On July 4, Trump signed a major budget bill (his “One Big Beautiful Bill.”) 

As we explained last week, this bill is a fascist leap in building up Trump's gestapo. (See “Part 1: Building a Massive, Gestapo-like Force to Use Against Immigrants and Other Regime Targets, And a Vast Network of Concentration Camps Too!”) 

This week, we focus in on the vicious and cruel shredding of what is called “the social safety net”—that is basic medical care, food aid, etc.—for over 100 million people. What Trump and his flunkies in Congress have done will result in needless deaths, disablement and disaster for many of those millions. Many of those millions—a disproportionate share of them—will be Black, Brown or Native American Indian. Women—again, especially “minority” women—will be hit particularly hard, as access to birth control and abortion is slashed. 

Slashing Medicaid and the Affordable Care Act (ACA)

Medicaid is an essential government program. For decades, poor people have relied on it for very basic health insurance. When the ACA (also known as “Obamacare”) passed in 2010, it allowed individual states to expand Medicaid to people with incomes up to 133 percent above the poverty line who are still too poor to get private insurance.¹ With this expansion, there are now 71 million people on Medicaid. Another 7 million are enrolled in CHIPS (Children’s Health Insurance Programs), which is for children whose families are too poor to buy health insurance but not poor enough to qualify for Medicaid. 

ACA (Obamacare) also subsidizes another 24 million people to buy private health insurance. 

These are people trying to scratch out a living at minimum wage or part-time jobs that don’t provide health insurance to employees. They’re also people who can’t find work at all, or can’t work because they are taking care of sick parents or small children, or because they are disabled. Or people working in the “gig economy.” Taken together, there are over 100 million people who rely on Medicaid and other government programs for what is extremely basic health care. Put another way, we’re talking about almost 1 in 3 people who live in this country.² 

So it is a very big deal that Trump is slashing about a trillion dollars over ten years from Medicaid and ACA (this will also impact CHIPS). The Congressional Budget Office estimates that these cuts will drive 11.8 million people out of these programs (some estimates are as high as 17 million). This will cause tremendous damage to the healthcare system as a whole, especially in rural areas and in oppressed neighborhoods in the cities. It will hurl millions of people into yet more desperate conditions than those that already stalk them.

Think about: the millions of children who won’t have a doctor to get checkups or vaccinations; the adults with undiagnosed, untreated hypertension or diabetes; the disabled people who depend on Medicaid-provided caregivers just to be able to get around. “Healthcare” for these people will now consist largely of emergency room treatment³ after they have a stroke or other health emergency. Millions will suffer greatly, and many thousands will die long before their time.

Trump claims he is just expanding work requirements to prevent people from gaming the system. This is BS. There is not some big “Medicaid scam” going on; in fact, most adults under age 65 receiving Medicaid already work, and the rest are either seeking work, or can’t work because of disabilities or caregiving responsibilities. Trump is just repeating the age-old BIG LIE that somehow the most bitterly oppressed and exploited in society—and Black and brown people in particular—"live in luxury off the taxpayer’s dime,” in order to “justify” kicking people off of programs that are life-or-death necessities.

To do this, the fascists are creating whole new layers of red tape that people have to go through to get and continue receiving benefits—and to repeatedly prove that they are “worthy” of health care! And it is a proven fact that for people on the bottom of this heartless society, scrambling daily to meet basic survival needs, every new level of red tape increases the numbers that will either give up, or make some mistake that will get them kicked off! 

A Pool of Slave Labor

These work requirements could be used to create a section of people so desperate for jobs of any kind that they can be super-exploited—forced to take dangerous and difficult jobs for wages that don’t even cover basic survival, just so they can hold onto health care. 

Trump’s secretary of agriculture Brooke Rollins spelled this out. Critics of Trump’s all-out assault on immigrants say it has wreaked havoc with the fruit and vegetable harvest, which relies heavily on undocumented immigrants. (Somewhere between one-half and three-quarters of California’s farmworkers are undocumented.) Now, with farm owners desperate for labor as the fruit and vegetable harvests start, Rollins proposed that Medicaid recipients replace the immigrants who are being mass-deported. Rollins said: 

The mass deportations continue, but in a strategic way, and we move the workforce towards automation and 100 percent American participation. … With 34 million people, able-bodied adults on Medicaid, we should be able to do that fairly quickly. 

A Threat to the Health Care System

The cuts in Medicaid and ACA will spill over to and devastate the healthcare system, especially in poorer areas. In rural areas and oppressed inner-city neighborhoods, hospitals depend on Medicaid payments to fund the hospital overall. This will way disproportionately target Black and Latino people, who together make up more than 50 percent of Medicaid recipients.

At the same time, more than 300 rural hospitals are estimated to be at risk of closing because of this bill. When a hospital closes, people have to drive greater distances (if they have a car) to get emergency medical care while going into labor, or having a stroke. Supposedly to help rural hospitals, the Republi-fascists added a $50 billion fund to support them. But you would need twenty $50 billion funds to cancel out the trillion-dollar cut!

At the same time, the fascists didn’t even make this kind of token effort for urban hospitals serving mainly Black and Hispanic people, which are just as hard-hit as rural areas. For example, 90 percent of the 1.4 million people who live New York City’s Bronx borough are Black, Hispanic or other people of color. Two-thirds of these residents rely on Medicaid, and at least 100,000 of them are expected to lose coverage. This means that either doctors and hospitals will refuse to provide them with non-emergency care, or if they do treat them, the providers will not be reimbursed by Medicaid.

Most hospitals in poor areas operate on a very slim financial margin already. So this sharp reduction in income will have serious impacts. Services that aren’t “traditionally profitable,” like pediatric care and women’s health, may be shuttered. Staff levels at health facilities—already inadequate—will run dangerously low. New York City may lose 116,000 healthcare jobs—which will further increase poverty and the need for drastically shrinking Medicaid funds as many of these newly unemployed apply for help. 

How did the fascists address this looming staffing crisis? Well, for one thing, they passed a rule repealing a regulation requiring a certain minimum level of staff in nursing homes! So now the older people in these homes, or those who are disabled, will lie humiliated and miserable in urine-soaked beds while they wait their turn from a badly overburdened worker.

Other forms of government-subsidized healthcare are also under attack. Medicare funding will be cut by $490 billion over 10 years. A new rule will eliminate eligibility for certain groups of lawful immigrants, who have been paying into Medicare. There are also cuts planned for the Children’s Health Insurance Program (CHIPS).

The Sneak Attack on Women’s Health and Reproductive Rights

The bill calls for immediately stopping all payments to Planned Parenthood (and other abortion providers) to cover any treatment of Medicaid patients.⁴ 

Medicaid hasn’t provided payment for abortion itself since 1976. (It is blocked by the infamous Hyde Amendment that Republicans and Democrats have dutifully renewed every year since then.) But Planned Parenthood and other clinics that perform abortion also provide a full range of women’s health coverage: screenings for cervical cancer, birth control, testing and treatment for sexually transmitted diseases, and so on. Planned Parenthood serves over two million women annually, and often it is the only women’s health provider in their area. Without Medicaid covering these payments, many women’s clinics will not be financially viable, meaning a catastrophic loss both of abortion rights, and of women’s healthcare overall. 

According to the “Abortion, Every Day” Substack:

Planned Parenthood estimates that two-thirds of its brick-and-mortar health centers across the country could be forced to shutter, with 90% of those closures happening in states where abortion is protected. In fact, a whopping 75% of abortion-providing clinics in pro-choice states could close.

What does that mean on a broad scale? One in four of all abortion providers in the U.S. could soon close—leaving abortion legal but almost impossible to access (at least in a clinical setting) in many states. [Emphasis ours.]

This is some ugly misogynist (anti-women) shit. The Christian fascists at the core of MAGA have been working for decades to strip all women of the right to decide whether to have a child, regardless of the woman’s wishes or circumstances. The MAGA bill brings them much closer to this goal.

Yes, They Are Snatching Food from the Mouths of Children

About 42 million people in this country receive SNAP benefits (food stamps). On average, SNAP provides a paltry $6.18 per person per day to stave off hunger in this land of obscene and plundered wealth. More than one third of recipients are children, and one-half are Black and/or Latino.

But the MAGA fascists find even that token support intolerable! Their new budget will slash at least 186 billion dollars from the SNAP program over the next ten years. Estimates are that between two and five million people will lose some or all of their benefits.

Once Again—A Five-Alarm Fire, NOT a Silver Platter

Along with the cuts, this bill also contains huge benefits for the wealthy in the form of tax cuts and other benefits. This has made it very unpopular, even with parts of the “MAGA base.” And that in turn has led to extremely harmful illusions. As we documented last week, the head of the Democratic National Committee crowed that the bill was a gift on a “silver platter.” By that he meant that the Democrats would surely be able to use this to their benefit in 2026 elections.

These kinds of illusions are literally deadly.

For all the horror of these cuts, as we said last week the key part of the bill is its strengthening of the fascist arm of the state. The bill hugely expands the face-masked goons of ICE with their growing network of Nazi-style prisons. Further, this bill comes at a time when the Supreme Court has handed Trump almost unlimited power to rule as a fascist “strongman.” 

The time to fight the monster with all we have is NOW—not next week, not next month, and surely not waiting for elections that may not happen at all (in any meaningful way)—but NOW, before these fascists are able to fully lock in their rule.