Will you be affected by Trump’s cuts to Medicaid, food stamps and other social programs? Contact the WSWS and tell us your story.

The Congressional Budget Office (CBO) estimates that 326,000 people in Massachusetts could lose their health insurance coverage over the next decade after the passage of the One Big Beautiful Bill Act on July 4. The OBBBA cuts $930 billion in funding to Medicaid nationwide, with billions of dollars projected to be cut annually from federal funds given to the New England state. Work requirements and new obstacles in filing for benefits are expected to go fully into effect by 2027.

Trump’s bill will cut approximately 15 percent of total federal Medicaid spending over the next decade nationwide. The CBO estimates that the bill’s cuts to Medicaid, including the discontinuation of enhanced Affordable Care Act (ACA) subsidies, will lead to an estimated 16-17 million people losing their health insurance nationwide.

Medicaid is a joint federal and state government program that provides health insurance coverage to low-income individuals and families and people with disabilities. One in three Massachusetts residents are enrolled in MassHealth (the state program combining Medicaid and the Children’s Health Insurance Program), including nearly half of all children and people with disabilities. Among those expected to lose coverage are hundreds of thousands of people enrolled in healthcare plans through the Massachusetts Health Connector, the state’s healthcare marketplace. This will have a cascading impact on the entire healthcare environment, broadly worsening conditions and costs of care for every worker in Massachusetts.

According to a new analysis by Oxford Economics, millions of Americans, regardless of where they live, will lose access to health insurance because of tighter eligibility rules and new work requirements. Those states like California and New York, largely controlled by the Democrats, which expanded Medicaid by raising the income eligibility criteria to 138 percent of the federal poverty level, and which have large immigrant populations, will be hit hardest. Massachusetts, which expanded Medicaid and whose population is 11 percent immigrant, will be one of the most affected. Other particularly vulnerable states include New Jersey, Florida, Nevada and Texas.

The Kaiser Family Foundation recently reported California has paused enrolling new immigrants in its health coverage program while Illinois has stopped state-funded health benefits for all immigrant adults between 42 to 64. Idaho and Tennessee have also enacted legislation limiting immigrant access to state health care benefits.

The impact in Massachusetts and beyond

The OBBBA’s cuts to MassHealth will impact all workers, who are reliant on a healthcare system put under enormous strain by hundreds of thousands of people losing their insurance. The consequences to the state’s healthcare system, including healthcare costs, increased premiums, diminished quality and lessened availability of care, would extend beyond those individuals who directly lose insurance, affecting workers who have private insurance.

When hundreds of thousands of people currently insured through MassHealth and the Health Connector become uninsured, they will still need to receive medical care. However, obtaining the most basic care will follow a more precarious and problematic route. Uninsured patients will delay care for chronic illnesses or forgo screenings, ultimately requiring more expensive care when their health deteriorates and reaches a critical stage, ultimately increasing health costs for all workers.

Another factor is cost shifting by healthcare providers. Because hospitals are legally required by federal law to provide emergency treatment to patients in need, treatment of an uninsured person becomes “uncompensated care.” This becomes a hidden tax on everyone with health insurance, as hospitals and healthcare providers will refuse to simply absorb these losses. To remain profitable, they will negotiate higher reimbursement rates from private insurance companies to make up for any shortfall. This leads directly to higher premiums for everyone with private insurance, both for individuals and for employers who offer insurance to their workers.  

Massachusetts has had near-universal coverage for many years, in large part owing to MassHealth, with the highest percent of its population insured of any state in the US. However, because MassHealth—which served as a model for the ACA (Obamacare)—is not universal healthcare for the poor and disabled, but rather is tied to private insurance companies through the “marketplace,” and to the for-profit hospital chains that provide care—the changes from Trump’s bill will be devastating. 

Reduced income from Medicaid would cause hospitals to cut services that are less profitable, which includes pediatric care, psychiatry, maternity wards, trauma centers and primary care. Less investment would go into new technology and equipment and hospitals will attempt to operate with even poorer staffing ratios than are currently in place, increasing wait times and creating dangerous conditions for patients. Emergency rooms would be overcrowded by uninsured patients who resort to the ER as a last-ditch option for care that would previously have been dealt with through routine checkups. These conditions set the stage for new levels of healthcare worker burnout and shortages. 

MassHealth covers vaccinations, screenings for diseases, and treatment for substance use and mental health conditions. If hundreds of thousands of people lose their healthcare access through MassHealth, it could lead to exacerbations of myriad social and public health crises.

A class-warfare measure

The One Big Beautiful Bill Act, passed by both houses of Congress and signed by Trump, is a class-warfare measure that entails the transfer of trillions of dollars from the working class to the ultra-wealthy. $4.5 trillion in tax cuts will overwhelmingly benefit the top 20 percent of the richest Americans. To counterbalance the budgetary gap made by filling the pockets of the wealthy, the bill strips over a trillion dollars in funding from Medicaid, food stamps (SNAP) and programs such as student loan debt relief.

Trump’s legislation also puts into question the sustainability of Medicare. The tax cuts for corporations and the wealthy stipulated by the bill will still result in the further ballooning of the federal deficit by an additional $3.3 trillion over 10 years. Under federal budgeting rules this is expected to lead to automatic funding cuts to Medicare totaling nearly $500 billion from 2026 to 2034, undermining future Medicare payments.

The crisis in Massachusetts cannot be dealt with at the state level, as Democratic officials claim they are attempting to do. Governor Maura Healey’s administration has promised an “outreach program” to help Massachusetts citizens navigate the intentionally difficult filing processes created by the OBBBA. State Attorney General Andrea Joy Campbell has joined a multi-state lawsuit against the Trump administration against its attacks on the ACA. These efforts will reap minuscule results, if any.

Mike Levine, MassHealth’s assistant secretary and one of the top two Massachusetts health officials, cynically emphasized that MassHealth enrollees “have some time.” “Most of the new Medicaid requirements won’t begin to take effect until after the 2026 midterm elections,” he said. “Keep seeking care… Take your meds. You don’t need to hoard them. You are not losing coverage tomorrow.”

The Trump administration has been engaged in a wrecking operation nationwide against social programs, government regulations and oversight of corporations. The administration has not only gutted the funding and social infrastructure involved in public health, but has put science itself in the crosshairs. Massachusetts has the most healthcare-concentrated economy in the country, with the healthcare industry being the state’s largest private employer. Cuts in research funding, such as the grants given by the National Institutes of Health (NIH), have had a disproportionate impact on the state economy and its population. 

In all his actions, Trump has been abetted by the Democrats, who during the Obama and Biden administrations advanced many of the social attacks now being accelerated by Trump. The Democrats, who, in Biden’s words, wanted a “strong Republican party” in the wake of the January 6, 2021 attempted coup by Trump, fear the working class far more than his fascist agenda. 

The working class must secure its political independence to mobilize its vast industrial and social power. This is a power that can shut down economies, halt war machines and decide the course of society. Workers must strive to replace capitalism, with its subordination of all social needs to profit, with socialism, which includes replacing for-profit healthcare with genuine socialized medicine. This requires the building and intervention of a conscious and politically independent socialist party, the Socialist Equality Party.

Will you be affected by Trump’s cuts to Medicaid, food stamps and other social programs? Contact the WSWS and tell us your story.