The Fulcrum strives to approach news stories with an open mind and skepticism, striving to present our readers with a broad spectrum of viewpoints through diligent research and critical thinking. As best we can, we remove personal bias from our reporting and seek a variety of perspectives in both our news gathering and selection of opinion pieces. However, before our readers can analyze varying viewpoints, they must have the facts.
As presently proposed, how much will be cut from Medicaid in the ‘Big, Beautiful Bill’?
The proposed "One Big Beautiful Bill" includes $880 billion in cuts to Medicaid over the next decade. These cuts would result in an estimated 10.3 million people losing Medicaid coverage by 2034 and 7.6 million becoming uninsured. The bill imposes work requirements for childless adults aged 19 to 64, penalizes states that provide Medicaid to undocumented immigrants, and ends certain tax practices that states use to fund their Medicaid programs.
Republicans argue that these changes will reduce waste, fraud, and abuse, while Democrats warn that millions will lose access to essential healthcare. The bill is currently advancing through Congress, with Speaker Mike Johnson pushing for its passage by Memorial Day.
Who would be most impacted by the Medicaid cuts?
The proposed Medicaid cuts could have major consequences for several vulnerable groups:
- Low-Income Adults: The bill introduces work requirements for childless adults aged 19 to 64, requiring 80 hours per month of work, education, or volunteering to maintain coverage. Many individuals with irregular employment or disabilities that don’t qualify for exemptions could lose coverage.
- Elderly & Disabled Individuals: Medicaid funds long-term care for millions of seniors and people with disabilities. The cuts could reduce nursing home funding, forcing some facilities to close or limit services.
- Children & Pregnant Women: Medicaid covers 4 in 10 children in the U.S. and provides prenatal care for low-income mothers. The proposed changes could increase co-pays for certain services, making it harder for families to afford care.
- Rural Communities: Many rural hospitals rely on Medicaid funding. The cuts could force hundreds of hospitals to close, particularly in states like Kansas, Oklahoma, and Alabama. This would leave many communities without emergency care or specialist services.
- Undocumented Immigrants: The bill penalizes states that provide Medicaid to undocumented immigrants by reducing federal funding. This could lead to coverage losses in states like California and New York.
- General Healthcare Access: The bill eliminates provider taxes, which states use to fund Medicaid. This could reduce payments to hospitals and doctors, leading to staff layoffs and longer wait times for care.
Is the ‘Big, Beautiful Bill’ as presently constructed revenue neutral?
The present version of the bill is not revenue neutral. The current framework is expected to increase the deficit by around $6 trillion over the next decade. The bill includes trillions in tax cuts, particularly making the 2017 Trump tax cuts permanent, while also introducing deep spending cuts to programs like Medicaid and food assistance (SNAP).
House Republicans have set a $4.5 trillion cap on tax cuts but only if $1.7 trillion in spending cuts are achieved. If spending reductions fall short, the tax cut cap will be lowered accordingly. Some lawmakers are pushing for state-specific exemptions, which could further impact the bill’s fiscal balance.
How do Republican deficit hawks justify voting for it?
Republican deficit hawks justify voting for the “Big, Beautiful Bill” by arguing that the tax cuts will spur economic growth, generating additional revenue to offset the deficit increase. They claim that extending the 2017 Trump tax cuts will lead to higher GDP, increased investment, and job creation, which will ultimately reduce the long-term deficit.
However, some fiscal conservatives are demanding at least $2 trillion in spending cuts to balance the tax reductions. Speaker Mike Johnson has promised $1.5 trillion in cuts over the next decade, but some lawmakers are pushing for $500 billion more in reductions or a narrowing of the tax cuts.
At the same time, moderate Republicans are resisting deep cuts to Medicaid and food assistance, arguing that such reductions would be politically damaging. This has led to internal GOP conflicts, with different factions setting red lines that may be difficult to reconcile.
Are there any specific quotes from Republican members of Congress expressing concerns about the deficit and the bill?
- Rep. Lloyd Smucker (R-PA) led a letter signed by over 30 Republicans, stating: "Under the House’s framework, the reconciliation bill must not add to the deficit. The House budget resolution assumes that enacting President Trump’s agenda, including extending the 2017 tax cuts, will generate $2.5 trillion in additional revenue through economic growth. This means that all additional tax cuts or increases in spending above this level must be offset."
- Rep. Chip Roy (R-TX) voiced his concerns, saying: "This bill falls profoundly short. I am a 'no' on this bill unless serious reforms are made."
What is the breakdown of how different tax provisions, if passed, will contribute to the estimated revenue?
- Individual Tax Rate Reductions: Extending the 2017 Tax Cuts and Jobs Act (TCJA) individual tax rate reductions would reduce federal revenue by $2.16 trillion over the next decade.
- Corporate Tax Provisions: Maintaining the 21% corporate tax rate and extending bonus depreciation would cost $551 billion but could boost investment and productivity.
- Child Tax Credit Expansion: Keeping the expanded Child Tax Credit would reduce revenue by $735 billion but provide relief to families.
- Alternative Minimum Tax (AMT) Exemption: Continuing the higher AMT exemption would cost $1.36 trillion, benefiting high-income earners.
- Standard Deduction Increase: Preserving the higher standard deduction would reduce revenue by $1.25 trillion, simplifying tax filing for many Americans.
Overall, the bill is projected to reduce federal tax revenue by $4.1 trillion over the next decade on a conventional basis. However, when accounting for economic growth, the actual reduction in tax revenue might change.
How are different states or regions impacted?
The proposed Medicaid cuts will impact states differently based on their Medicaid expansion status, budget flexibility, and healthcare infrastructure. Here’s how some states are expected to be affected:
- Expansion States (California, New York, Washington, etc.): These states expanded Medicaid under the Affordable Care Act (ACA) and will face higher financial burdens to maintain coverage. If they don’t compensate for federal cuts, millions could lose coverage.
- Southern States (Louisiana, Kentucky, Montana): These states will see state spending increase by 18-20% to maintain Medicaid expansion. If they drop coverage, hundreds of thousands could lose insurance.
- Rural States (Kansas, Oklahoma, Alabama): Many rural hospitals rely on Medicaid funding. The cuts could force closures, leaving communities without emergency care.
- States Funding Coverage for Undocumented Immigrants (California, New York, Illinois): The bill penalizes states that provide Medicaid to undocumented immigrants by reducing federal funding. This could lead to coverage losses in these states.
- States with High Medicaid Enrollment (Texas, Florida, Pennsylvania): These states have large Medicaid populations and will need to increase taxes or cut benefits to offset federal reductions.
David Nevins is co-publisher of the Fulcrum and co-founder and board chairman of the Bridge Alliance Education Fund.
Children watch a July Fourth Parade along the Walkway of Heroes and Independence Avenue on July 04, 2026 in Tappan, New York.
The Great American Grumpfest
Our nation’s 250th birthday party didn’t feel especially patriotic and wasn’t as much fun as the 200th anniversary was.
President Trump, who did his best to co-opt our holiday for his personal aggrandizement, was a major reason. The party he threw in Washington, D.C., was crankier than uplifting, and less about celebrating our shared past and a promising future than about reminding us how far we have strayed from our founders’ plan to create a republic that future Americans would keep in good working order.
Credit Trump this much. He has a singular gift for picking at scabs that other politicians would rather ignore and pushing us into reckonings we don’t need.
The thing is, Americans have seen all this before. Sometimes the makeover we were encouraged to undertake was more conservative, sometimes more liberal. Whatever direction we were pushing, however, the reckoning we had in mind this time had to be more forthright and the conclusion more definitive than it was the last time.
Our current discontents, the ones behind the reckoning President Trump has been trying to inspire, are not trivial. Included among them are immigration, birthright citizenship, exploding healthcare costs, election rigging, a gag-inducing national debt, how we educate our children, too many genders, racial differences we can’t move past, a lopsided economy that favors more well-off Americans, and historic levels of political corruption and graft. Add to these the several foreign adventures he has pushed us into or is anxious to undertake, and you have the makings of a national headache the likes of which we haven’t had in half a century.
All the elbow-throwing and overheated rhetoric we’re using today have begun to look almost normal in all the ways that bickering neighbors and feuding family members appear normal. But they have also made us look mean-spirited and have portrayed our differences as irreconcilable. To ourselves, of course, but also to many people outside the United States who might be forgiven for turning their heads and not looking at the national car wreck we Americans show no interest in avoiding.
The good news, as I suggested above, is that Americans have had a great deal of practice dealing with challenges and national car wrecks like these.
This essay begins to lay out the reasons why.
By way of illustration, we have our seemingly insatiable demand for more bad news about race in America.
Sixty years after being released from the legal constrictions that bedeviled both white and black Americans, many white people have come to believe the color that used to make them unassailable is now a sign of a moral inferiority born of a racial animus they can never wash off. Many black people, on the other hand, are insisting that America is as hopelessly stacked against them as the formerly unassailable white people’s ancestors used to tell their black ones.
The result is that many people today are buying into racist nightmares and mumbo jumbo that their black and white ancestors worked hard and effectively to put in each other’s heads.
This might be dismissed as crazy behavior if it weren’t so important to rituals Americans have long used to express their deepest fears about each other while figuring out what move they can make that won’t end with their world crashing down on everybody’s head.
Unfortunately, the kind of cultural sleight of hand we have used to ramp up our racial differences has been appropriated by people who have many other cultural fears and unresolved differences with each other. Their clumsy but culturally prescribed missteps are making all these other issues look as irremediable as our racial problems.
A good place to start an answer to how we back away from ledges is Alexis de Tocqueville’s writing on early-19th-century American democracy. He had an optimistic take on Americans’ unscripted displays of public bravado, recrimination, and payback.
For him, these were occasions when people tried to mitigate the effects of the unfair hand they were dealing someone else or had themselves been dealt by behaving in ways quite at odds with how they would otherwise be expected to act. These inversions of what Tocqueville called “the natural order of conscience” presented themselves as a loud but culturally muted challenge to the hypocrisies that people had built into the world they’d made together.
One of his favorite illustrations of early-American hypocrisy involved slave masters sleeping with their less-than-worthy slaves. To the best of my knowledge, he didn’t pick up on all the ways that slaves messed with their owners. Their well-chronicled and quiet resistance showed that even severely ill-treated people can exercise more control over their lives than outsiders appreciate.
Be that as it may, such inversions of a people’s “natural order of conscience” make a good public show of them wrestling with demons they can’t or may not want to shake off, but in any case, are nowhere close to figuring out how to cast out.
Implicit in these disruptions was the discomforting idea that people might flip the entire script and turn the world on its head in more permanent ways. That kind of flipping worked out better for us in our revolution against England than in our Civil War. These events taught us the value of stepping back from historically unprecedented ledges.
Americans of late have been giving loud expression to a long list of things they don’t like about each other and the last makeover they started but didn’t finish a half-century ago. The outcome of our fights today will be as revealing as they are embarrassing to everyone who imagined they could recast our country in a way that privileged their favorite kind of Americans.
Their disappointment with the accommodations they strike will be palpable, but the middling results they achieve with all their pushing and shoving won’t be anything they can’t live with.
Anthropologists who have written about such moments in other cultures less “advanced” than our own show that people find ways to work around their seemingly irreconcilable differences without ever fully resolving them. Indeed, the patches and repairs people make have the unheralded effect of reinforcing rather than undermining the legitimacy of the practices and values they thought were fundamentally flawed.
For example…
White guilt and black pessimism do more good than putting cash into the pockets of professional shamers and handwringers. They give the rest of us who don’t feel guilty or powerless more time to make the world less racially unequal. Good news.
Regarding illegal immigration, the entrance requirements for future immigrants will remain stringent. Americans will applaud the continued detention and deportation of the few illegal immigrants who commit serious crimes. Good news.
All the people who came to the United States without being legally vetted and were locked up for a time will be released in numbers small enough to avoid serious media attention. Along with the several million other good people who snuck in but avoided capture, the former detainees will go to school, find gainful employment, pay their taxes, and stay out of trouble. Many will eventually become citizens. Good news.
Investigations into election tampering and Donald Trump’s 2020 presidential loss will come to an unceremonious conclusion the day after his second term ends. Many Americans will grumble about this, but there will also be some quiet partying, too. Good and bad news.
Congressional hearings into all the grifting accomplished by people tied to the Trump administration will end without anyone having to pay a dime back to the American taxpayers. Bad news, we’ll learn to live with.
New laws and regulations will be created in the hope that the kind of corruption practiced by President Trump will not be repeated for another 250 years. Good news, I hope we’ll live long enough to enjoy.
Show trials for people who allegedly vandalized the Lincoln Memorial Reflecting Pool, if they happen, will get big television viewer ratings. Good news.
Trials for pardoned Capitol insurrectionists who committed serious crimes after their release should get more attention, but won’t. Bad news.
We will continue to hear nothing from most of the people who were pardoned for crimes they committed in the insurrection at the Capitol on January 6, 2021. They will keep their mouths shut and their heads down for the rest of their life. Good news.
The gold-gilded ornaments that Donald Trump had plastered all over the White House will be shipped to Mar-a-Lago, where the former president will sell them on eBay. Fun news.
American taxpayers end up paying for most of the new East Wing, the removal of the miniature gladiatorial arena that was built behind the White House, and the restoration of the White House rose garden. Bad news.
The Triumphal Arch was never built. Good news.
Trad wives and gay couples raise perfectly lovely children. Good but unsurprising news.
Trans men and women learn that most Americans can’t figure out who they used to be. No one gives a second thought to their use of “family bathrooms” or “unisex bathrooms” in public settings, businesses, and schools. Communities will sponsor athletic teams that have trans boys and girls just to show they can. Good news.
Budget deficits will be kicked down the road for someone else’s children to pay down. Bad news.
Federal agencies that had their budgets and employee ranks slashed during President Trump’s second term are getting some of the money and lost positions back. Good news.
Elite universities will buy their way out of DEI purgatory by competing for conservative scholars whose inflated salaries dwarf those of their liberal colleagues, who will think about suing their institutions for reverse discrimination but won’t be able to figure out who would pay for it or care. More fun news.
Okay. I’ve probably missed some ways that Americans will step back from the ledges they have been making noises about leaping off. But to the extent that my predictions pan out, the best and most important moral of the stories about us stepping away is this: everything we lost and took back, or had returned to us, will have happened without our government collapsing, civic traditions crumbling, or our people beating each other up.
The reason why is that the differences Americans have with each other really weren’t as irreconcilable as we made them out to be. The empty-sounding bromide that Americans have more that unites us than divides us turns out to be true, not just metaphorically but in fact.
Now that is really something to celebrate.
Daniel J. Monti (danieljmonti.com) is Professor of Sociology at Saint Louis University and the author of American Democracy and Disconsent: Liberalism and Illiberalism in Ferguson, Charlottesville, Black Lives Matter, and the Capitol Insurrection.