The Not So Beautiful Facts

Healthcare Edition

They call it the One Big Beautiful Bill. The name is so over the top that calling it Orwellian would insult the intelligence of Big Brother’s Oceania. Beautiful it is not.

But it is Big, and many commentators believe it will serve as the focal point of the 2026 midterm elections. So, it is critical to understand what the bill contains and what subsequent damage it will be responsible for.

For starters, let’s call it was it really is – “One Cruel Law”.

This post discusses how the One Cruel Law will affect Americans’ – all Americans’ – access to healthcare.

Top Line Message

The One Cruel Law illustrates the injustice that motivates this Administration: It gives tax cuts to the rich by cutting healthcare for the not-rich (the middle class, the poor, and much of working America). This is Reverse Robin Hood like never before.

In 2026 alone, the nation’s richest 1% will enjoy $117 billion.

Meanwhile, annual cuts to Medicaid, the health program for the poor, average $91 billion over the next 10 years. Cuts to food stamps are about another $19 billion per year. Oh, and it adds $3.4 trillion to the national debt over ten years. (Trillion, with a T).

Consequences for Medicaid Beneficiaries

We all know the consequences for Medicaid beneficiaries are dire. The unprecedented cuts are expected to cause approximately 10 million Americans to lose Medicaid coverage (and some estimates are over 14 million).

Only part of this, however, is due to reduced funding. Many people will lose Medicaid coverage because the One Cruel Act intentionally makes it extraordinarily difficult for eligible individuals to enroll or stay in the program. It imposes nationwide work requirements, and even though most Medicaid beneficiaries would satisfy those requirements – most either DO work or are children, disabled, and otherwise unable to work – the mere bureaucratic requirements of certificating work will kick off people who qualify.

This certification hurdle is not a bug; it is a deliberate feature of the “reforms”. The onerous requirements are intentional, and the aim is to reduce aid to the working poor. (In fact, the work requirements are responsible for the largest single source of funding cuts in the bill, single-handedly causing 5.2 million to lose coverage).

Consequences for Other Working Americans

Medicaid beneficiaries are not the only ones who suffer. The One Cruel Act is expected to cause an additional 5 million Americans to lose their health insurance – individuals who have purchased health insurance from the Obamacare exchanges.

Some of these individuals will lose insurance because the Bill removes low-income subsidies for purchasing on the exchanges. These individuals are often young and reasonably healthy, and they would not purchase insurance at all were it not for the subsidies. Many others are self-employed and building businesses that do not yet have steady revenue. Significantly, the absence of these younger, healthy insureds will raise premium prices for all.

The arrival of the exchanges made insurance readily accessible to these entrepreneurs, along with young self-employed, workers in transition, and individuals who simply could not afford insurance without a job that offered it. The exchanges are not a safety net or a hand-out – they are the foundation to wise public policy that encourages entrepreneurship, individual responsibility, and a marketplace for affordable health care.

Consequences for All of Us

What about those of us who are not on Medicaid and who have Medicare or stable jobs with health insurance? How will we be affected?

The erosion of the Obamacare exchanges will affect all of us. It will be harder for innovators to leave their current jobs and start new businesses, since health insurance will be more expensive and less available. Because entrepreneurialism is critical to the economy, this increased barrier to entrepreneurship will have long term consequences.

Moreover, the erosion of access to health insurance will mean more disruption: a less healthy workforce, even more overcrowding at hospital emergency rooms, some hospitals (especially rural ones) unable to stay in business because of the need to treat more uninsured patients, and the reduced ability to manage even rudimentary public health crises. Our healthcare infrastructure will be under strain, and that will affect all of us, because even the healthiest of us require healthcare.

The Big Cruel Act is mean-spirited, risky and irresponsible.

We are better than this. Better than crafting mean-spirited legislation with a dark view of power, and better than acting with short-sighted recklessness while willfully ignoring long term consequences for the nation.

Post note: As the first paragraph of this post was being drafted, and the Orwell reference was added, it was announced that President Trump fired the Bureau of Labor Statistics Commissioner after the Bureau reported slowing job growth. We expect that the replacement candidate will be Squealer.

Healthcare Edition

They call it the One Big Beautiful Bill. The name is so over the top that calling it Orwellian would insult the intelligence of Big Brother’s Oceania. Beautiful it is not.

But it is Big, and many commentators believe it will serve as the focal point of the 2026 midterm elections. So, it is critical to understand what the bill contains and what subsequent damage it will be responsible for.

For starters, let’s call it was it really is – “One Cruel Law”.

This post discusses how the One Cruel Law will affect Americans’ – all Americans’ – access to healthcare.

Top Line Message

The One Cruel Law illustrates the injustice that motivates this Administration: It gives tax cuts to the rich by cutting healthcare for the not-rich (the middle class, the poor, and much of working America). This is Reverse Robin Hood like never before.

In 2026 alone, the nation’s richest 1% will enjoy $117 billion.

Meanwhile, annual cuts to Medicaid, the health program for the poor, average $91 billion over the next 10 years. Cuts to food stamps are about another $19 billion per year. Oh, and it adds $3.4 trillion to the national debt over ten years. (Trillion, with a T).

Consequences for Medicaid Beneficiaries

We all know the consequences for Medicaid beneficiaries are dire. The unprecedented cuts are expected to cause approximately 10 million Americans to lose Medicaid coverage (and some estimates are over 14 million).

Only part of this, however, is due to reduced funding. Many people will lose Medicaid coverage because the One Cruel Act intentionally makes it extraordinarily difficult for eligible individuals to enroll or stay in the program. It imposes nationwide work requirements, and even though most Medicaid beneficiaries would satisfy those requirements – most either DO work or are children, disabled, and otherwise unable to work – the mere bureaucratic requirements of certificating work will kick off people who qualify.

This certification hurdle is not a bug; it is a deliberate feature of the “reforms”. The onerous requirements are intentional, and the aim is to reduce aid to the working poor. (In fact, the work requirements are responsible for the largest single source of funding cuts in the bill, single-handedly causing 5.2 million to lose coverage).

Consequences for Other Working Americans

Medicaid beneficiaries are not the only ones who suffer. The One Cruel Act is expected to cause an additional 5 million Americans to lose their health insurance – individuals who have purchased health insurance from the Obamacare exchanges.

Some of these individuals will lose insurance because the Bill removes low-income subsidies for purchasing on the exchanges. These individuals are often young and reasonably healthy, and they would not purchase insurance at all were it not for the subsidies. Many others are self-employed and building businesses that do not yet have steady revenue. Significantly, the absence of these younger, healthy insureds will raise premium prices for all.

The arrival of the exchanges made insurance readily accessible to these entrepreneurs, along with young self-employed, workers in transition, and individuals who simply could not afford insurance without a job that offered it. The exchanges are not a safety net or a hand-out – they are the foundation to wise public policy that encourages entrepreneurship, individual responsibility, and a marketplace for affordable health care.

Consequences for All of Us

What about those of us who are not on Medicaid and who have Medicare or stable jobs with health insurance? How will we be affected?

The erosion of the Obamacare exchanges will affect all of us. It will be harder for innovators to leave their current jobs and start new businesses, since health insurance will be more expensive and less available. Because entrepreneurialism is critical to the economy, this increased barrier to entrepreneurship will have long term consequences.

Moreover, the erosion of access to health insurance will mean more disruption: a less healthy workforce, even more overcrowding at hospital emergency rooms, some hospitals (especially rural ones) unable to stay in business because of the need to treat more uninsured patients, and the reduced ability to manage even rudimentary public health crises. Our healthcare infrastructure will be under strain, and that will affect all of us, because even the healthiest of us require healthcare.

The Big Cruel Act is mean-spirited, risky and irresponsible.

We are better than this. Better than crafting mean-spirited legislation with a dark view of power, and better than acting with short-sighted recklessness while willfully ignoring long term consequences for the nation.

Post note: As the first paragraph of this post was being drafted, and the Orwell reference was added, it was announced that President Trump fired the Bureau of Labor Statistics Commissioner after the Bureau reported slowing job growth. We expect that the replacement candidate will be Squealer.