How Congress Sold the Gutting of Medicaid
And Millions don’t even realize it’s their own coverage on the chopping block.
Imagine showing up at your pharmacy and being told your child’s asthma medication isn’t covered anymore. Or going in for your cancer treatment only to find out your insurance has been terminated. You’ve been working. You’ve paid your taxes. You thought you were covered. You had no idea this was coming.
That’s what will happen to millions of hard working Americans. Behind layers of political spin and strategic branding, the so-called “Big Beautiful Bill” was crafted to quietly dismantle Medicaid expansion. And the biggest irony? Many of the people this bill will hurt have no idea they’re even on Medicaid—let alone that they’re about to lose it.
It’s all timed to happen after the midterm elections. So by the time they realize what’s happened, it’ll be too late to do anything about it.
What Is Medicaid Expansion, and Why Was It Created?
When Medicaid was created in 1965, it was designed for very low-income Americans—primarily children, pregnant women, seniors, and people with disabilities. But over time, the economy changed. As businesses came under pressure to maximize shareholder profits, many cut back on employee benefits—making employer-sponsored health insurance less generous, less reliable, and less available.
Millions of working adults fell into a dangerous gap—earning too much to qualify for traditional Medicaid, but too little to afford private insurance.
The Affordable Care Act (ACA) addressed this by creating Medicaid expansion, allowing states to cover all adults with incomes up to 138% of the federal poverty level. The federal government initially covered 100% of the cost, later stepping down to 90%, with states covering the remaining 10%.
In a 2012 Supreme Court decision, states were given the option to choose whether to participate. As a result, Medicaid expansion was adopted in some states and rejected in others. This created a fragmented system where access to health care now depends on your zip code.
My home state of New Jersey chose to expand Medicaid through its NJ FamilyCare program—opening the door to working adults and medically fragile individuals to gain coverage they otherwise would not have.
Who Is Covered by Medicaid Expansion?
Despite the rhetoric of right wing media, the overwhelming majority of people covered by Medicaid expansion are not freeloaders or scammers. They are often the hard working people, who while poorly paid, keep the country running:
Home health aides
Restaurant workers
Delivery drivers
Retail cashiers
Gig workers
Part-time employees without benefits
And Medicaid expansion also covers people who are too medically fragile to survive without support—people like Emmanuel Oluwadare.
Emmanuel was born at just 23 weeks gestation—a “micro-preemie” with extraordinarily high medical risk. Since birth, he has faced a relentless fight to survive and grow. He’s been diagnosed with severe cerebral palsy, chronic lung disease, a seizure disorder, and developmental delays. He relies on a ventilator, a feeding tube, and a brain shunt—and he needs 24-hour skilled nursing care just to stay alive at home. This level of intensive care is far beyond what private insurance typically covers.
Medicaid makes it possible—not just for Emmanuel to receive the care he needs, but for his parents to work, support their family, and remain active members of their community.
As his mother, Issata, put it: “Medicaid is not just about health care; it is about dignity, independence, and the right to live in a supportive home environment. It allows families like mine to provide the care our loved ones need, without being financially ruined by insurmountable medical costs.”
Today, Emmanuel is 7 years old. Thanks to NJ FamilyCare, he’s able to live at home with his parents, rather than being institutionalized. Without that coverage, his only option would likely be a hospital or long-term care facility—far from the daily comfort, love, and connection that every child deserves. (Justice in Aging, 2025)
Emmanuel’s case is not an exception—it’s part of the reason Medicaid expansion exists in the first place. Without it, thousands like him across New Jersey and throughout America would be left behind.
The Hidden Crisis: NJ FamilyCare Is at Risk—And Many Recipients Don’t Know It
One of the biggest challenges with cutting Medicaid expansion is that many people don’t even realize they’re on it. In New Jersey, for example, the program is called “NJ FamilyCare”—a name designed to reflect dignity and compassion, not poverty or welfare.
That branding helps reduce stigma and encourages families to seek care. That’s a good thing. But it also creates confusion. Many enrollees believe they have some kind of state-sponsored insurance—not a federally supported Medicaid plan. In fact, a 2024 study by KFF Health News found that one‑third of Medicaid enrollees don’t know they’re on Medicaid.
So when politicians talk about “cutting Medicaid expansion,” many of the people most affected don’t realize the threat applies to them. They have no idea that they are in the crosshairs.
This program covers more than 2 million New Jerseyans, including children, working adults, and people with serious medical needs. And it depends on federal funding.
The bill proposes shifting more of the financial burden to states through block grants or per capita caps—models that set a fixed amount of money, no matter how many people are enrolled or how high the costs go. If a public health crisis hits, or the economy shifts, New Jersey would be forced to make cuts: fewer people covered, fewer services offered, lower provider payments.
The bill also introduces “integrity” measures that make it easier to lose coverage—paperwork deadlines, frequent income checks, and red tape that disproportionately hurts working families and caregivers.
All of this shifts care back into costly private managed care plans—where cost-cutting typically leads to narrower provider networks, longer wait times, and more denied claims.
So yes—NJ FamilyCare will still exist on paper, but the quality, stability, and accessibility of that coverage will be hollowed out. And because so many people don’t even realize their coverage is part of Medicaid, they won’t understand what’s been taken from them—until it’s already gone.
For people like Emmanuel Oluwadare, who depends on NJ FamilyCare for round-the-clock care, this isn’t an abstract policy debate. It’s a matter of life, dignity, and survival.
The Timing Trick: Cuts Scheduled for After the Election
Many of the cuts in the “Big Beautiful Bill”—are cleverly set to take effect after the next election. That’s no accident. It means the people who don’t realize that they’re about to lose coverage won’t know until it’s too late to hold anyone accountable at the ballot box.
When the pain comes, it will be dismissed as paperwork problems or eligibility reevaluations, not as the result of a deliberate legislative decision.
What Does “Winning” Look Like in NJ’s 7th District—and Across the Country?
Shortly after voting “yes” on the Big Beautiful Bill, my Republican congressman, Tom Kean Jr., sent a newsletter to constituents. The very first accomplishment he celebrated wasn’t protecting healthcare or supporting vulnerable families—it was the quadrupling of the SALT deduction. SALT stands for “State and Local Taxes,” and this deduction allows homeowners to write off a portion of their property taxes on their federal tax return.
Kean proudly announced that the cap had increased from $10,000 to $40,000—a move that will benefit many in his district. According to an analysis of property tax data from the New Jersey Department of the Treasury, the average 2023 property tax bill in NJ’s 7th Congressional District is $11,934, meaning the typical homeowner will now be able to deduct an additional $1,934 on their federal taxes.
For most residents, the expanded SALT deduction translates to about $400 to $450 in federal tax savings each year. It’s not nothing—but it’s not life-changing either. A modest tax break for the comfortable comes at a staggering cost for the vulnerable.
So what did Congressman Kean trade for that deduction?
He traded the healthcare of millions of so-called “undeserving” Americans. In his newsletter, Rep. Kean claimed he voted to “safeguard Medicaid” by eliminating “waste, fraud, and abuse.” But let’s be clear about what that really means.
Under this bill, “waste” refers to anyone who wouldn’t have qualified under the 1965 rules. That includes children like Emmanuel Oluwadare—and thousands more across our state: low-wage workers, kids with disabilities, and people managing serious chronic illness.
They’re being told that their survival matters less than a property tax write-off for people who are already pretty comfortable.
And Congressman Kean is calling that a victory.
This bill also reflects a broader set of Trump’s national priorities. While Medicaid expansion is being slashed, the same bill pours money into:
Tax cuts for high income earners.
Military budgets topping $850 billion.
And nearly $170 billion into the expansion of immigration enforcement, giving ICE the largest budget of any federal law enforcement agency
According to the Brennan Center and the American Immigration Council, this makes ICE the largest federal law enforcement agency, with a funding level larger than the combined budgets of the FBI, DEA, ATF, US Marshals Service, and Bureau of Prisons.
Think about that….
Americans were told that we needed to expand ICE to remove illegal and violent criminals from our streets. And yet, despite claims that ICE is targeting dangerous criminals, the data tell a different story. Under the current administration, fewer than 10% of ICE arrests involve individuals with violent crime convictions. The overwhelming majority—nearly 90%—have no serious violent convictions. (People, 2025).
So let’s be clear: this isn’t about what we can afford. The U.S. has the resources to preserve Medicaid expansion. This is about what—and who—we value more.
Who Really Pays the Price?
It’s important to understand that the United States doesn’t have a true healthcare system. We don’t invest in keeping people healthy. What we have is a sick care system—and Medicaid is its most vital safety net, serving those with the greatest medical needs.
According to the Kaiser Family Foundation, Medicaid enrollees are significantly sicker and more likely to be disabled than those with private insurance. Many are living with multiple chronic conditions, recovering from serious injuries, or relying on ongoing care to survive.
That’s what makes the proposed cuts so dangerous. When you slash Medicaid, you’re not trimming “waste.” You’re pulling the rug out from under the people who need help the most—those who are already struggling to stay alive, stay housed, or stay employed while managing serious health conditions.
Private insurance often doesn’t cover these patients at all—or does so with high deductibles and narrow networks. Medicaid is designed to meet their needs in ways private coverage cannot.
And no, despite what you hear in the right wing media, there aren’t waves of undocumented immigrants abusing the system.
A recent analysis by Georgetown University makes it clear: federal law bars undocumented immigrants from receiving full Medicaid benefits. The only care they’re eligible for is emergency treatment—such as childbirth or trauma care—which accounts for less than 1% of total Medicaid spending.
So when Congress votes to “reform” or “streamline” Medicaid expansion, let’s stop pretending it’s a harmless belt-tightening. It’s a direct hit on the most vulnerable Americans—people who already face steeper odds just to get through each day.
And for what? A modest tax break for upper-middle-class homeowners? Corporate subsidies? A record-breaking budget for ICE?
I grew up in a family that believed something simple but powerful about America: if you have the ability to help, you have the responsibility to protect those with the greatest need. These are the values I was raised with. And it’s why I believe defending Medicaid isn’t just sound policy—it’s a moral imperative.
Will Cutting Medicaid Raise Your Commercial Insurance Premiums? Yes—Here’s Why.
When hospitals treat uninsured patients, the cost doesn’t disappear—it gets shifted. Hospitals raise prices on private insurers to cover those losses. Then insurers raise premiums for everyone else. It’s a well-documented phenomenon called cost shifting—and I saw it firsthand when I worked in healthcare administration for New Jersey’s largest hospital system.
States that expanded Medicaid saw significant reductions in uncompensated care—and as a result, slower growth in private insurance premiums. When that coverage is rolled back, those savings vanish. Everyone ends up paying more—including those with private insurance—just in less visible, more regressive ways.
That fact didn’t make it into Congressman Kean’s letter.
What You Can Do Now
Check your coverage. If you're on NJ FamilyCare or similar state coverage, verify whether it's Medicaid-based. Don’t assume you’re safe just because you’re working. You’re not.
Talk to others. Share this information. Many people affected don’t even realize it yet. They need to know.
Find out how your representatives voted. They can try to spin it any way they want to. But if they supported the “Big Beautiful Bill”, then they voted to take people off of Medicaid. They’ll say it was never meant for these people. But that doesn’t make their needs—or the government’s responsibility to meet them—any less real.
Hold them accountable. Make Medicaid a voting issue. Replace those who chose tax breaks over live-saving care. Organize. Volunteer. Vote.
What This Fight Is Really About
When my Congressman supported the “Big Beautiful Bill,” he called it a matter of efficiency. And maybe from his perspective, it is. But from where I stand, it’s a moral failure.
This bill shifts the burden from the wealthy to the vulnerable—cutting care for children, the working poor, and people with disabilities so that homeowners in higher-income districts can get a modest tax break… while corporations collect new subsidies, defense contractors secure more funding, and ICE receives a record-breaking budget.
We’re told Medicaid is too expensive—yet this same bill hands billions more to those who are already doing just fine.
It’s not about the dollars. It’s about our priorities.
Many of the people who stand to lose the most don’t even know it. Some proudly wear their MAGA hats, unaware that the very insurance keeping their families afloat is Medicaid. They don’t have any idea that their coverage is being gutted. And by the time the denial letters come, it’ll be too late to fight back This administration doesn’t care about them. But I do. Because this isn’t about politics—it’s about people.
The Big Beautiful Bill has passed. But laws can be reversed. It all begins with the midterms.
I’ll be thinking about Emmanuel Oluwadare as I cast my vote…
Thanks so much for reading. 🙏
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This is a moment for all of us to raise our voices—together.
Hal Benz is a Licensed Clinical Social Worker, business strategist, and life coach with more than 30 years of experience helping people and organizations grow with purpose. He blends emotional insight with sharp strategic thinking to support personal transformation, leadership development, and values-driven activism.
He lives in northern New Jersey with his wife of 34 years and their two rescue cats, affectionately named after folk singers Harry and Tom Chapin.
It's already happening. A friend received a letter informing her she'd be dropped by her carrier at year's end. She gets her coverage through NJ's marketplace since she's retired but not yet qualified for Medicare. The "Big Beautiful Bill" strips away incentive $'s previously paid to insurers which made it possible for them to participate in health insurance marketplaces/exchanges in the first place. My friend has no idea what she's going to do & can't afford a pricier policy from a private insurer. This is the real world impact this legislation has set in motion- nothing "Beautiful" for tens of millions of Americans.
The ACA was designed to try to back-load the real costs of the plan onto later years, and to minimize transparency of those costs, so it would be able to pass in Congress. Please reference Jonathan Gruber, the MIT economist who played a large role in the development of the ACA. The ultimate end game was that when ACA failed because it was financially unsustainable in later years (i.e. about where we are right now), the U.S. would then be primed to transition to a single-payer health care system. Regardless of trying to blame everything bad on Trump, the ACA as originally implemented was never going to be sustainable in the long term, because it wasn't meant to be a long term plan--simply an on-ramp to establishing a single-payer health care system in the U.S.A. In fact ACA isn't even "insurance"---it's a subsidy system for young healthy people to subsidize the health care costs of older sicker people.