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I served in the Georgia House of Representatives for eleven years—seven of them as leader of the loyal opposition. My job was to hold together a fractious caucus, just like my counterpart, the majority leader. Both of us had the unenviable task of keeping our members in line under pressure from a powerful governor—one who could fund or famine your local economic development plan. Legislative leaders who could block or pass your bills. Corporations, backed by well-funded lobbyists, ready to bankroll your opponent and cost you the job you were fighting to keep.
In the face of that pressure, too often, what got lost were the needs of the constituents we were sent to the Capitol to defend. Now add a few trillion dollars, bigger egos, and even greater cowardice—and you’ve got the U.S. Congress. This week, the Republicans’ terrible, tyrannical, no-good tax bill is moving forward in the Senate, despite its clear harm to families, children, jobs, and healthcare. Why? Because Republicans are so desperate to keep their jobs, they refuse to do their jobs.
Senate Republicans have advanced a bill that goes beyond even the version already passed by the House. Thanks to the parliamentary Byrd bath, we know that this bill contains deep cuts to Medicaid, new bureaucratic hurdles for patients, and rollbacks to health care funding that could shutter hospitals and cut off lifesaving services.
In exchange for $800 billion [ [link removed] ] in tax breaks for companies like Meta and private jet owners, Republicans settled for a $25 billion [ [link removed] ] slush fund to prop up rural hospitals through the next election. But mostly in red states. And it’s not even guaranteed.
The consequences will be that long-term disabled care homes may have to evict patients. Grandmothers living in nursing homes will be told to find shelter elsewhere. Children will lose life-saving care. This is not hyperbole—it’s a reality already playing out in states that have adopted the worst of these policies already.
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One of the more explicit attacks is on the arcane “provider tax”—a funding gimmick that has become a lifeline for hospitals—urban, rural and suburban. Senators are trying to sneak in changes that would gut the very provider payments that keep our hospitals running—especially in rural communities. Republicans are targeting a critical financing tool that hospitals rely on to care for Medicaid patients and keep essential services operating.
Without it, many families—particularly in small towns—will be left with nowhere to turn when they need care most. But big cities aren’t immune. In states where private equity is gobbling up healthcare services, the loss of revenue will likely be the reason they shut the doors. However, as cities like Atlanta have learned, when the beds are gone, they don’t come back. Instead, emergency room lines get longer, doctors flee for saner pastures and death rates rise.
But the attacks are also hidden in plain sight. Using sleights of hand like changing how they calculate the impact to delays in implementation, Republicans are hoping we don’t see the chainsaws or the axes in the trees. On Medicaid, Senate Republicans decided to bury the cuts to state coffers in a three-year delay—so that the reduction starts in 2028, one year later than originally planned.
Then there’s the pernicious fiction peddled by U.S. Senators like Katie Britt who blatantly disputed the impact of Medicaid cuts on kids. When asked if the Medicaid cuts would harm kids, she boldly declared that the cuts don’t touch the Children’s Health Insurance Program [ [link removed] ]. What she deliberately omitted is that CHIP covers children whose families can’t afford private insurance but are considered too wealthy for Medicaid (in Alabama, that’s capped at $26,650 for a family of three [ [link removed] ]). So if your family is actually on Medicaid, yes, Katie, there will be cuts that affect kids.
Medicaid is a national system that recognizes how convoluted, inaccessible and expensive health care is in America. As a result, this program funds more than families and hospitals. Medicaid finances nursing homes, veterans and their families who don’t qualify for Tricare, mental health services, maternal care, and drug rehabilitation. The opioid settlement [ [link removed] ] just approved will barely scratch the surface of the gaping hole this will blow into state finances. Medicaid is how we do the bare minimum for those who fall into the economic breaches we’ve become too used to accepting.
The leaders sent to Washington cry out about fraud, waste and abuse, knowing that the private providers fleecing Medicaid and Medicare will get away with their scams at the expense of diabetic children who can’t afford their insulin. The Fortune 100 companies whose business models include government-financed healthcare for underpaid workers.
The frauds are those congressional members who cast their votes, knowing exactly what will happen. The waste lies in their willingness to abandon the appearance of principle for the surety of Trump’s favor. And the abuse will come fast and furious, with working families overwhelmed by paperwork and poverty being told to survive on the crumbs of a budget that cares little for them.
The Senate has done Americans a grave disservice, but the fight isn’t over yet. Politicians are like teenagers: they respond to money, peer pressure and attention.
As this cruel budget barrels forward, we must use the lever of attention to show them we mean business. The business of unseating them and replacing their seats with champions of the people. To do so, we need every senator—Democrat or Republican—to hear from the people whose lives and livelihoods are on the line.
We need hospital workers, local leaders, patients, and caregivers to raise their voices and make clear: this bill will devastate workers, seniors, children and local economies and shift the burden onto those who can least afford it.
When the wealthiest corporations get a tax break while rural hospitals close and babies lose access to care, that’s not policy. That’s a moral failure.
We deserve better. Democracy can deliver if we use its levers just like the rich do. Relentlessly. Tenaciously. Righteously. Together, we will keep fighting until we get it.

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