Medicaid is under siege

I care for stroke survivors in a rehabilitation hospital. My job is to help them relearn how to walk, speak, eat, and live with dignity. But lately, I’ve taken on a new and heartbreaking role: explaining to patients why their therapy is being shortened, denied, or abruptly cut off — not because it won’t help, but because the system that pays for it is being quietly dismantled.

Across the country, Medicaid is under siege. And what’s happening in my hospital in Iowa may be a warning for the rest of America.

The newest federal budget proposal — now under Senate review — would slash hundreds of billions of dollars from Medicaid and nutrition assistance programs, while simultaneously locking in an estimated $3.8 trillion in tax cuts, according to the nonpartisan Congressional Budget Office.

Those tax cuts overwhelmingly benefit the wealthiest Americans and multinational corporations.

This isn’t budgeting. It’s a betrayal.

In my hospital, Medicaid isn’t a political issue. It’s a lifeline. I’ve seen it help a farmer return to his fields after a stroke. I’ve watched a grandmother speak her granddaughter’s name again. I’ve seen it buy time — time to heal, to relearn, to hope.

Medicaid is what makes those moments possible. But under this proposal, the people who rely on it most — older adults, people with disabilities, stroke survivors, and working-class families — are being asked to give up their therapy, their independence, and, in too many cases, their future.

In stroke rehabilitation, time is everything. Cut coverage, and you don’t just shorten hospital stays — you shorten lives.

Supporters of this bill frame it as a matter of fiscal responsibility. But the numbers — and the history — tell a different story.

President Bill Clinton erased a $255 billion deficit and left office with a $128 billion surplus. President Barack Obama inherited the Great Recession’s $1.4 trillion deficit and cut it by more than half. President Joe Biden reduced the COVID-era deficit from $3.1 trillion to approximately $1.4 trillion by 2022.

The three largest peacetime debt increases in modern U.S. history came under Republican administrations — Ronald Reagan, George W. Bush, and Donald Trump — each of whom signed sweeping tax cuts that disproportionately favored the wealthy. All three left office with significantly higher deficits than when they began.

According to the Tax Policy Center, more than 60% of the benefits from the 2017 Trump tax law went to the top 20% of households. The bottom 60% received relatively little — and many of those provisions have already expired.

Now, Congress is trying to make those tax cuts permanent while hollowing out Medicaid — a program that serves over 90 million Americans, including nearly 40% of all children and 60% of nursing home residents. Medicaid is not bloated or inefficient; in fact, it spends less per person than private insurance and covers many of the nation’s sickest and most vulnerable.

This isn’t fiscal discipline. It’s abandonment, dressed up as reform.

Even Elon Musk — hardly a fan of government-run health care — recently called the bill a “disgusting abomination.” When billionaires and bedside nurses agree, something is profoundly broken.

Cutting Medicaid won’t reduce the national debt. It will simply shift the costs elsewhere — to emergency rooms, unpaid caregivers, state budgets, and ultimately to families like yours and mine. It undermines public health, destabilizes hospitals, and dismantles the very safety net that helps people recover from life-altering events like strokes, injuries, or chronic illness.

And it tells my patients they are expendable.

I’ve stood at the bedside and explained to a patient why their therapy sessions were canceled — not because they failed to improve, but because their insurer wouldn’t approve another day. That’s what Medicaid cuts look like. They don’t feel like line items. They feel like loss.

This budget doesn’t ask those who profited most to contribute. It asks those with the least to sacrifice more.

But stroke survivors didn’t cause the debt. Neither did people with spinal cord injuries. Children born with disabilities didn’t. Seniors who worked for decades and now need help walking again didn’t.

And yet, they’re the ones being told to tighten their belts — while corporations and high-income earners receive permanent tax relief.

This is not policy. It’s a value system.

Budgets are more than numbers. They’re moral documents. They tell us who counts and who doesn’t.

If lawmakers are serious about addressing the deficit, they should consider fair taxation, reduce waste, and make evidence-based investments in health and infrastructure. But let’s not pretend that cutting Medicaid is about fiscal prudence. It’s about choices — and right now, Congress is choosing to protect the wealthy while abandoning the vulnerable.

That’s not just bad policy. It’s morally indefensible.

Christopher R. Crossett, DNP, MBA, MSN, RN, CRRN, is a board-certified rehabilitation nurse and doctor of nursing practice specializing in health systems leadership. Based in Cedar Rapids, he advocates for equitable health care policy, with a focus on Medicare, Medicaid, and access to post-acute care. Dr. Crossett merges clinical expertise with systems-level insight to promote accountability, ethical governance, and patient-centered reform.