result in more than 51,000 additional deaths annually. The breakdown includes 11,300 deaths from Medicaid and ACA coverage losses, 18,200 deaths from seniors losing drug subsidies, 13,000 deaths from the elimination of nursing home staffing standards, and 8,811 deaths due to lapses in ACA tax credits.
“If the proposed bill is passed and [my patients’] Medicaid insurance is cut, it doesn’t mean their asthma will go away,” said Dr. Gregory Omlor of Akron Children’s Hospital in Ohio. “It will mean that in most cases they will not receive preventative care, and as a result, their asthma will worsen… Worse yet, they would be seen in the emergency room more often and admitted to the hospital. This care is more expensive, and less effective, than preventative care, and some children will die of their asthma.”
The legislation also introduces burdensome new paperwork and eligibility restrictions. Patients on Medicaid would be required to prove they work at least 80 hours per month, and automatic ACA re-enrollment would end. This would be a major barrier for many low-income and disabled individuals. “Some of my eligible patients have waited nine or 10 months to be appropriately reinstated after a paperwork glitch,” said Dr. Lisa Navracruz of Ohio. “INSTITUTING DECEPTIVELY NAMED WORK REQUIREMENTS WILL EXACERBATE ALL OF THESE PROBLEMS.”
Healthcare administrators expect to divert already strained resources to handle increased bureaucracy. “We would likely need to hire at least 1–2 full-time administrative staff just to track patient eligibility, navigate complex documentation requirements, and assist families with enrollment or appeals,” said Ashley, a social worker in South Carolina. “This would divert already limited funding away from clinical care and impose new costs on our department.”
The impacts would be particularly devastating for rural hospitals and safety-net providers. The Louisiana Rural Health Association reported that “38% of hospitals operate on negative margins and 27 percent are currently vulnerable to closure. Medicaid cuts would worsen these losses, putting more hospitals at risk of shutting down entirely.”
Tom Reinhardt, CEO of Cascade Medical Center in Idaho, said, “Our margin last year was -31%, burning through cash to see patients, the majority of whom are on Medicare or Medicaid. If they lose Medicaid, we’ll still take care of them because that’s what we do, but the bills won’t get paid.”
According to the report, community health centers would lose up to $32 billion in revenue over five years from the Medicaid work requirements alone, while nursing homes project that 27% could close and another 58% would be forced to lay off staff.
Meanwhile, the Penn Wharton Budget Model shows the bill would shift the tax burden downward. Americans making $51,000 or less would see their taxes increase by hundreds of dollars, while those making at least $4.3 million would see tax cuts of approximately $390,000. Over 800,000 millionaire households stand to benefit.
“We have an existential choice to make,” said Dr. Peter K. Shaw of Maine. “The very wealthy want to steal from the less wealthy and poor Americans.”
The proposal, which passed the House by a single vote, is advancing in the Senate without any hearings or formal testimony from medical professionals, hospitals, or patient advocates. Sanders and the entire Democratic membership of the HELP Committee have called on Chairman Bill Cassidy (R-La.) to allow debate and patient testimony before bringing the bill to the floor. So far, those calls have been rejected.
“We cannot allow Republicans to take health care away from 16 million Americans in order to pay for more tax breaks to billionaires,” Sanders said. “As the Ranking Member of the HELP Committee, I will do everything that I can to see that it is defeated. Health care must be a human right for all, not a privilege for the wealthy few.”
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