How Sick Will America Get? The Full Weight of the “Big, Beautiful Bill”

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.