Skip to content
Search

Latest Stories

Top Stories

Musk budget cuts will leave millions uninsured

Musk  budget cuts will leave millions uninsured

Female doctor and senior woman looking at digital tablet in exam room

Getty Images//Stock Photo

As Donald Trump begins his second term, America’s healthcare system is in crisis: medical costs are skyrocketing, life expectancy has stagnated, and burnout runs rampant among healthcare workers.

These problems are likely to become worse now that Trump has handed the job of cutting the federal budget over to Elon Musk. He will lead the newly formed Department of Government Efficiency (DOGE), a non-government entity tasked with slashing $500 billion in “wasteful” spending.


The harsh reality is that the mission can’t succeed without gutting healthcare access and coverage for millions of Americans.

Deleting dollars from American healthcare

Since Trump’s first term, the country’s economic outlook has worsened significantly. In 2016, the national debt was $19 trillion, with $430 billion allocated to annual interest payments. By 2024, the debt had nearly doubled to $36 trillion, requiring $882 billion in debt service—12% of federal spending that is legally untouchable.

Add to that another 50% of government expenditures that Trump has deemed politically off-limits: Social Security ($1.35 trillion), Medicare ($848 billion) and Defense ($1.13 trillion). That leaves just $2.6 trillion—less than 40% of the $6.75 trillion federal budget—available for cuts.

With Medicare off limits to DOGE, the options for major reductions are extremely limited. Big-ticket healthcare items like the $300 billion in tax-deductibility for employer-sponsored health insurance and  $120 billion in expired health programs for veterans will prove politically untouchable. One will raise taxes for 160 million working families, and the latter will leave veterans without essential medical care.

This shortfall will require Musk and DOGE to cut billions in government healthcare spending. But where will they find it?

In a recent op-ed, Musk and Vivek Ramaswamy proposed eliminating expired or misused funds for programs like Public Broadcasting and Planned Parenthood, but these examples account for less than $3 billion total—not even 1% of their target.

If significant reductions in cost are to be realized, DOGE will have to attack Medicaid and the ACA health. Here’s how 20 million people will likely lose coverage as a result, assuming this level of deficit savings is achieved:

1. Reduced ACA exchange funding

Since its enactment in 2010, the Affordable Care Act (ACA) has provided premium subsidies to Americans earning 100% to 400% of the federal poverty level. For lower-income families, the ACA also offers  Cost Sharing Reductions, which help offset deductibles and co-payments that fund 30% of total medical costs per enrollee. Without CSRs, a family of four earning $40,000 could face deductibles as high as $5,000 before their insurance benefits apply.

If Congress allows CSR payments to expire in 2026, federal spending would decrease by approximately  $35 billion annually. If that happens, the Congressional Budget Office expects 7 million individuals to drop out of the exchanges. Worse, without affordable coverage alternatives,  4 million families would lose their health insurance altogether.

2. Slashing Medicaid coverage and tightening eligibility

Medicaid currently provides healthcare for over 90 million low-income Americans, including children, seniors, and individuals with disabilities. To meet DOGE’s $500 billion goal, several cost-cutting strategies appear likely:

· Reversing Medicaid expansion: The ACA expanded Medicaid eligibility to those earning up to 138% of the federal poverty level,  reducing the uninsured rate from 16% to 8%. Undoing this expansion would strip coverage from millions in the 40 states that adopted the program.

· Imposing work requirements: Proponents argue this could encourage employment, but most Medicaid recipients already work for employers that don’t provide insurance. In reality, work requirements primarily create  bureaucratic barriers that disqualify millions of eligible individuals, reducing program costs at the expense of coverage.

· Switching to block grants: Unlike the current Medicaid system, which adjusts funding based on need, less-expensive block grants would provide states with fixed allocations. This will, however, force them to cut services and reduce enrollment.

Medicaid currently costs $800 billion annually, with the federal government covering 70%. Reducing enrollment by 10% (9 million people) could save over $50 billion annually, while a 20% reduction (18 million people) could save $100 billion.

Either outcome would devastate families by eliminating access to vital services, including prenatal care, vaccinations, chronic disease management, and nursing home care. As states are forced to absorb the financial burden, they’ll likely cut education budgets and reduce infrastructure investments.

The first 100 days

The numbers don’t lie: Musk and DOGE could slash Medicaid funding and ACA subsidies to achieve much of their $500 billion target. But the human cost of this approach would be staggering.

Fortunately, there are alternative solutions that would reduce spending without sacrificing quality. Shifting provider payments in ways that reward better outcomes rather than higher volumes, capping drug prices at levels comparable to peer nations, and leveraging generative AI to improve chronic disease management could all drive down costs while preserving access to care.

These strategies address the root causes of high medical spending, including chronic diseases that, if better managed, could prevent 30-50% of heart attacks, strokes, cancers, and kidney failures, according to CDC estimates.

Whether Musk and DOGE will consider the kinds of reform options I have suggested in their pursuit of immediate budgetary cuts remains to be seen.

If they choose not to, the health of millions of Americans is at major risk.

Robert Pearl, the author of “ ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.

Read More

Is the Ban on Abortion More Important Than Democracy?
Abortion at the Dinner Table
Getty Images

Is the Ban on Abortion More Important Than Democracy?

After the U.S. Supreme Court overturned Roe v. Wade, 93 prosecutors from 29 states vowed in a statement that they would not pursue abortion cases. In return, 17 states have attempted to pass laws curbing prosecutorial discretion, a legal principle that has existed since the United States’s founding.

On average, more than a quarter (28%) of cases are dismissed by prosecutors for various reasons, including insufficient evidence, constitutional violations, procedural errors, lack of resources, more pressing priorities, or negative public opinion. Prosecutors are public servants, propelled to power by the people, committed to justice. They make decisions based on the tenets of their position.

Keep ReadingShow less
Vance Makes Push To Increase Support for Trump’s Big Bill in Ohio, but Locals Remain Divided

Vice President JD Vance speaks to the Metallus workers in Canton, Ohio to speak on the Big Beautiful Bill on Monday, July 28, 2025.

Angeles Ponpa/Medill News Service

Vance Makes Push To Increase Support for Trump’s Big Bill in Ohio, but Locals Remain Divided

CANTON, Ohio — Vice President JD Vance returned to Ohio on Monday to promote the Trump administration’s “Big Beautiful Bill,” casting it as a path to revive local industry and reward workers.

Inside the Metallus steel plant, Vance was welcomed by local officials and workers who embraced the tax and labor provisions. Outside, critics voiced concern over cuts to health care, education, and safety-net programs.

Keep ReadingShow less
Red Wave Health Care Tsunami is Coming

It may be shrewd politics, but it’s disastrous policy: offer upfront benefits like tax cuts but delay the painful provisions for future years.

Getty Images

Red Wave Health Care Tsunami is Coming

It may be shrewd politics, but it’s disastrous policy: offer upfront benefits like tax cuts but delay the painful provisions for future years. That’s exactly what Congress has done with the so-called “One Big Beautiful Bill Act” (OBBBA). Don’t be misled by the name. This partial repeal of the Affordable Care Act (ACA) is, in effect, the largest cut to health care in U.S. history.

The bill is projected to cut federal Medicaid spending by $793 billion and reduce financial assistance to those who buy insurance through ACA Marketplace by another $268 billion over the next decade. Admittedly, the bill will provide some tax benefits, primarily to those with higher incomes, but at tremendous costs to many of our friends and neighbors.

Keep ReadingShow less
Democrats: From Programs to Policy – a New Vision for Families

"...The overreliance on programmatic solutions has left Democrats without a coherent policy framework to meet the needs of today’s families," writes Capita CEO/Co-Founder Joe Waters.

Getty Images, The Good Brigade

Democrats: From Programs to Policy – a New Vision for Families

As the Democratic Party reassesses its direction after last year’s electoral losses, it's encouraging to see new initiatives like Project 2029—a proposed, albeit late, answer to Project 2025—taking shape. But as Democrats rethink their policy, narrative, and electoral strategies, they risk repeating a familiar mistake in domestic social policy: substituting programs for policy.

By “programs,” I mean the specific interventions—like subsidies, grants, and services—designed to address particular social problems. Useful tools, yes, but too often, they are treated as ends in themselves. By “policy,” I mean the broader vision and principles that guide and integrate those tools toward a coherent national goal.

Keep ReadingShow less