A $1 Trillion Medicaid Cut Is THIS Close to Happening. Here’s What It’d Look Like.

Salisbury, North Carolina
ENID RODRIGUEZ KNOWS WHAT A DIFFERENCE Medicaid can make, because it’s made a huge difference for her.

Rodriguez, 51, has been working for pretty much her entire life—first in organizations that provided support and therapy to at-risk children, more recently in a small electrical business she helps her husband run while she also takes care of her aging mother. She loved working with children and now is invested in the new enterprise. She even managed to get bachelor’s and master’s degrees (in human services) along the way.

But Rodriguez has never made enough money to pay health insurance premiums. That’s been a big problem because she’s had serious health conditions literally since birth, when she was born prematurely and developed an infection while spending two months in the NICU of a hospital in Puerto Rico.

Severe asthma. Chronic chest and gastric problems. Back pain from a hip injury a few years ago. She could count on a local free clinic to help manage symptoms, to provide preventive care and, frequently, to provide much-appreciated hugs. But Rodriguez also needed specialty care the clinic couldn’t provide. And when an apparent heart attack brought her to the emergency room a few years ago, she ended up with a $20,000 bill she had no way to pay.

All of that changed in late 2023, when North Carolina officially opened its Medicaid program to anybody with incomes below or just above the poverty line—in other words, to people like Rodriguez who were too poor to get insurance on their own but did not qualify for the older, narrower standards North Carolina had for its Medicaid program.

Since then Rodriguez has been able to see those specialists—including one who figured out her chest pains were an upper GI condition, not a heart issue. She’s also getting physical therapy for her old injury, and is on weight-loss medication that doctors think will help with other conditions.

“Medicaid has literally been a lifesaver,” she told me this week, when we met at the Community Care Clinic of Rowan County, where she used to get care. But there was a tinge of anxiety in her voice, because, she said, she is worried the cuts in Republicans’ One Big Beautiful Bill will leave her without coverage.

“I wouldn’t be able to see the cardiologist who makes sure my heart is okay, the gastroenterologist who’s treating my gastrointestinal problems, the weight-loss specialist,” Rodriguez said.

Medicaid isn’t perfect, she said, and she doesn’t expect government programs to provide everything she and her husband need. But, she said, “we shouldn’t have to work fifty-, sixty-hour weeks to pay our bills, and still struggle to take care of ourselves when it comes to our medical expenses.”

But worry she must. Medicaid coverage for millions of Americans like Rodriguez is in jeopardy. In fact, it could be doomed in a matter of days.

THE LEGISLATION THAT DONALD TRUMP is pushing and Republicans are trying to pass by July 4 seeks to cut Medicaid by nearly a trillion dollars over the next ten years, through a variety of changes that could include everything from so-called “work requirements” to complex changes in financing that could directly or indirectly lower the federal government’s contribution to the program.

“Could” is a key word there, because the emerging bill that leaders in the Senate hope to approve by Monday is different from the bill House Republicans approved last month. And some House members are already saying they can’t vote for it.

But Republicans have made threats to tank big bills before, before ultimately falling in line. And there’s a good reason to think they will do so again: Downsizing Medicaid is a longtime goal of many conservatives, who believe society is better off with less government and less government spending. Plus, the bill with the Medicaid cuts also has lots of tax cuts, which pretty much the entire party is desperate to pass.

The public doesn’t seem too enthusiastic about that prospect, based on polls showing Americans already have strong, negative views of the bill, and that they don’t want anybody touching Medicaid. That undoubtedly explains why Trump and his allies keep insisting that they are “strengthening” the program, and downplaying or denying that the cuts would cause harm.

Those claims don’t hold up when the Congressional Budget Office is projecting that nearly 12 million people would end up uninsured if something like the Senate bill becomes law—and when a slew of new academic studies, like so many earlier ones, suggest that people losing Medicaid are more likely to miss out on medical care, get sick, and in the worst cases die prematurely.¹

Republicans say the experts making these predictions can’t be trusted. But you don’t need to put stock in academic-style research to grasp what Medicaid has meant to individuals and their communities in recent years—and what its absence could do to those individuals and communities now.

All you need to do is talk with people who know firsthand. And there may be no better place to find them than North Carolina.