'We All Are Going to Die' — The Deadly Big Beautiful Bill

June 30, 2025 | Vol. 29 No. 6 | Archives

“We all are going to die”: The Deadly Big Beautiful Bill
Medicaid Legislation We Like!
No Kings Protests: Taking Back Our Power!
What’s Happening at HHS?
Supreme Court Decisions
What (Else) We’re Reading

That was Iowa Senator Joni Ernst’s cruel, dismissive response to her constituents expressing concerns about the harms coming from the Medicaid cuts in the reconciliation bill. Cuts that, when combined with other provisions in the package, will result in over 51,000 preventable deaths annually with around 16,000 annual deaths as a result of work requirements.

The indifference to human life isn’t new, but it’s becoming a standard response from policymakers in DC seeking to gut Medicaid and other safety net programs in order to pay for tax cuts (largely to the wealthy) and border security and immigration enforcement—measures that increase the federal deficit by over $3 trillion. (Note how quiet the deficit hawks are about this.)

Senate Republicans continue to claim they are against Medicaid cuts and insist the bill will only target “waste, fraud and abuse” or those who are “gaming the system,” but numerous analyses show just how devastating the cuts will be to communities across the country. Here’s the impact:

$800 billion in cuts to health care spending over the next decade
Nearly 16 million people at risk of losing health insurance
6 million health center patients in expansion states at risk of losing coverage
Over 300 rural hospitals at risk of closure
Millions of working adults at risk of being kicked off Medicaid
Millions of immigrants and their families at risk of losing health care and food assistance

These cuts are not popular with the public. Most U.S. adults support increasing or maintaining funding for programs like Medicaid. Even hospitals are pushing back with over 250 hospital leaders flying to DC to advocate against the bill.

Voting on this bill is happening NOW: Despite all of this information and public outrage, the Senate released their version of the reconciliation bill— which would result in 12 million more uninsured, compared to 10.8 million under the House bill, and even MORE work requirements that will take Medicaid away from an additional160,000 to 380,000 people. Senators have been rushing to meet their self-imposed July 4th deadline, pushing through several procedural steps including rulings from the Senate parliamentarian, revisions to the bill text, and a 16 hour floor reading of the 940 page bill, forced by Senator Schumer. Late Saturday night, the Senate narrowly voted 51-49 to advance the bill to floor debate.

As of this writing, the bill is being debated through a process called “vote-a-rama” and could be brought to a final vote as early as today (Monday, June 30) or tomorrow. It remains unclear whether Republicans have the necessary 51 votes to pass the bill as several Senate Republicans seem to still be on the fence and persuadable. If they get the votes and the bill passes the Senate, it will then return to the House for a vote on the revised version.

Millions are at risk of losing coverage, tens of thousands of people will die, and communities across the country will be harmed. Now is the time to speak out. Call your Senators today and tell them to vote NO on this awful bill.

Related Reading:

Three ways to oppose this bill:

Call your Senators TODAY at 202-224-3121: Urge your Senators and Representatives to vote NO on the reconciliation bill which will devastate individuals across the country. Use some of the bullets from above as talking points—or use our materials if you want more information: letter to Senate leadership, fact sheet on the bill, fact sheet on homelessness and work requirements!
Turn out: We need to continue to show up at local rallies, protests, and town halls to make it clear that these attacks on our communities need to stop. Find events near you: Indivisible and 50501
Activate a friend: Reach out to at least one friend and encourage them to call their elected officials and show up. If you live in a blue area but have friends in red areas, make sure you call them!

In response to the attacks on Medicaid, Democrats in Congress have introduced a slate of new bills aimed at strengthening and improving the program. A group of Senators unveiled 13 new bills that offer “common sense improvements” that would strengthen the program—such as 12-month continuous eligibility for all Medicaid recipients, adding dental/vision/hearing benefits, increasing federal reimbursement for medications for opioid use disorder (MOUD), giving states a public option health plan, and mandating 12 months of post-partum coverage in all states.

This month 5 million people showed up in more than 2,000 protests across the country to speak out against the rise of tyranny and the attacks on our communities.

The No Kings protests, held on Saturday, June 15th, started in defiance to Trump’s multimillion dollar military parade (which turned out to be incredibly underwhelming) and quickly expanded after the ICE protests in Los Angeles in response to immigration raids. The protests were inspired by the 3.5% principle, which is the idea that when 3.5% of the population engages in advocacy and resistance, real change can happen. On June 15th, the nation took a powerful step in that direction, a step to reject the threats to our communities, and a step to raise our collective outrage. But a single day is not enough—we cannot lose this momentum. Continue turning out to public rallies and protests—they are an important part of advocacy in a democracy!

Related Reading:

FY26 Budget: The White House released more information on its FY26 budget, with large-scale changes outlined in the HHS Budget in Brief document specifically. As mentioned in the May 1 Mobilizer, the plan is to rename HHS to the Administration for a Healthy America (or, AHA), organized around seven program areas: primary care, maternal & child health, mental health, health workforce, environmental health, HIV/AIDS, and policy, research & oversight. Numerous programs and/or agencies have been identified to be ended, consolidated with other programs, or defunded. Importantly for the HCH Community, the health center program is level-funded at $6.1 billion. On Tuesday, HHS/AHA Secretary Kennedy testified at a budget hearing about the changes to take place, with the most contentious discussions revolving around vaccines (see below). (Full recording of the hearing here and here.)

Sidenote: Because housing is health care, Mobilizer readers should also know that the Administration proposes significant cuts to HUD, across rental assistance and other housing programs, consolidates CoC funding into the ESG program and ends many responsibilities, eliminates funding for the Housing Opportunities for People with AIDS (HOPWA), reduces homelessness assistance grants, and ends CDBG (among other changes).

Hearings will continue in the coming weeks—stay tuned for more information.

Vaccine committee unraveled, replaced with vaccine skeptics: In an extraordinary and dangerous move, Secretary Kennedy removed all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP) which is responsible for voting on updates and changes to the immunization schedule. He replaced the panel with 8 new individuals who have histories of criticizing the government over vaccine policies. This decision has sparked outrage from medical groups and Senate leaders, with Senator Sanders requesting a congressional inquiry into the firings. The firing of ACIP is not only unprecedented, it poses a threat to public trust in vaccines and could have enormous consequences for public health because insurance coverage for vaccines is based on ACIP recommendations. The first meeting of the new ACIP group has started the process to change the childhood vaccine schedule.

CMS and DHS team up to target immigrant communities: At the end of May, CMS announced it would increase federal oversight of states to prevent the “misuse” of federal Medicaid funding to cover undocumented individuals. The letter cited the President’s executive order “Ending Taxpayer Subsidization of Open Borders.”

This announcement came just as governors in California, Illinois, and Minnesota began to freeze or cut government funded health care for undocumented immigrants. That was coupled with further attacks from the Administration, who, a few weeks later, required CMS to send the personal data, including immigration status and claims data, of millions of Medicaid enrollees in California, Illinois, Washington, and Washington DC to the Department of Homeland Security.

This data sharing is the latest step in the Administration’s strategy to target and criminalize immigrant families and aligns with previous attempts to collect sensitive information from the IRS, SSA, and HUD. The Trump administration also published a list of sanctuary cities, ordered ICE to expand enforcement efforts in Democratic-run cities, and targeted immigrant families through the reconciliation bill.

Related Reading:

HARMFUL RULINGS

Planned Parenthood: The court ruled that states can ban Planned Parenthood providers from their Medicaid programs. This harmful decision will limit access to a wide range of health care services for many low-income people.

Transgender care: In a devastating ruling, the Supreme Court upheld Tennessee’s categorical ban on gender-affirming hormonal therapies for transgender young people. The ruling allows the Tennessee law to go into effect, as well as similar bans which exist in 25 states, cutting off treatment for thousands of transgender youth. This is a heartbreaking ruling that came a day after the Trump administration announced they are ending the specialized suicide prevention services for LGBTQ+ youth on the 988 Suicide and Crisis Lifeline. LGBTQ+ youth who need support and counseling can still access it through the Trevor Project.

Deportations: The court ruled the Trump Administration can deport immigrants to a third country, reversing a lower court order. This harmful decision puts even more people at significant fear of being sent to a country where they have no family, no connections, and no civil or human rights.

HELPFUL RULINGS

FCC broadband services: The court affirmed that the Federal Communication Commission’s Broadband Access Program is legally funded. The fund has been used to expand service to low-income Americans and people living in rural areas and Native American tribal lands, as well as other beneficiaries such as health clinics, schools and libraries. This is great news for everyone who thinks access to care (and basic telecommunications) is a good thing.

MIXED RULINGS

Preventive care under the ACA: Fortunately, the court upheld the Affordable Care Act’s requirement that insurance plans fully cover all preventive services recommended by the U.S. Preventive Services Task Force. While it was a challenge to the requirement to provide PrEP to prevent HIV infections, the ruling would have extended to all preventive care such as treatment for blood pressure screenings, as well as birth control, breast and lung cancer screenings, immunizations, and more. However, in a concerning twist, the ruling also upholds the HHS Secretary’s power to appoint (or fire) members to that Task Force, which strengthens the Administration’s assault on vaccines and other preventive care.

Temporary injunctions: The court ruled that federal judges are limited in their ability to issue nationwide injunctions. The driving issue at the heart of this case is in response to President Trump’s Executive Order nullifying the Constitutionally protected right of birthright citizenship. Importantly, the ruling did not rule specifically on the Executive Order—but on the right of judges to stop enforcement nationwide. We call this a mixed ruling because nationwide injunctions can be helpful or harmful, depending on the issue.

Other Litigation Updates:

Laura Brennan
Senior Policy Manager
National Health Care for the Homeless Council

lbrennan@nhchc.org

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