Back in May, I wrote this blog post to share a white paper I had written on the quiet dismantling of America’s healthcare safety net—Medicare, Medicaid, and the VA.

At the time, I knew it was serious. I didn’t expect it to start moving this fast.

Since then, the “Big Beautiful Bill” passed, triggering new waves of cuts, privatization, and eligibility rollbacks—some hidden in plain sight, others buried in legislation that few people outside of Washington noticed. Even fringe healthcare proposals have started creeping into the mainstream.

So I’ve written a follow-up.

This new essay is far more than an update—it’s a deep dive into the accelerated erosion of Medicare, Medicaid, and VA healthcare, the growing risks for millions of Americans, and what we can still do to push back before it’s too late.

You can read it here on my Substack:
👉 Hollowed Out: How America’s Healthcare Safety Net Is Quietly Being Dismantled

I’m keeping this blog as a running record of these shifts—not because I think anyone’s sitting around reading my archives, but because these fights over healthcare are going to define the next few years in ways that many people won’t see coming.

If you’ve followed my writing before, you know this isn’t just a political exercise for me. This is personal. These policies affect veterans, working families, seniors, and anyone who depends on the healthcare safety net to survive.

I’ll keep tracking it.

The U.S. healthcare and life sciences (HCLS) sector is entering a period of historic disruption. Policy upheaval, budget cuts, and aggressive regulatory changes—some embedded in the Senate-passed “Big Beautiful Bill”—are colliding with ongoing innovation in tech, care models, and data strategy.

We’re not just being asked to build smarter systems. We’re being asked to build them in a rapidly shifting—and often contradictory—environment. Eligibility systems are being pushed into surveillance territory. AI is driving opaque denial algorithms. Privacy frameworks are eroding just as new therapies and delivery models require more nuanced consent and record-sharing structures.

As a long-time consultant in this space, I’ve watched integrators, vendors, and health systems struggle to keep pace. But I’ve also seen glimmers of hope—low-code tools deployed quickly, ethical stances taken quietly, and modular designs that allow for faster adaptation. There are ways to navigate this. But they require not just new tech, but a new mindset.

✅ Design for uncertainty.
✅ Build modular.
✅ Align with real-world needs, not just margins.

This post is part call to action, part personal reflection. And while I don’t claim to have all the answers, I do know this: what we build now will shape how patients experience care, how clinicians work, and how public trust is won—or lost.

📖 Read the full piece on Substack:
Bridging the Innovation Gap: Preparing Healthcare IT for an Unstable Future

Agentic AI—systems that act on data rather than just analyze it—is being hailed as a cure-all for the healthcare industry’s inefficiencies. Payers, providers, and pharma firms are investing fast. But how much of what’s being promised is actually feasible today, and how much is branding-driven hype?

In a new white paper, I explore the advertised, actual, and emerging uses of agentic AI in healthcare. From Salesforce’s acquisition of Informatica to UK-based “AI” firms exposed for running smoke-and-mirrors operations, it’s clear that the field needs clarity—and accountability.

This blog provides a preview of what you’ll find in that deeper dive.

​What’s Being Promised:

• Automated prior authorizations and appeals in payer operations
• Clinical documentation and decision support
• Ambient listening for providers
• AI agents in trial site selection and adverse event detection for pharma

What’s Working Now:

• Clinical ambient tools (Nuance DAX, Abridge, Suki) are helpful but still human-in-the-loop
• Automation of narrow workflows like intake triage or formulary lookups
• Some trial modeling, where data quality is strong and regulatory paths are clear

The Gap:

• APIs struggle with fragmented or unclean data
• Regulatory bodies still require auditability and explainability
• Firms overpromising agentic autonomy rarely disclose how brittle their models are

Consulting Firms: The Connective Tissue
It’s not just product companies shaping this space. Many consulting firms—Cognizant, Deloitte, EPAM, Accenture, Slalom, and others—play a unique hybrid role. They may:

• Build their own agentic tools (sometimes as ISVs)
• Partner with platform vendors like Salesforce or AWS
• Drive real-world implementation and integration of AI in healthcare settings

Far from adding confusion, these firms often bring much-needed structure, compliance rigor, and domain context. They’re helping AI move from lab demo to daily workflow.

Case in Point:

British “AI” firm Repliq was exposed by the Financial Times for passing off manual processes as generative AI, with junior developers writing responses behind the scenes. It was a textbook case of vaporware wrapped in buzzwords.

Read the White Paper:
The companion white paper explores:

• Why Informatica fills a critical data hygiene gap in Salesforce’s Data Cloud
• How to spot poser AI companies (regardless of whether they’re vendors or services firms)
• The regulatory drag on agentic deployment in clinical vs. administrative workflows
• Who’s actually building credible healthcare AI—and how to tell

Conclusion:
AI won’t save healthcare overnight. But real, responsible agentic AI—built on clean data, governed properly, and validated openly—can still move the needle. We just have to know where to look.

Read more: 
Get the Full White Paper - Agentic AI in Healthcare: Sorting Real Innovation from Vaporware

In earlier posts--“Can We Automate Our Way Out of Healthcare Cuts?” and “Why It Feels Like We’re Being Left Behind”—I looked at how federal retreat from public health investment erodes trust and destabilizes care. Now, with the true scope of Trump’s so-called “Big, Beautiful Bill” in view, it is easier to assess its cumulative toll: sweeping cuts to Medicaid, Medicare, SNAP, veterans’ health, tribal care, research infrastructure, and environmental protections. The result? A nation that will get sicker.

A Nation Made Sicker
Recent research in the Journal of General Internal Medicine finds that people who lose public coverage due to redetermination suffer higher mortality and avoidable ER use. This is already underway: over 20 million people have been removed from Medicaid since post-pandemic eligibility reviews resumed (KFF, 2025).

This is denial by design—and it’s expanding.

A Fragile Safety Net: Veterans, Tribes, the Working Poor
The VA system, historically excellent at delivering veteran-specific care (PTSD, MST, toxic exposure), is being hollowed out. Under the MISSION Act, funding is redirected to civilian providers who lack military cultural competency. That leads to misdiagnoses, disengagement, and preventable deterioration (RAND Corporation, 2022).

Tribal health programs are equally vulnerable. With IHS underfunded and reliant on Medicaid reimbursements, coverage losses hit Native communities hardest—compounding already stark health disparities.

Medicare Advantage is a Costly Illusion
Despite its popularity, Medicare Advantage (MA) costs taxpayers 6–9% more per enrollee than traditional Medicare—and comes with higher denial rates and narrower networks (MedPAC, 2024). A 2022 HHS OIG report found that 13% of MA denials were for services that would have been approved under traditional Medicare.

More money, less care.

Environmental Rollbacks: The Invisible Health Threat
While rarely discussed in healthcare briefings, environmental deregulation—air quality standards, water protections, pesticide safety—affects everything from asthma rates to cancer prevalence. The Lancet Commission on Pollution and Health estimates over 200,000 premature U.S. deaths per year due to pollution alone. That number will rise as oversight shrinks.

SNAP, Nutrition, and the Health-Hunger Feedback Loop
SNAP isn’t just an anti-poverty program; it’s a public health policy. Undernourished people are more prone to chronic conditions like diabetes and hypertension. Cuts to nutrition assistance will silently raise disease burdens, especially for children and the elderly.

The Economic Impact: A Sicker, Less Productive Workforce
According to the Brookings Institution, chronic disease now erodes U.S. GDP by hundreds of billions annually. With more people uninsured or underinsured, hospitals absorb rising uncompensated care costs—and many rural hospitals are forced to close. This feeds a downward spiral of health deterioration, labor force dropouts, and medical bankruptcies.

Can This Be Reversed?
Yes—but not passively. The safety net is a legislative construct. That means it can be restored.

• Reform Medicare Advantage: Require transparency in denials and cap risk scores.
• Preserve the VA: Freeze downsizing and ensure veteran-specific training for community providers.
• Protect Medicaid Access: Ban work requirements, streamline eligibility, and enforce nondiscrimination.
• Invest in Modern Infrastructure: Interoperable EHRs, cross-agency coordination, and integrated care models
• Reduce Costs Ethically: Expand drug price negotiations and outcome-based payment models.

These and other ideas are outlined in my white paper, Undermining the Safety Net (PDF) .

What Can We Do—Even When Leadership Won’t
It is a fact that many of the people with the power to fix this lack the moral courage and incentive to act. They defer, deflect, or distract. But that doesn’t mean we’re powerless. Here’s how ordinary people are already pushing back—and how you can join them:

🧠 Get Loud Locally

• Your city council, school board, and county health office may seem small—but they have direct influence on Medicaid enrollment, hospital funding, and public health rules.
• Attend meetings. Ask questions. Demand public discussion on how federal cuts are affecting your community.

📣 Tell Real Stories

• Data is easy to ignore. Human stories aren’t. Share how healthcare policy has affected you or someone you know.
• Contact local media. Post on social platforms. Join campaigns like Advocates for Community Health that amplify patient and provider voices.

🧭 Support People Doing the Work

• Donate to or volunteer with Federally Qualified Health Centers (FQHCs), free clinics, and advocacy groups who are holding the line where policy has failed.
• Encourage your local providers—nurses, therapists, case managers—to share what they’re seeing. Front-line stories cut through political spin.

📜 Watchdog and Report

• Work with organizations like the Center for Medicare Advocacy to track denied claims, inaccessible services, or unlawful eligibility purges.
• File complaints. Join public comment periods. Bureaucracies change when they are flooded with documented, on-the-record pushback.

🗳️ Vote—but Don’t Wait for an Election

• Voting matters. But elections are the bare minimum. Pressure representatives between elections. Call. Email. Show up. Make it known that these policies aren’t just abstract budget items—they’re life and death for your neighbors.

This isn’t about partisan slogans or “resistance.” It’s about reclaiming the public systems that made us healthier, safer, and more just.

Even if it feels like a drop in the bucket, action matters. Enough drops? That becomes a tide.

Final Thoughts
America’s public health institutions aren’t perfect—but they’ve helped us live longer, live better, and recover faster. If we let them wither, we will pay not only in dollars but in lives.

Let’s not look back in ten years and ask how we let this happen. 

Lately, I’ve been reading a lot in the news about staffing and service cuts at hospitals and clinics. What struck me wasn’t just the headlines—it’s that this feels increasingly personal. My wife works as a practitioner in a rural, federally funded health clinic. I’ve watched firsthand how under-resourcing affects care, staff morale, and ultimately, patient outcomes. At the same time, I’m seeing stories about states refusing to expand Medicaid, even as their hospitals struggle to stay open. And across the industry, there's rising chatter that maybe we can just automate our way through this.

As someone who works in digital health, AI platforms, and go-to-market strategy, I understand the appeal. But I also know it’s not that simple.

What’s Causing These Cuts?
Financial pressure in healthcare isn’t new, but it’s deepening. Cuts to Medicare and Medicaid funding are placing real strain on provider organizations. In 2025 alone, Medicare saw a 2.83% payment cut—the fifth year in a row this has happened—while a proposed $880 billion reduction in Medicaid could result in more than 13 million Americans losing coverage by 2034 (The Guardian, AMA).

The challenge may soon grow deeper: the latest federal budget proposal includes further cuts to Medicaid and related safety-net programs, which would likely accelerate service reductions and make sustainable solutions even harder to achieve.

In my view, this isn’t just a budget issue. It’s systemic. We’ve created a model that underfunds essential services and expects innovation to fill the gap without investing in the infrastructure that makes it sustainable. Layer on rising costs, workforce shortages, and aging populations, and it’s no surprise that many organizations—especially rural or safety-net clinics—are being forced to scale back staff or shut down entire categories of service.

Can AI Help? Yes—but With Limits
There’s no denying that AI, machine learning, and automation can streamline tasks. In Medicaid programs, for example, AI has been used to assist with eligibility determination and to predict patient risks and outcomes (arXiv). Care planning, coordination, and documentation are all ripe for tools that reduce manual overhead.

But this can’t be a swap-out strategy. CMS has already issued guidance that AI should support, not replace, human decision-making in coverage and clinical determinations (Norton Rose Fulbright). We’ve also seen lawsuits and compliance reviews over the misuse of algorithms to deny care (Maynard Nexsen).
​
So yes, AI can help—but only if implemented ethically, with transparency, and as a tool to extend, not replace, human care.

So What Can We Actually Do?
Here’s what I think is realistic—ground-level actions that make a difference:

🏥 At the Policy and Grassroots Level:

• Advocate for Medicaid expansion in non-participating states. The data shows expansion reduces uncompensated care and improves access.
• Push for fair and predictable Medicare/Medicaid reimbursement structures, not year-to-year instability.
• Support funding models that prioritize community health clinics, telehealth access, and preventative care (CT Insider).

💡 As Practitioners and Technologists:

• Use AI tools to free up staff—not replace them. Automate repetitive documentation, appointment follow-ups, and claims triage.
• Build decision support tools into care workflows that help identify risk earlier and coordinate better across care teams.
• Train staff on ethical AI use and ensure transparency in how tools inform decisions, especially in eligibility and benefits management.
• Share success stories and failure points openly. The more we learn from each other, the better the tools—and outcomes—become.

This isn’t about “saving jobs for the sake of jobs.” It’s about making sure patients don’t suffer because a system tried to cut corners where it couldn’t afford to.

So... Is This a Real Problem?
In short: yes. If we don’t address it, we’re not just risking operational inefficiency—we’re risking community health. Automation alone won’t fix it. We need better policy, better tools, and more collaboration between clinicians, technologists, and administrators who are willing to tackle this head-on.

We’re not making a mountain out of a molehill. The mountain has a name now.

Sources

• US health groups vow to fight GOP cuts to Medicaid and Obamacare – The Guardian (link)

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• Medicare pay cuts: How they endanger physician practices – American Medical Association (link)

• AI-driven innovation in Medicaid: enhancing access, cost efficiency, and population health management – arXiv(link)

• CMS clarifies Medicare Advantage organizations' use of AI in coverage decisions – Norton Rose Fulbright (link)

• The legal landscape for AI-enabled decisions for health care claims and coverage – Maynard Nexsen (link)

• CT must act now to save its health care workers – CT Insider (link)