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By: Zachary Wright
WORCESTER, MA – On July 4, 2025, Donald Trump signed into law his “Big Beautiful Bill.” The bill is draconian and destructive on every level of the social contract. One of the most deadly provisions is the Big Beautiful Bill’s decimation of Medicaid programs.
During my career as a rank-and-file nurse, I’ve worked with diverse populations of different cultures and ages. I’ve worked in cardiac, intensive care, and the emergency room, so I’ve been able to see patients from many different stages of their hospital stay. Rootedness in the workplace allows us not only to advocate for and observe our patients and their needs, but that of the wider community in which the hospital exists. The community around the hospital is a mix of urban and rural, lower-income workers and tenants.
Many are part of the two million Massachusetts residents who rely on Medicaid assistance to obtain healthcare in the form of MassHealth.
When MassHealth Falls, So Do Patients
MassHealth is the name we give Medicaid in Massachusetts. Almost 2,000,000 of our family members, friends and neighbors are enrolled in MassHealth. 76% of the adults enrolled in Medicaid are employed, most full-time. Approximately ⅓ of births in Massachusetts are covered by Medicaid and ⅔ of nursing home residents receive assistance from Medicaid through MassHealth.
This “Big Beautiful Bill” will cause severe challenges to the most vulnerable of our fellow residents by taking a dagger to MassHealth. Those already struggling with rising prices of groceries, housing, childcare and more will be unable to cope with higher out of pocket costs. People will choose feeding their children, keeping roofs over their head, and gas for the car to get to work instead of medical care. Even before Medicaid cuts began, American workers were rationing. In April 2024, researchers found a fifth of Americans rationed medication. And as heart disease, diabetes, and cancer rise in Massachusetts just like the rest of the nation, our neighbors who put aside seeking medical care due to their inability to afford it will be sicker when and if they do finally seek care.
Rural hospitals rely on Medicaid reimbursement to keep their doors open; those funds help pay their staff, keep medications stocked, their lights on and their beds available. Hospitals, when deprived of those reimbursements, will need to cut costs to make up the difference if they want to stay open. That means fewer nurses, fewer beds, fewer procedures, greater costs for the patients, longer wait times, and an overall decrease in the availability of care.
We are “fortunate” in Massachusetts that only one hospital is at risk of closing due to Medicaid cuts: Baystate Franklin Medical Center, in Greenfield. But as we saw when Steward Health Care’s CEO oversaw a regime of mismanagement resulting in the closing of both Carney and Nashoba, even the closure of a single facility can cause secondary effects downstream that harm patients and communities. Surrounding hospitals caring for the former Carney and Nashoba patients had more patients to care for with their limited beds; fewer beds on the medical floors led to admitted patients waiting longer for a bed in the emergency room; packed emergency rooms led to greater waiting times for those in the waiting room, delaying critical and time sensitive care.
Time is tissue; strokes and heart attacks need prompt treatment to prevent disability or death.
Cuts to Medicaid Mean Cuts to Workers’ Community
Over 300 rural hospitals across the country may close due to the Medicaid cuts. Many of them not only serve rural white Americans; they serve Native communities and Tribes that depend on access to rural healthcare from reservations they were forcibly displaced to live in. Despite HHS Secretary Kennedy’s alleged attempts to shelter critical services like the Indian Health Services (IHS) from these cuts, rural Native communities are still on track to face the impact of rural hospital closures as well as by the cuts that many Tribal leaders consider violations of sovereign treaties between their nations and the United States. For rural people, both Native and non-Native, every hour traveled is one less hour of healthcare.
Every minute matters.
As a result of Medicaid cuts, long-term care facilities will become affordable only to the richer and fewer. Residents rely on Medicaid to afford the care they receive in these facilities; without Medicaid, they would be unable to afford the 24/7 care they need. Cuts to Medicaid ensure some working families will need to shoulder the burden of care for elders. Caregiving is not easy, nor possible within the backbreaking wage labor necessary to pay even for rising cost of living and rent, so accommodating this to make up for Medicaid will come at a significant cost. If you work full-time, you cannot be present to help change the diaper of your incontinent mother every other hour, or turn them to ensure they don’t develop bed sores. Without these being attended to, skin breakdown, ulcer formation, infection, sepsis, disability and death can result.
The challenge grows exponentially when you add chronic conditions such as Alzheimer’s, Parkinson’s, diabetes, heart disease, arthritis and other musculo-skeletal conditions, COPD and more. All of these require intensive caregiving that working families will feel forced to shoulder as a result of stupendously high costs for healthcare.
Caregiving can be difficult in other ways, as well, from potential violence to fall prevention. I was once struck by a confused patient who mistook me, the nurse caring for them for the past week, as a burglar who broke into their house at night. Every winter there are news stories of an Alzheimer’s patient who left home, incapable of understanding the risk or preparing for the conditions, who died of exposure. And when elders fall, from poor lighting to brief loss of balance to disability, they face one of the leading causes of deaths for older adults: injury.
It’s possible to make a home fall-resistant, but not fall-proof. Medicaid cuts will force working families to try to make their homes increasingly fall-resistant, another hidden cost and burden upon pocketbooks caused by the “Big Beautiful Bill.”
Cutting Medicaid isn’t just going to affect the patients who lose their insurance coverage; it affects their whole community. From the workers who lose their jobs when their hospital closes, to the families who must now find a way to care for their elderly parents, to the febrile baby waiting hours in the ER to be seen. Downstream effects will eventually negatively impact the lives of every American and every resident of the Commonwealth.
An Urgent Care in Cambridge, Massachusetts. (Working Mass)
Death For What?
An additional 50,000 deaths per year are estimated to result from Medicaid cuts.
For what? What are these cuts for? For the most simple, capitalistic reason you can imagine: money. The money cut from the healthcare of our people will be used to fund tax cuts for the wealthy, who already have more money than most of us can even imagine. The oligarchs and bourgeoisie who pull the strings of the government for their own benefit will see the numbers in their bank accounts go up as we will watch our loved ones die.
MassCare is one step. The United States famously lacks any form of universal healthcare, alone among industrialized nations, despite some of the best medical education, the best rates hospitals, and cutting edge technology. We have the wealth to ensure that no American needs to worry about being unable to afford medical care or risk crushing debt to obtain it, with the means to guarantee healthcare for every workers. And we don’t. Instead, our leaders have decided that the people should die. They have decided that the American people do not deserve the healthcare that we are capable of providing. They have decided that the working class must bear the burden to ensure that the wealthy elite continue to live lives of luxury. If we want to ensure the healthcare of all workers in the face of the Trump Administration’s cuts, we could fund universal healthcare for all workers.
I dread what is coming for my patients and my community. I have already seen what happens when a patient can’t obtain or afford care; I had a patient who waited to come in and go into cardiac arrest when they did; someone lost their mother that night. I’ve heard the cry of someone told that their father will never wake up; they weren’t able to afford their blood thinners, threw a clot, and had a catastrophic stroke. I fear that there will be many more such stories as a result of these cuts.
Thanks to the “Big Beautiful Bill,” many more loved ones will be lost too soon just to satisfy the greed of the wealthy.
Zachary Wright is a Registered Nurse (RN) at UMass Memorial in Worcester and a rank-and-file member of the Massachusetts Nurses Association (MNA). He is a member of Worcester DSA.
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