As a family medicine physician who has spent the last 15 years treating patients of all ages and socioeconomic backgrounds in my clinic in Reno, Nevada, I’ve witnessed firsthand how access to healthcare can mean the difference between a family thriving and falling apart. Unfortunately, I predict I’ll see access crumble increasingly in the years ahead now that Trump’s Big Beautiful Bill has been signed. By 2028 (and possibly sooner), we will see changes to our healthcare system that will impact the welfare of all Americans.
The Big Bill includes $1 trillion in cuts to Medicaid (mainly through work requirements and limiting how states can help fund their programs, known as the provider tax). But what lawmakers in Washington see as budget numbers, I see as human faces.
I think about my patient Maria and her five-year-old son David, who has an intellectual disability requiring regular monitoring and specialized care. Maria drives into town for appointments because there’s no clinic in her rural community. She always looks exhausted from the drive and from caring for David while managing her 80-year-old mother’s dementia at home.
During her most recent visit, she shared her fears with me. “Doctor, I don’t know what we’re going to do,” she said, her voice breaking. “If we lose our Medicaid, how will I afford David’s therapy? How will I get Mom to her appointments?”
Maria’s story has become heartbreakingly common in exam rooms across the nation. Understanding how Medicaid works and what’s coming next, I know her fears are well-founded.
How this will impact all patients
These cuts will create a healthcare system divided between those who can afford care and those who cannot. This divide will hurt everyone, including those not currently receiving Medicaid coverage.
Many people are already drowning in medical debt, and even those with insurance coverage find it financially crippling. Here’s how this will hit you directly, even with insurance: hospitals will pass these uncovered costs to your insurance company, which means your monthly premiums may skyrocket. That $40 copay you’re used to? It could jump to $150. Your $6,000 out-of-pocket maximum might balloon to $12,000.
Everyone has a budget, and with increased costs in all areas of life, even insured patients will likely delay care to save money. Emergency rooms will become the primary care option for countless families across the country. When people can’t afford a $200 office visit, whether they have Medicaid or not, they’ll wait until they’re desperately ill and end up in the ER with a $20,000 bill. With so many people flooding emergency rooms, wait times will increase for everyone.
Rural communities will lose their lifelines. Hospitals and clinics serving areas like ours operate on razor-thin margins; when Medicaid reimbursements get cut and provider taxes are eliminated, they’ll close. Research shows over 300 rural hospitals are at risk of closure or significant service reductions, and the Big Bill will push many over the edge. The $50 billion included in the bill won’t be enough to support rural hospitals, which serve 20 percent of the US population.
This means limited access to essential surgeries, including labor and deliveries, as well as critical stroke and heart attack care. You might find yourself being airlifted to the nearest medical center that offers the services you need, saddling you with an even larger bill and potentially incurring dangerous delays in treatment.
Wait times for specialty appointments that are currently two weeks might stretch to three months or longer.
Those most at risk
Our most vulnerable patients will bear the brunt of these changes. Forty percent of babies in America are born with Medicaid’s support, nearly 50 percent in rural areas like mine. When these cuts take effect, many patients will lose access to labor and delivery services. Pregnant women will have to travel hours to give birth, putting both Mom and Baby at risk.
The new work requirements for Medicaid (which might be implemented in 2026) appear reasonable on paper: Adults under 65 must work, volunteer, or attend school for at least 80 hours per month. But understanding how these systems work in practice, I can see the bureaucratic nightmare ahead that will strip coverage from people who desperately need it.
Take Maria again. She spends more than 80 hours a month caring for David and her mother, but unpaid caregiving won’t count under the new rules. She’ll have to find outside work while managing two dependents with significant needs to meet the administrative burden of proving her work status.
Patients with disabilities who cannot physically or mentally meet work requirements will find themselves in an impossible situation, losing the healthcare coverage they need to manage their conditions.
Even the copayments, which will require Medicaid patients to pay up to $35 for services, might seem modest, but studies consistently show that even small copayments cause low-income patients to skip necessary care. I’ve seen patients ration medications and delay appointments over much smaller amounts.
What about the doctor shortage?
The cap on student loans that this bill will enforce could worsen our physician shortage, just when we’ll need doctors most. Professional students, like those in medical or law school, will face a yearly cap of $50,000 and a lifetime cap of $200,000. Most medical degrees cost over $200,000, and limiting access to loans means fewer people will be able to pursue a career in medicine. This will hit rural and underserved communities the hardest, as we’re already struggling to recruit doctors.
My own story illustrates what’s at stake. My father retired from the military after 26 years of service, then worked as a special education teacher. Despite his dedication to public service, he couldn’t afford my medical school tuition. Although I had worked through college, I still relied on loans to pursue a higher education. If this bill had been in effect when I applied, I wouldn’t have been able to afford medical school.
As a Black female physician, I represent less than 3 percent of physicians in the US. This new policy will shrink that percentage even more. The loan requirements will limit who has access to funds for professional degrees, reducing not only diversity within medicine but also the total number of physicians available to provide care.
Among my colleagues, many are already considering early retirement or leaving clinical medicine altogether. Those staying are burning out from increased patient loads and administrative demands. When the Big Bill’s effects hit, this exodus will accelerate.
A perfect storm approaching
The combination of widespread coverage losses and weakened hospitals creates a perfect storm, and all patients will pay the price. As someone who understands both the healthcare system and Medicaid’s role in it, I can see this disaster approaching.
The faces of Medicaid aren’t statistics. They’re Maria and David. They’re the grandmother with diabetes who won’t be able to afford her insulin. They’re the veterans struggling with PTSD. They’re the working parent whose child needs surgery. These are our neighbors, our friends, our community members.
What we can do now
We need healthcare policies that strengthen our safety net, not tear it apart. We need to support rural hospitals, not defund them. The damage is already done now that the bill has been signed, but there are preventive measures we can enforce immediately before these changes take effect.
Share your story: Contact your representatives and share stories like Maria’s. Policy makers need to hear from constituents about the real-world impact these changes will have. Your voice matters, especially when you share specific examples of how healthcare access affects your community.
Prepare for what’s coming: If you’re on Medicaid, start documenting your work or volunteer hours now. Understand the new requirements and keep careful records. If you’re caring for family members, research what will count as qualifying activities under the new rules.
Support community health initiatives: Many communities are developing innovative solutions to bridge care gaps. Mobile clinics, telemedicine programs, and community health workers will become even more crucial as traditional healthcare options disappear.
Build networks of care now: Communities that work together fare better during healthcare crises. Organize carpools to medical appointments, share information about available services, and create support systems for families managing chronic conditions.
Plan for emergencies: Familiarize yourself with the location of the nearest hospitals and the services they offer. Understand that your local emergency room might not be available when you need it most.
Under this new set of rules, when you or someone you love faces a health crisis, the care you desperately need might simply not be there. Our healthcare system is already stretched thin, but it will get even worse. Sick people don’t disappear when they lose insurance. They just get sicker.
It won’t matter if you have Medicaid, private insurance, or pay cash. Closed hospitals and clinics can’t treat anyone. But if we act now, we can work to minimize the damage and protect the most vulnerable members of our communities before it’s too late.
