Sherry Robinson

During recent debates over the president’s big beautiful budget bill, I wanted to know how the safety net would work. After all, New Mexico has the nation’s highest per-capita rate of Medicaid coverage with 840,000 people enrolled, more than 40% of the state’s population.

Nationally, Medicaid covers more than 71 million poor, elderly and disabled people. The big beautiful bill would cut the program by nearly $700 billion over 10 years and take health coverage away from more than 10 million people.

The big numbers and potential impacts generated endless debate about poor people, and what I heard made me wonder if the debaters had met any actual poor people. I have, and they’re not as lazy as the right would have you believe.

Let me introduce you to some neighbors from my time on the wrong side of the tracks.

Across the street was a woman I’ll call Mary, a single mom with three boys. She was a cleaning lady who worked long hours in other people’s homes to pay the rent. My next door neighbor was an older woman who was in poor health and on Social Security disability. That wasn’t enough to support two teenagers still living at home, so the fourth member of the household, an adult daughter I’ll call Alex, worked a low-wage retail job. Alex was the family’s primary supporter.

One major change mandated by the bill is work requirements for able-bodied, single adults. Sounds reasonable, right? What you might not know is that most Medicaid recipients are already working. So Alex will have to document 80 hours of work each month or prove she qualifies for an exception. But Alex is a high-school dropout who might have a hard time negotiating the new red tape. She might also be reluctant to take time off work, at a loss in pay, to visit a state office and make her case.

Benefits experts predict that millions of Alexes will get lost in the new system and lose their coverage. That seems to be the goal of the new requirement. The nonpartisan Congressional Budget Office projects the number of uninsured Americans will increase by 7.6 million.

The bill also requires states to check Medicaid eligibility more frequently, which the governor has said is a costly new administrative burden on top of Medicaid cuts the state can’t afford.

The big beautiful bill frays another strand of the safety net by cutting $300 billion (30%) from the Supplemental Nutrition Assistance Program (SNAP), formerly food stamps, which helps 42 million people. It’s the biggest reduction in the program’s history. More than 2.7 million households will lose benefits.

SNAP too has a job requirement. This one sweeps parents like Mary the cleaning lady into that category, so she would have to take time off work to document her hours and contend with unfamiliar new rules. And for the first time, states will have to absorb some of the costs of SNAP. Again, millions will lose their SNAP benefits at a time when federal cuts to food banks have emptied shelves.

Maybe you don’t give a hoot about poor people and their troubles, but you probably care about hospitals.

An emergency doctor told me, “What most people don’t know is that we have to treat people whether we’re getting paid or not.” He said his own hospital is also contending with tariff-induced price hikes on supplies and equipment.

As the number of uninsured people increases and expenses of uncompensated care rise, hospitals will see red ink. Medicaid is typically their largest source of revenue, followed closely by Medicare, which will also be hammered by the big beautiful bill.

Hospitals will try to compensate by raising rates for those with insurance and curtailing more services. It won’t be enough. They will look to the state, which has already tried to help struggling rural hospitals.

But Medicaid is the largest single source of federal funding for states and the second largest expenditure behind education. Replacing that revenue could mean raising taxes. Meanwhile many rural hospitals, already on the edge, will close.

The big beautiful bill is a complex piece of legislation, and Medicaid and SNAP are just two of many pieces. This is the House version, and the bill will change in the Senate. However, Medicaid will still be a target because it’s a big expenditure, and budget architects must come up with enough savings to pay for their tax cuts.

Sherry Robinson is a longtime New Mexico reporter and editor. She has worked in Grants, Gallup, the Albuquerque Journal, New Mexico Business Weekly and Albuquerque Tribune. She is the author of four books. Her columns won first place in 2024 from New Mexico Press Women.