NOTE: This essay is Part 1 of a three-part series examining the human toll of the Big Beautiful Bill — a law that manages to be equal parts cruel, cynical, and unnecessary.
In this first installment, I focus on the bill’s brutal cuts to Medicaid: a decision that will strip health care from millions, condemn tens of thousands to early graves, and shatter families — all so that the wealthiest Americans can gild their yachts and expand their champagne cellars.
If that does not unsettle you, I invite you to read Part 2, which explores another devastating consequence: the bill’s deep cuts to the Supplemental Nutrition Assistance Program (SNAP), which will pull food from the mouths of children and force more families into hunger.
Together, these two essays examine a singular and sobering truth: our leaders have chosen to sacrifice the health and dignity of the many to indulge the appetites of the few.
If justice means anything, it demands we call this what it is — and refuse to look away.
How dare they.
Last week, Congress and President Trump signed what they call the “Big Beautiful Bill” — a law that slashes Medicaid by nearly $1 trillion over the next decade. They did this knowing full well what it means: people will die. Not a few. Not hypothetically. Tens of thousands of Americans — real, breathing people — will lose their lives so the richest 0.1% can get even richer.
Image generated by AI with reference input provided by the author using the prompt, ‘Create an image that depicts a ‘A pair of hands, elderly, frail, and clutching a hospital discharge form stamped “Denied” or “Uncovered”,’ Created by ChatGPT (Open AI), July 2025.
Lawrence Summers, the former Treasury Secretary, estimates over 100,000 preventable deaths over the next decade as more than 11 million people are shoved off Medicaid like unwanted cargo. Others will be left stranded without home health aides, dumped out of hospitals with nothing but a cab voucher and a prayer, forced to choose between medicine and food, between life and despair.
And for what?
If this were a sacrifice that brought us some transcendent good — if it saved our democracy, defeated some existential threat, healed the earth — maybe the dead could at least be honored for giving their lives to something bigger than themselves.
But that is not what this is.
And let’s not pretend this is some disinterested act of statesmanship. This bill personally enriches the very man who signed it. Donald Trump — a self-proclaimed billionaire with sprawling real estate holdings, shell companies, and a family dynasty waiting to inherit his fortune — stands to pocket millions from the very tax cuts he delivered at the expense of the poor and the sick. He is not sacrificing for the greater good. He is looting the treasury while telling us to clap.
The wealthiest families in America, those in the top 0.1%, will each receive, on average, over $1 million in tax breaks over the next decade. Trump and his family are at the very center of that rarified elite. Every dollar stripped from Medicaid — every ride to dialysis denied, every home health aide fired, every coffin nailed shut too soon — is a dollar that helps finance another yacht, another golf course, another golden trinket for the already-rich, including the president himself. This is not governance. This is plunder.
There is no serious economic or moral case that America needs to starve its poor and sick to fatten its billionaires. Even the hospitals will suffer — closing doors, raising costs on everyone else. Rural communities will become health-care deserts. Whole families will collapse under the weight of caregiving with no support. This is not just cruel. It’s stupid — as stupid as cutting the brakes to save gas money while driving full-speed toward a cliff.
Image generated by AI with reference input provided by the author using the prompt, ‘Create an image that depicts a ‘Rural hospital under a stormy sky, with a sign reading “Closed” or “For Sale”, while people wait outside.,’ Created by ChatGPT (Open AI), July 2025.
And — of course — there’s always a chorus of armchair experts ready to climb aboard the misinformation train, insisting — without a shred of evidence — that Medicaid is just a bloated swamp of fraud and freeloaders. These are the folks who’ve never let facts derail their righteous indignation. But study after study shows that Medicaid not only provides vital care — it saves lives. A major study led by Dartmouth College, found that states that expanded Medicaid saw death rates fall by about 3%, with even greater benefits in the poorest counties. That’s thousands of lives saved every year — while cutting it would cost lives. Meanwhile, the much-ballyhooed “fraud” is a rounding error: Government Accountability Office audits find that fraud accounts for only a tiny fraction of Medicaid spending — far lower than the administrative waste and profiteering in private insurance. The overwhelming majority of Medicaid beneficiaries are children, pregnant women, seniors, and people with disabilities — the very people who most deserve our care. Pretending they are undeserving, or that Medicaid is squandered on fraud, is like blaming the fire department for being too busy putting out fires. It’s a lie designed to justify cruelty and greed.
And when the “fraud and waste” fairy tale starts to fall apart, they switch tracks to an even more magical notion: that states, with their limitless budgets and boundless goodwill, will simply pick up the slack without breaking a sweat.
Some defenders of this bill, including members of Congress, have shrugged off the devastation by claiming that states can simply “fill the gap” left by federal Medicaid and SNAP cuts. That sounds nice in a press release — but it’s nonsense in reality. States can’t print money, and nearly all are required to balance their budgets every year. If they want to replace lost federal funding, they must either raise taxes, cut other essential services, or both — none of which is easy, popular, or guaranteed. And not every state even wants to help. We already see how some states refused to expand Medicaid under the Affordable Care Act, leaving millions without coverage. This bill would deepen that injustice, creating a cruel patchwork where your access to food and health care depends entirely on which side of a state line you live on. Poor states with already frayed budgets will be forced to let their residents sink, while wealthier states struggle — and still fall short — to cover the difference. Punting responsibility to the states isn’t a solution. It’s a cop-out dressed up as federalism, and it will leave the most vulnerable twisting in the wind.
And make no mistake: Congress knows all this. That is why they buried the most devastating cuts until after the 2026 midterms, like a snake coiling out of sight, waiting to strike. They know the pain is coming, and they want to keep their jobs long enough to avoid accountability. They’re gambling that by the time voters feel the knife in their backs, it’ll be too late to do anything about it.
How dare they.
We elect leaders to protect us, to serve the common good. What kind of leader knowingly votes to kill his own constituents to make a tiny number of people richer — including himself?
What kind of country allows that?
We should not let them hide behind jargon about “budget discipline” and “work requirements.” We know the truth: this is not about work or discipline. It is about power. It is about greed.
We cannot quietly accept this. Not when our neighbors are being pushed into their graves to fund another tax cut for people who already have everything. Not when the lives of the elderly, the disabled, the poor — and yes, maybe even us someday — are treated as disposable.
Every member of Congress who voted for this should have to look each of those 100,000 doomed Americans in the eye and explain why their lives were worth so little.
But they won’t. Because they know there is no justification.
And that is why we must speak. Loudly. Relentlessly. Until this law is reversed, until no more lives are fed to the sharks of greed.
How dare they.
How dare we let them.
Steven Teske is an attorney and retired judge. He has testified before Congress on four occasions and numerous state legislatures on law and policy reform. He received his Juris Doctor and Masters in political science degrees from Georgia State University in Atlanta. He has been appointed by governors to several state boards, and is a former adjunct law professor and currently is an adjunct professor in criminal justice studies. He has published extensively on law and policy reform.
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