Medicaid and Other Dirty Words.

I wish public health and child health could be apolitical. Health should be apolitical, don’t you think? Take a moment here and wonder, is health not a human right? How has public health become something that an elected official can vote yay or nay on? How on earth is government assisted insurance coverage a series of dirty words? We’ve come so far, advanced so much in healthcare, and yet one man’s quest for tax breaks has set us back decades. I want you to look at those dirty words, “Public Health,” and I want you to realize that you’re part of the public.

For many years health being a human right has been a bit of common sense, at least I’d like to believe. We had research, funded research, for cancer, Alzheimer’s, ALS, infectious disease, advancing life support, organ transplant, and the list goes on. This research has borne what should be a longer and healthier life for you and I. What happens when the funding is cut off?

The elderly had medicare because they couldn’t work anymore at an advanced age. They still were able to receive emergency care, primary and specialty care, rehabilitation, medications. What will happen to them when millions of dollars in medicare funding is in jeopardy?

Children and pregnant mothers have been covered by medicaid because of low income in a country that refuses to raise minimum wage as the cost of living and the cost of care continue to rise. Because of medicaid, children receive ventilators, feeding pumps, home nurses, chemotherapy, primary care, and so much more. Because of medicaid, the provision of safe and healthy birth is made possible for mothers in unthinkable circumstances. What will happen to them as millions of dollars in funding are gone?

We’ve had food assistance for folks living under the poverty line. Children and families have been able to eat when they otherwise wouldn’t have anything, often not even a free school lunch. What will they eat when the food stamps are gone and their mothers and fathers are working all shifts and still not making enough to make ends meet.

What happens when a family has to bear working multiple jobs, caring for a complex child who no longer qualifies for a paid-for part-time nurse, caring for an elderly relative who can’t afford to go into a skilled nursing facility, and the food and housing assistance that helps them get by just got cut by the US government to give tax breaks to billionaires. Money has to come from somewhere, you see? And the choice that the Big “Beautiful” Bill just made is one that takes that money from the needs of vulnerable populations and public health. The most obvious thing that a government should do is care for the needs of its people, and now millions of people will have needs that cannot be met.

Public health should be apolitical. But, now that it’s become increasingly political and the empathy trick doesn’t seem to be working to put Americans into each other’s shoes, allow me to take a different approach:

“Okay, but how does this affect me?”

Great question! It affects you in many ways, no matter who you are.

1. Medicare cuts: Critical access hospitals are small medical facilities who provide emergency care and inpatient care to smaller, rural communities. These facilities serve many medicaid and medicare patients as rural communities are aging and getting sicker. Many of these hospitals are open largely thanks to reimbursement from services rendered to medicaid and medicare patients. Without this reimbursement, doors will have to close. These facilities closing means that thousands of people in your communities will now be taken to urban and suburban medical centers for simple emergency care and med/surg admissions. This will extend wait times in the ER for all patients, decrease the number of available ambulances to take emergency patients, and create a bed crisis in the inpatient setting. Now, with less funding from medicaid and medicare, hospitals won’t have as much spending money. this should translate to hospital executives taking a pay cut, but they seem really comfortable in their McMansions so let’s be honest: what will be cut is nursing staff and pay, physician coverage, state of the art equipment, ancillary staff and pay, and upkeep of facilities – generally, patient safety will suffer, and your relatives will suffer. As for the bed crisis, some critical access and community hospitals have converted inpatient beds into “swing-beds” for medicare patients who require extended admission with skilled nursing care and aren’t quite sick enough for large medical facilities to make money off of but not well enough to go home. Now, let’s say that those start to close (they will), now your inpatient units are crammed with elderly patients and you need an admission for observation and antibiotics? You might get stuck in the ER hallway on a stretcher for days and never see a nurse to patient ratio below 7:1.
2. Medicaid cuts: Another service largely funded by government assisted insurance is child health, specifically children’s hospitals, NICUs, and pediatric primary care. Approximately 41% of US children are covered by medicaid. This means that children can go to their primary care office, get prescribed antibiotics, get referrals to specialists, get early intervention services and health screenings – all covered. This helps healthy children have the childhood they deserve: a healthy one. Now for children navigating complex illness or injury, medicaid provides things like medical equipment, home nursing care, rehabilitation, developmental care, inpatient care, intensive care, care for cancer, neonatal intensive care. We bring babies into this world, and medicaid helps 41% of them stay alive. That’s an incredible feat of public health. However, the BBB cuts funding in a way that has drastic impact. Without medicaid covering primary care, the ER will become child primary care, which redirects resources and space away from true pediatric emergencies, and doesn’t truly provide the continuity of care required to give a child the best primary care possible. Without medicaid to cover wheelchairs, disabled children will outgrow their wheelchair and lose their mobility when their butt no longer fits the seat. Without medicaid, how will children who need feeding pumps and seizure medications and insulin to keep them alive get them? HOW will they get them? Medicaid coverage funds children’s hospitals as most of their patients (chronically ill children) are covered by medicaid. Without medicaid money, what’s paying for specialty children’s hospitals to stay open and provide the best care for your child in an emergency (pediatric ER’s), or critical situation (PICUs), or if they get cancer (Pediatric Oncology Units), or if they need surgery (pediatric surgeons and anesthesiologists), or they get diagnosed with a unique genetic disorder (pediatric sub-specialists)? 40% of births are covered by medicaid. Medicaid cuts will close community and urban hospital birthing centers (which are already closing at a rate that is absolutely and breathtakingly alarming), putting mothers in cars for two hours on the way to the hospital with a cord prolapse they don’t even know is cutting off blood supply to their baby’s brain, causing devastating effects on their lives that they can’t even foresee, all because their town OBGYN was forced out by a holding company that left a shell of an ER in place of a booming community hub.
3. SNAP cuts: This one I have to appeal to your humanity. Everyone has seen those commercials for UNICEF, right? The starving children? That’s going to happen in this country, right under our noses. Food assistance isn’t a handout. It’s fulfilling a basic human need. No one can go back to work if they’re starving and perform at a level that ensures they keep their job. No child can go to school and learn in such a way that they’ll go to college or trade school if they’re starving. Food is a basic physiologic need that all other needs depend on. The brain needs food to work. The muscles need food to work. The spirit needs food to feel loved and cared for. To cut food assistance is to look at a family on the brink of starvation and say “work harder,” when a good bit of the time they can’t. It’s inhumane.
4. Immigration: Wouldn’t you do anything to save your child? If you knew that better treatment for your child’s cancer was across the border and you were denied access by an administration that hates you, wouldn’t you try to cross anyways? With your child on your back? Screaming in pain because nothing that hospital in Mexico City could do would help but you heard that somewhere in Georgia they can take away her pain? Would you watch your daughter die because God saw fit for her to be born in Mexico? Would you take the death sentence knowing that something else was possible. If you say no, you’re a damn liar. Now, you can bring your daughter to that hospital if you make it that far, and you can be on your knees in the ER begging for help and ICE can walk in and take you and your daughter to the everglades without asking your name or why you came. I’ve met children who have been carried on the backs of their mothers and I’ve been damn happy to help them. Need surpasses creed. At least, it should. The money that could be going to NIH research funding, medicaid, and rural health is going to be spent on hate for desperate people. That impacts you directly. We aren’t making legal immigration any easier, we’re just making illegal immigration more dangerous.

Money doesn’t come from nowhere. When you get a little more in your check because you make hundreds of thousands of dollars, think of where that money came from. And when you realize that this bill doesn’t make us better people and you wonder what can, take a look at what you can do.

• Donate to your local food bank or food pantry. They’re going to have a heavier burden to carry in the coming months and they’re depending on your community to help.
• Donate to homeless shelters and aid funds. As medicaid and medicare coverage are impacted, medical bills will pile up in such a way that people will lose their cars, homes, and everything else they have. The collections agencies of a for-profit healthcare system don’t care what circumstances have struck. It’s possible that people will lose everything. This bill asks that people go to work for their medicaid and medicare, but I have a secret – most people on disability? They’re disabled!
• Medical professionals donate your time to local and national community health initiatives – vaccine clinics, community health screenings, dental outreach – please get involved if you can.
• Call your congressmen and women and ask what they’re going to do for your community’s health. Hold them accountable. Part of the service they promise to provide is caring for your community, and this is the time we need them most.
• Have some empathy. People are going to be drastically affected. Medications are going to become unattainable and unavailable. Psychiatric care will be bogged down in a system that already is too small for our country’s need. Birth centers closing will make pregnancy scarier and more dangerous in a country who’s births are already more fatal than any other developed nation. Parents will be stressed leaving babies at home to be watched by barely-not babies anymore because they have to pick up a third job to pay for food on minimum wage.
• Vote in mid-term elections for someone who will advocate in state and national legislature for your community and children’s health. Do what you think is ethical and right.

Public health should be apolitical. Health should be considered a human right. The fact is that I cry in bed at night thinking about the children who we bring into this world and save from devastating illness may go home to starve. I can’t express how much that it hurts to look in their eyes and discharge them to live in a car.

For the Littlest is founded on a Bible verse, Matthew 25:40, “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me,” but that chapter continues:

“Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’ They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’ He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.”

Thanks for reading, if you did.

Go forth and give a damn about vulnerable people, please. Our lawmakers have shown that they don’t.