Below is a transcript to our video, part 4 of We’re All Going to Die, But Does It Have To Be So Soon?
Welcome to the third episode of “We’re all going to die, but does it have to be so soon?”
In this episode, I want to talk about health threats to you by the Trump Administration and its allies in Congress.
Let’s start with the most high-profile current example, which was actually the main issue in the recent federal government shutdown — and that was the looming expiration of some of the important tax credits that help people get health insurance under the Affordable Care Act.
The Affordable Care Act, or ACA (also known as Obamacare), helps people get health insurance when they can’t get it through employers. One way it does that is by offering insurance plans through state-run health exchanges. And it helps people afford those plans with tax credits.
In 2025, more than 20 million Americans relied on the tax credits to help them get their insurance through the ACA exchanges. So what did the shutdown have to do with your health insurance? The issue is that the tax credits that have been making the ACA insurance affordable will expire at the end of this year. The Republicans who control Congress plan to let them expire.
For 54 days, the Senate Democrats would not agree to spending bills without an extension of the credits to keep health insurance affordable. Then in mid-November, eight Democratic Senators agreed to funding bills that would enable the government to re-open for at least a couple months.
That may have been an effort to protect federal employees from further harm, or part of some political calculation, but whatever it was, one immediate effect was to abandon the public to the cruelty that the expiration of the credits will cause. If the credits don’t continue, an estimated 4.8 million Americans will lose their insurance – and many will probably get sick and die.
Many of the 2026 insurance rates on the exchanges have already been announced, based on the credits expiring. And those rates are as much as 2-5 times higher. Sometimes, actually, even more.
In fact, about half of the people getting health insurance through the ACA are so close to the poverty line that they right now they are paying zero for their health insurance premiums, but without credits, they may have to pay up to $85/month, or much more.
Those payments may be impossible for people living at or close to poverty. One report said that even a single person earning $64,000/year will get no help, leaving them with payments of more than $1,000/month for health insurance, a very large burden.
So if we don’t want millions to lose their health care, it is important to fight to continue the tax credits, so the Affordable Care Act can remain true to its name. Please call your Members of Congress today and urge them to keep people on their health insurance. But that is just the tip of the iceberg.
Today, I also want to talk about the Billionaire Welfare Bill, which Republicans called the “Big Beautiful Bill” when Trump signed it into law a few months ago, at a July 4th celebration at the soon-to-be destroyed White House.
Rich people sure have a lot to celebrate. The bill gives them $4.5 trillion in tax cuts, according to final estimates from the Congressional Budget Office. That will add $3.4 trillion to the national debt, so Trump and his friends can spend it on yachts, private islands, and trips to space. I guess those things can be beautiful, which is why “beautiful” is in the bill. But that’s the last time I can say that word in relation to the bill.
Despite the White House celebration, the Billionaire Welfare Bill is basically an attack on poor people and the middle class. That is because it also includes about $1.1 trillion in cuts to the federal health care programs. So just to examine the math, that’s: $4.5 trillion in tax cuts, mainly for the rich Minus $1.1 trillion “saved” by stealing health care from the poor Equals $3.4 trillion added to the national debt.
So, the federal health spending cuts offset only a quarter of the money lost to the massive tax cuts. The rest just gets added on to the debt for our children and grandchildren to pay. None of that is acceptable, but we’ll just focus on the health care cuts for now.
Where are the health care cuts? Mainly, the bill cuts Medicaid, which provides health insurance for people who are poor or disabled. It cuts Medicaid by imposing burdensome and unnecessary new paperwork requirements that many people will not be able to meet, whether because their lives are not stable enough or the requirements are just too much administration for the average Medicaid recipient to handle.
This group of people comprises most of my patients, and I can tell you they need help, not the assault on their lives from the cuts in this bill. Medicaid makes the difference between my patients’ being able to work and their being paralyzed. It makes the difference between their being able to feed themselves and take themselves to the bathroom, as opposed to being dependent on someone else for all their physical needs. And it makes the difference between their being able to breathe…and dying.
Another bad feature of the bill for Medicaid is that copays will rise from nominal amounts to $35 for certain Medicaid services. That may not seem like a lot, but if you are earning minimum wage, it would take 5 or 6 hours to earn. And it could mean the difference between getting health care and not getting it. In addition to refusing to extend the Affordable Care Act subsidies I mentioned earlier, the bill also makes it harder for people to get insurance through the ACA by increasing paperwork and making re-enrollment manual instead of automatic.
The effect of that will be to boot many more people off their health insurance without them even knowing it’s happening. That is not an accident. It is the purpose of that part of the bill to hurt the most vulnerable. And the Billionaire Welfare Bill also greatly reduces the number of lawfully present immigrants who are eligible for the tax credits to help them afford ACA insurance.
This is a cruel blow to our fellow immigrants. Why do I say “fellow immigrants,” when my family has been here for many generations? As a reminder for all of us. Unless you are a Native American, you are, like me, an immigrant. So let’s stop with the high horse garbage of “I belong and you don’t” and be more accepting, welcoming, and generous to our fellow residents. And stop calling them “illegal.” It is not illegal for anyone to be alive. That language is what leads to concentration camps and genocide, and is wholly unacceptable.
The Billionaire Welfare bill also cuts the Children’s Health Insurance Program or CHIP program. That program insures kids who are not below the poverty line, but not well off enough to afford private health insurance. Why does anybody think it’s good to take health care away from kids?
The Billionaire bill also cuts the Supplemental Nutrition Assistance Program (or SNAP), which provides food benefits for poor families. The bill does that in several ways, especially by shifting costs to the states, some of which will then cut benefits, and also through more work and paperwork requirements.
And the Billionaire Welfare bill even cuts Medicare, which provides health care to older people. It does that in several ways, especially by triggering automatic cuts to the program by increasing the federal deficit, which could lead to as much as $500 billion in automatic cuts to that program.
The bill also ends Medicare eligibility for some lawfully present immigrants – no matter how long they have already paid into the system. Everyone needs and deserves health care—and in the rest of the industrialized world, they get it, at little or no cost. Impoverished countries are the ones that have a piecemeal, ad hoc method of healthcare financing because that is the best they can do with what they have.
The wealthiest country in the world should act like one, by providing health care and assuring all its residents are as healthy as they can be, because a healthy country is a strong and happy country. These cuts to health care–that is no way to treat each other.
The Billionaire Welfare Bill means at least 16 million people will lose their health insurance over the next decade, according to the Congressional Budget Office. And according to some estimates, the bill means more than 40,000 more people will die preventable deaths every year.
Why are those numbers so big? One reason is that Medicaid does not just help people labeled poor. The label for who is living in poverty is ridiculously low. Since rich people are hoarding the vast majority of the money, most everyone else is just scraping by, even without the poverty label. The poverty line in the US is an annual income of $15,650 for a single person. Do you think somebody earning even two or three times that feels like they have a lot of money?
Medicaid actually covers about one in five Americans, and more than half of the people in the US will have it at some point in their lives. Here are some ways these cuts will affect people at ground level. First, insurance coverage has everything to do with how likely you are to survive or thrive in a health problem or crisis. Why? Because insurance gives you access to nurses, other health professionals, medicines, and hospitals.
Studies show that with Medicaid coverage, more people get regular access to care. And so more of them are diagnosed early with serious chronic conditions like diabetes and cardiovascular disease. That leads to earlier treatment, which leads to better outcomes and lower mortality rates.
But not getting that early care increases costs, suffering, and death. That’s because it’s much harder and more expensive to treat chronic conditions after they spiral out of control. People who don’t have access to regular preventive care or basic outpatient care will wait until problems get very, very bad to get care.
I’d like to tell you about a patient I had once when I was working in the ER at DC General Hospital, in Washington, DC. He asked for a drink of water, and I gave him one. But as he swallowed, most of the water ended up on his lap. That’s because what was causing his wound was a case of head and neck cancer, which had gotten so bad that it had eaten a hole through the bottom of his mouth, That is how sick he had gotten before he even came in to get seen – because of a lack of health insurance, and fear that a hospital visit would make his family that much more impoverished, perhaps losing them their home. I will never forget him or the cruel system that let him get that sick before seeking help.
We still have that system. This same pattern applies to many other common conditions. For example, consider a treatable urinary tract infection. If people wait until that condition spreads to their kidneys, they can end up septic and in the ICU, in great pain, near death, or perhaps dead, and also costing hundreds of thousands of dollars – when they could have just gotten a $10 round of antibiotics and continued going to work or school, or at worst stayed home.
When people delay and then finally go to the emergency room, it is much harder and more expensive to treat the problem that has been neglected. And often that emergency care will be limited — like broken bones splinted in the ER but with no proper setting at a follow-up orthopedic visit because the patient cannot afford the $35 copay. That could result in permanent disability that might afflict people lifelong.
Some Republicans say they are not really denying anybody health care, because people can always go to the ER. But as that example shows, ERs cannot provide specialty care, ongoing maintenance care, and preventive care for all health problems. They can’t really care for chronic conditions, like cancer, asthma, congestive heart failure, or COPD.
The ER is so expensive and overcrowded because of health policy dysfunction, and such the wrong place for these needs. We should treat people at the right time, in the right place, and with the right health professionals – basically, with comprehensive preventive care – so they get the right care and as a whole, we don’t waste time, money, or lives. But without health insurance, many people will just die for lack of care, as has already been happening to the uninsured for many years.
So, with the Billionaire Welfare bill, we can expect to see more families pushed beyond the breaking point, trying to pay for care, or trying to care for loved ones without help. More desperate GoFundMe campaigns will appear to try to pay health bills. GoFundMes only work if you are connected with enough people who are not poor. And with a nation where 2 out of 5 people are soon to be in crisis, GoFundMe is not the answer.
With billionaires taking more and more of society’s money, we are going to see more lost jobs. More bankruptcies. And more homeless people. It costs cities much more money to leave people living on the street than it does just to give them homes. Taking away health insurance is not saving money, but shifting costs around and wasting money. And destroying lives in the process.
How about some more examples of what happens to patients without insurance? One Texas physician, writing in the New Yorker in July, related how one of her patients was a child with epilepsy. The child’s mother went to the pharmacy to get her usual anti-seizure medicines. But her Medicaid coverage had lapsed, and the medicines would cost thousands of dollars she did not have. So the child ended up in the ER. Staff stopped her seizures, but the child could not be discharged safely without the meds. Eventually, a charity agreed to cover them, but not before the child and the mother endured a lot of avoidable suffering and an expensive hospital stay.
Another patient the Texas physician described, had tonsils so enlarged he could barely eat. He got a primary care referral to an ear, nose, and throat specialist. But he could not see the specialist because he did not have the money. So he could only get his tonsils out after being later admitted to the hospital for malnutrition.
These new cuts will hurt a lot more kids. The Medicaid cuts don’t seem to target kids directly, but the paperwork requirements will result in many parents losing coverage, and when that happens, the kids often lose it as well. Even if only the parents lose coverage, it increases the burdens and threats to the whole family, risking the kids’ futures.
That Texas physician I mentioned told how her state’s aggressive efforts to disenroll kids from Medicaid and CHIP, the Children’s Health Insurance Program, once the federal government allowed them to do that in 2023, hurt her ability to provide kids with life-saving care. These Texas state bureaucratic barriers were very similar to those the Billionaire Welfare Bill now applies to the whole nation. Thanks, Texas!
And the physician cited an estimate that the Texas rules have led to a situation where half of the state’s children who are uninsured actually are eligible for some kind of coverage, but they still don’t have it. With the nation now following the lead of Texas, people all over the country will soon suffer that same type of harm. The SNAP cuts will hurt kids too.
That is the Supplemental Nutrition Assistance Program, often called food stamps. The Billionaire Welfare bill will result in more than 22 million people losing some or all of their food stamp benefits, according to the Urban Institute. One estimate is that about 6 billion meals would be lost every year. Those cuts will reduce the ability of schools to provide free breakfast and lunch to kids, which is extremely important for many families. Without those meals, many kids will face hunger, increased health threats, and negative effects on their attendance and academic success.
By the way, we have been creating some t-shirts and hoodies for nurses who want to express their objection to the cruel health policies of this government. Here’s our t-shirt in favor of free school lunches for all on the front, and objecting to the rich starving the poor on the back. We also have anti-fascism shirts and some nursing advocacy shirts. We try to keep prices as low as possible so nurses can spread pro-nurse and anti-cruelty messages, but all proceeds go to support our work. OK, moving on.
The Billionaire Welfare bill cuts will also hurt older Americans and their families. First, even Medicare—healthcare for the elderly– will likely be cut, because of the cuts triggered automatically by the bill’s increase in the federal deficit and the other features discussed above. And even if you have Medicare, that program does not cover long-term care. So older Americans rely on Medicaid for that.
But cutting Medicaid, as discussed earlier, means many nursing homes will need to close. One recent survey found that more than a quarter of nursing homes would close because of the cuts, with more than half saying they would reduce staffing – staffing that is not good to begin with. For those who can no longer find nursing home care, the burden again will fall on their families, with potentially huge economic and social effects.
Also, many older people who now live at home can only do so because Medicare pays for critical things they need, ranging from home health aides to rides to health appointments. What will happen to them? Some may end up in health facilities, consuming resources they did not need to consume, so that the facilities are less available to others. And some will just not get the care they need, and they will die.
In fact, more broadly, these cuts will lead to closures of health care facilities, provider shortages, overcrowding, and higher costs, even for people who have private insurance. That is because Medicaid funding helps keep health facilities going. Medicaid cuts will put more pressure on facilities, which will mean longer wait times, higher charges for people who do have insurance, and in many cases, the facilities will close down.
One estimate is that more than 300 hospitals may close. That means many people, especially in rural areas that are already underserved, will have to travel further to find care, or they won’t have access to care at all – even if they still have insurance. That will especially affect obstetric and pediatric care, which is already reimbursed at lower rates.
Why is that anyway? Care for women and children is not as important as care for men? Such a blatant disrespect for women and children and their care providers.
So with obstetric and pediatric routine visits happening in the emergency departments, they will get more crowded for everyone, as more uninsured people wait until preventable or at least manageable problems get so bad they have to go to the ER.
Poverty and poor health reinforce each other in a brutal cycle. Poverty makes people sick. That’s because poor people tend to have poor living conditions, lead in their homes, contaminated air to breathe, inadequate educational resources, a lack of healthy food, a lack of preventive and outpatient care, economic instability, dangerous jobs, and other challenges.
Quoting Melissa Boteach, chief policy officer for Zero to Three:
The attacks on the basic supports that families rely on, from health care to nutrition to early education and child care, have meant that not only have babies lost access to services and supports, but that there’s been increased chaos and fear in their communities, which in turn, affects their relationships with their caregivers, and that affects their brain architecture and development.
As a result of poverty, people can’t get the right health care to manage their sickness, or they are ruined financially trying to. That increases their poverty. And they get sicker and less likely to prosper financially. And more likely to experience neglect, abuse, chronic health conditions, and premature death.
But it does not have to be that way. Obviously, the cruel, needless cuts I have described should be reversed. But even more than that, we can actually improve public health by moving toward a Medicare for All care model. That has the potential to cover everyone, saving lives, improving outcomes and saving money.
That’s what other wealthy nations do, and what do you know, their life expectancies are much higher than ours is, at a lower cost. Why is the US carrying on with our antiquated, dysfunctional, expensive system that is killing people? Because with Medicare for All, Billionaires would end up with less of the money.
But who cares? Are you a billionaire? If not, you will only be helped by Medicare for All, not hurt. There is no need for us to protect any of those people.
We need to place a hoarding tax on them until they are no longer billionaires to pay for what the whole society needs, because something is wrong with an economic system and a tax code that allows some people to hoard so much money that it hurts other people.
As Billie Eilish said recently at the Wall Street Journal Magazine’s 2025 Innovator Awards where Mark Zuckerberg and his wife Pricilla Chan were in the audience.
“We’re in a time right now where the world is really, really bad and really dark, and people need empathy and help more than kind of ever, especially in our country, and I have to say, if you have money, it would be great to use it for good things and maybe give it to some people who need it. If you’re a billionaire, why are you a billionaire? No hate. But, yeah. Give your money away.”
The most recent Medicare for All bill was introduced in Congress in April 2025, by Senator Sanders and Representatives Jayapal and Dingell. Passing a bill like that really would be beautiful. Support such a world by calling your Senators and Congressional Representatives now. Thank you.
