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Diminishing the axis of healthcare and wellness

It took 60 years for Medicaid to expand health care access to over 70 million Americans with low incomes and/or disabilities. The largest federal subsidy rollback in history threatens to end healthcare justice with the passage of the Big Beautiful Bill which slashes federal Medicaid spending by 15 percent.

In a national briefing ACoM, a medical director at one of the largest Federally Qualified Health Centers in the US, a nationally recognized expert on Medicaid, and two veteran healthcare advocates in California and Washington, D.C. discussed the future of healthcare. 

Why healthcare is critical

Medicaid (called Medi-Cal in California) was created in 1965 as part of President Lyndon B. Johnson’s “War on Poverty”.

“Medicaid or Medi-Cal was the answer for people who were working, but needed to choose between medicine and food, and/or education of their children and taking care of their medical problems, " said Dr. Ilan Shapiro Strygler, a pediatrician, Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services.

“We can now see the difference from what actually started happening 60 years ago to what's happening now. More than 75 million people, about 1 in 5 Americans, actually are in touch with Medicaid,” said Shapiro.  

All this will be upended by the Big Beautiful Bill. “This was a disastrous bill that just passed,” said Anthony Wright, who, before heading Families USA in Washington, D.C, was Executive Director of Health Access California. Over the next decade, OBBA will eliminate over $1 trillion from federal health care and food aid, largely by imposing work verification requirements on recipients and shifting cost burdens onto states.

“It is a major setback to healthcare.The estimates are that over 15, 16, 17 million people will lose coverage as a result either because they are pushed or priced out of coverage, largely through bureaucratic barriers, but also through increased costs.”

Emergency Rooms will be slammed

When people do not have health insurance, the emergency room becomes their main point of care, because ERs can’t legally turn patients away (under EMTALA law). People delay routine care until their condition is severe enough to require urgent attention.
“ER is not the best place to take care of mammograms, talk about diabetes, and high blood pressure,” said Shapiro. Things that we can 
prevent will become critical. 

Treating late-stage complications costs far more than preventing them. Besides overcrowding ERs with patients who could have been treated earlier in a clinic, means true emergencies wait longer. 

“The moment we invest in preventive services we have a healthier future. We have a healthier community,” said Shapiro. 
Healthcare isn’t just about treating illness, it’s also a pillar of local economies and community stability, especially in rural areas
In many towns, the hospital is the largest or second-largest employer. Fewer doctors, nurses, and staff means fewer jobs, and that ripples through the community.

“A lot of the rural hospitals and community clinics are the drivers of economic hope and well being.  Less physicians and nurses will have a direct impact only in our lives, not only in our patients, not only us as healthcare providers but on the community. We'll start diminishing the axis of healthcare, of wellness.”

“We are 6 percentage points away today from achieving universal coverage. This is our starting point. We don't want to go back,” said Cary Sanders, Senior Policy Director, California Pan-Ethnic Health Network.

The next generation of our community is going to be hindered

Millions of people, in California alone, around 2 million, are at risk of losing healthcare coverage. That number isn’t just a statistic; it represents families, children, and the future of our communities.

“The next generation will be most affected. Many of the children I serve face complex health challenges: neurodivergence, chronic illnesses, heart conditions,” said Shapiro. These are not issues that can be managed by occasional ER visits — they require ongoing tools, evaluations, and preventive care to ensure they can grow, thrive, and reach their full potential”.

“When we pull away healthcare, we don’t just disrupt a clinic visit. We hinder the next generation.”

Think of the father who is working two or three jobs. He is the breadwinner, protecting his family’s stability. If he loses his healthcare coverage, it’s not just his health at risk. It’s the family’s economic security, the children’s future, the entire community’s resilience.

“As much as Medi-Cal or Medicaid is a healthcare program, it's also an anti-poverty program, said Sanders. “Healthcare is very expensive, and a key driver of personal bankruptcy”.

Medical debt is going to be a deathtrap. 

“Medicaid is more than an insurance program. It is a lifeline,” said Shapiro. 

There is fear in the community 

The consequences of the federal cuts and the current political climate are clear. Fear has replaced trust, and survival has replaced wellness.
Right now people are choosing, not out of neglect, but out of fear and necessity, to set aside their health. And when health is set aside, the  human, economic, generational costs only grow.

“We probably will start seeing more chronic diseases. What will happen in the influenza season at the end of the year?”

“A lot of people will probably get influenza.”

What can be done?

Congress has one last chance this fall to prevent premiums from spiking. September 30 is the deadline for Congress to pass or kill the Health Care Affordability Act, which makes the ACA tax credits permanent.

If the credits expire, 20 million Americans could see premiums rise by 75 percent on average, and 4.2 million more could lose coverage altogether.
“That’s why it’s critical for members of Congress to hear from their constituents now. Voters need to make clear: they do not want to see health costs spiral out of reach. The decision is urgent, and it has to be dealt with this month,” said Anthony Wright, executive director of Families USA and former head of Health Access California.

“This is a long fight, but it starts literally with the fight around the expiration of the tax credits in the next month."