In nearly six months of hits to the health of Americans, the actions of the House in passing Trump’s so-called “One, Big Beautiful Bill” budget last month have reached a new level of callousness and ignorance. The $880 billion dollar cuts over 10 years in aid to states for Medicaid programs would have disastrous effects.

Medicaid is not “welfare.” It is a program — established as an amendment to the Social Security Act in 1965 — that was part of President Lyndon Johnson’s Great Society program. Medicaid allocates money to the states that helps them provide health insurance to low-income Americans, those with disabilities, and elderly requiring long-term care. States did not have to take advantage of federal funding to begin Medicaid programs, but since 1992, all states have. Eighty-five million low-income and disabled Americans are now covered by Medicaid, including half of all children.

With good reason: Studies have shown that Medicaid decreases infant and child mortality, especially among children of color. Women receiving Medicaid have had lower mortality rates from breast cancer. In fact, for every 240-310 adults enrolled in Medicaid programs, one life is saved.

Medicaid provides mental health services in the form of counseling, medicines, hospitalization and long-term care for millions of adults and children. Medicaid pays for dental and vision care for millions of children. Half of all obstetric deliveries are covered by Medicaid.

People on Medicaid are more likely to seek preventative care. Adults who have Medicaid, compared to those who are uninsured have billions of dollars less in unpaid bills, and better credit scores, so are more likely to find housing for themselves and their families. They and their children have less food insecurity. Medicaid recipients have lower instances of depression. Young people receiving Medicaid are less likely to commit crime.

Rural hospitals, which have had a tough time staying afloat, benefit from Medicaid funding. Overall, health care providers and the states benefit financially. In the absence of a national health insurance program, Medicaid is a win-win-win program.

President Obama’s Affordable Care Act expanded Medicaid eligibility to those adults and families earning up to 138% of the federal poverty rate — dramatically expanding Medicaid services. The Supreme Court upheld state’s rights to refuse these additional Medicaid benefits but to date, 40 of 50 states, have utilized expanded Medicaid — benefiting their citizens, health care providers, and their economies.

Of course, there are problems. Over my 40 years of pediatric practice, I saw many families who suddenly lost benefits or became ineligible, because they had moved or become homeless, and did not receive mailings telling them to renew. Or a name was spelled wrong, or there was some other bureaucratic snafu. But these problems would only be exacerbated in spades by the “One, Big Beautiful Bill” because enrollees will have to recertify or reapply, not annually, but several times a year to prove they are working.

This new work requirement for all adults receiving Medicaid — something Mike Johnson said makes commonsense and will “add to the self-esteem” of young men who get Medicaid but are apparently just loafing around. But this experiment has been done before. Bill Clinton’s work requirement in the program that replaced welfare — Temporary Assistance for Needy Families (TANF) — did not increase employment. Neither did the work requirement that Arkansas added to its Medicaid program when the first Trump Administration allowed states to add it.

Why? Because two-thirds of people receiving Medicaid are already working. In fact, in my experience, many of the parents with children on Medicaid are working 2-3 low paid jobs to make ends meet. The other one third cannot work because of disabilities, illness or childcare responsibilities. (The need for low-income parents to watch their preschoolers at home instead of work is sure to rise, since this administration cut funding for HeadStart, where thousands of my patients were able to receive quality child care and early education.)

What did happen in Arkansas, when they tried a work requirement on for size? 18,000 people lost health insurance. And illness increased.

The Republican bill also bans Medicaid for illegal immigrants. But the Deficit Reduction Act of 2005 already includes this provision. The bill bans Medicaid funding for non-profit organizations that fund termination of pregnancy.

All in all, this beaute of a bill would slash the numbers of Americans enrolled in Medicaid by several million. Unless the states, who now depend on Medicaid funding for a third of more of their budgets, raise state taxes or dramatically cut funding for the second biggest state budget item — education.

This debacle is all part of a plan to address a $4.1 trillion deficit created by increased Defense spending and tax cuts that will bring an average of $389000 dollars in increased annual income (over 4%) to the upper 0.1% most wealthy Americans, while the poorest 20% get an average of $90 a year, in benefits (0.6%), according to the Penn Wharton Budget Model.

This bill is certainly big. But it’s beastly, not beautiful.

Dr. David Gottsegen is a pediatrician who focuses on the interrelationship between mind body and spirit. He lives in Belchertown.