As a physician who serves as governor of Hawaii, I’ve seen firsthand what a profound difference it makes when the government invests in public health. Our state is proud to lead the nation in the quality of health care for our residents, topping the U.S. News and World Report rankings year after year as the best state for health care.
One reason is that we make sure the people of our state have access to health care, regardless of their income. Nearly one-third of our residents rely on Medicaid, an $880 billion-a-year state-federal program that provides health coverage for millions of low-income and disabled Americans. The program also keeps hospitals open and medical workers employed in underserved and rural communities across America.
All of this is now under threat because Congressional Republicans have proposed $1.1 trillion in cuts to Medicaid and Affordable Care Act coverage – fiscally irresponsible cuts that pose a grave threat to our health care system. Racing against the clock to meet the president’s deadline to have the so-called “Big Beautiful Bill” on his desk to sign before July 4, Senate leaders have vowed to begin voting this Friday, June 27.
The GOP-controlled House of Representatives passed a budget last month that calls for $863 billion in cuts to Medicaid alone over the next decade. Senate Republicans have called for billions of dollars of additional cuts to Medicaid to help defray the cost of President Donald Trump’s tax cuts for the wealthy.
Contrary to what the bill’s supporters say, these cuts won’t “reform” Medicaid. Millions of people will fall into the “Medicaid gap,” meaning their incomes are too low to afford private health insurance but are above the Medicaid eligibility level in their state. The nonpartisan Congressional Budget Office estimates that the number of uninsured Americans will increase by 16 million in the coming years if these cuts are made. That translates into needless suffering and the loss of thousands of American lives.
Indeed, an estimated 16,600 Americans will die avoidable deaths each year because of the proposed cuts, according to a study published last week in the Annals of Internal Medicine. The Republican proposals would also push 5.4 million Americans into medical debt and increase total medical debt in this country by $50 billion, according to a new analysis by Third Way, a moderate think tank. That’s millions of Americans going into debt or losing access to life-saving care.
We already live in a nation where your zip code determines your life expectancy, and cuts to health care will widen that divide even more.
In rural America, nearly half of children and 1 in 5 of adults are covered by Medicaid, which is often the single largest payer to rural hospitals. Operating on razor-thin margins, hundreds of these hospitals will be forced to shut down and others will drastically reduce services.
When a rural hospital shuts down, it doesn’t just affect Medicaid recipients – everyone, including those with private insurance, suffers. When a rural hospital closes, the community loses jobs, economic stability and lives.
Critical Access Hospitals serve the most geographically isolated communities and depend on Medicaid reimbursements for their survival. When these go under, state and local governments are forced to raise taxes sharply or allow infrastructure to vanish. Slashing Medicaid will also force urban public hospitals to lay off staff, cut services or close.
Medicaid currently covers 41% of all births in the U.S. and provides cost-effective preventive care, including routine childhood and adult immunizations, for 71 million Americans.
Cut Medicaid, and you destroy these programs. That means lower immunization rates, increased outbreaks of preventable diseases such as measles and whooping cough, and greater risks to everyone’s health, as we have learned during numerous epidemics.
Cutting Medicaid will also accelerate the flight of doctors and nurses from underserved communities, creating “medical deserts” where patients don’t have access to health care. All across America, obstetric units are already closing. Women will be forced to travel hundreds of miles to give birth safely – and some won’t make it in time. Medicaid is also the largest payer for mental health and addiction services. Gut it, and people in crisis will be left with nowhere to go but jail or the streets.
Cutting Medicaid also means private employers will face higher insurance premiums, state budgets will be stretched thinner and all hospitals will be overwhelmed.
Preserving funding for Medicaid is not just a fiscal decision – it’s a moral one.
Do we believe health care is a privilege for the wealthy – or a basic right for all? Do we believe rural Americans deserve hospitals? Should a child’s vaccination, a mother’s safe delivery or an addict’s recovery depend on how much they can pay?
As a doctor, I took an oath to do no harm. As a governor, I took an oath to serve the people. These reckless cuts to Medicaid violate both. We must act now to prevent a dangerous future.