By Anna Gustafson for the Pennsylvania Independent.
Broadcast version by Danielle Smith for Keystone State News Connection reporting for the Pennsylvania Independent-Public News Service Collaboration

Josie Badger doesn't know where she would be without Medicaid.

"I use a ventilator, power wheelchair," said Badger, a disability rights advocate who lives in western Pennsylvania's Lawrence County. "I have 24-hour care. I could not get out of bed every day without that care, let alone work, have a business, be a foster mom, own a home, any of that. So, without that coverage, Josie would not be here."

Badger was born with a physical disability called congenital myasthenic syndrome, which leaves an individual with weakened muscles, and she spent months on end in the hospital as a child. While she was growing up, Badger's parents repeatedly considered getting a divorce solely so they could each have their own private insurance plan that Badger could use.

"Fortunately, that didn't happen," Badger said of her parents divorcing. "Now, as an adult, I receive waiver through Medicaid home-based services, and it is my lifeline."

Now, however, Badger is fighting to keep that lifeline.

In an effort to pay for President Donald Trump's tax cuts for the wealthiest Americans, House Republicans on May 22 passed legislation, which they named the "One Big Beautiful Bill Act," that would carve about $700 billion from Medicaid, add approximately $3.3 trillion to the national debt over the next decade, and cause about 13.7 million people to lose health care coverage nationwide. The bill passed the House by a vote of 215-214, with all but five Republicans voting for it and no Democratic support. Every Republican House member from Pennsylvania supported the bill, which is now before the Senate. Trump is expected to sign the bill if it passes the Senate. If the Senate changes anything in the House bill, the two chambers must work out those differences and vote on the final legislation before sending it to the president.

In Pennsylvania, where close to one-quarter of the population is enrolled in Medicaid, the federal Medicaid cuts could strip health coverage from hundreds of thousands of residents, including people with disabilities, individuals in nursing homes, and children. About 750,000 people with disabilities use Medicaid in Pennsylvania.

"We're at a place where we need to become very public about what's going on, because I don't think enough people realize that these cuts are going to affect them," Badger said. "They don't realize that Medicaid pays for services in schools. They don't realize that the Affordable Care Act that they're buying, those services could go away."

'I become paralyzed with the fear'

For Badger, a loss of Medicaid or reduced benefits would be life-changing. Currently, she is able to afford six nurses and three home-care attendants who provide around-the-clock services through her Medicaid plan. It's this kind of care that keeps her out of a nursing home and living in her own house with her family, running her own consulting firm, which works to empower people with disabilities, and generally living a life she loves.

As Republicans push for the largest cuts to Medicaid in the program's 60-year history, Badger is trying to focus less on how her own personal life would be affected by the GOP's plan and more on galvanizing people to fight for the public health insurance program that covers about 80 million people nationally, or about 20% of the country's population.

"For me, I can't think a lot about it in terms of my own life because I become paralyzed with the fear, with the anxiety, and so I have to go and activate other folks to get involved," Badger said. "The community is really what keeps me going and realizing why it's important that there's hope. And so a lot of my work time I've been donating towards trying to elevate people's voices for a lot of issues, not just Medicaid. I'm not even sure I can process it on a personal level."

Should the House bill be signed into law, Badger said, she expects her home caregivers could lose their jobs, or leave them, because of a lack of funding. That, then, could leave older people and people with disabilities with no option but to go into a nursing home.

"Nursing homes, historically, have been last resort, even though they are one of the most expensive options, and so I think that there's going to be a come-to-Jesus moment when we start seeing millions of folks with disabilities and older adults needing care not being able to get it and ending up in nursing homes that are also underfunded," Badger said.

Losing home- and community-based services

Jennifer Garman, the president of Disability Rights Pennsylvania, is also deeply worried about cuts to home- and community-based services that are funded by Medicaid, including housing and employment support. Through those services, people with disabilities are able to live in their own homes as well as work.

"We already also have a waiting list for home- and community-based services for people with intellectual disabilities," Garman said. "And so we would also be concerned that waiting lists will grow for services and that people will have to wait a longer time than they're already waiting."

"It will just be a tremendous strain on the commonwealth and really deeply impact the community and people accessing the services that they need," Garman continued.

Cutting or decreasing those services would be disastrous, said Christie Cyktor, the youth leadership and training coordinator for western Pennsylvania at the PEAL Center. The PEAL Center works with youth with disabilities and their families to help them advocate for themselves in a variety of settings, such as school or the workplace.

Cyktor, who has a congenital disability that affects her joints and has used a power wheelchair since the age of 8, explained the youth she works with want to go to college, be in the workforce and live independently. In order for them to do that, they need to have a direct-care worker who helps them with various tasks, depending on their needs, such as dressing themselves, she explained.

Cutting those services would harm people who want to contribute to their families, communities and economy, Cyktor said.

"They want to contribute to the workforce and economy and give back that way, but they're like, How am I going to afford this if I can't fund a direct-care worker?" Cyktor said.

Cyktor doesn't currently have a direct-care worker, but she did in college, and she said that support allowed her to graduate.

"There's no way that I would have been able to go live independently at college if I did not have this woman," Cyktor said. "She was the sweetest woman and would come in the morning, help me get up, get dressed for the day, get me set up, and I could go do things independently during the day. And then she'd come back at night, and, same thing, sort of helped me get ready for the night and everything. And that enabled me to go get my degree."

Support at school

Medicaid also funds school-based services, which is the only way that many school districts are able to afford means of support for students with disabilities, such as occupational therapy, nurses, mental health care, and specialized equipment such as wheelchairs.

Cuts to those services could have lifelong consequences for students, Cyktor said. In addition to working at the PEAL Center, Cyktor also provides virtual occupational therapy for students across Pennsylvania.

"So many school-based services are funded by Medicaid, and so it's already something I've sort of been thinking about for these families who I see all across Pennsylvania, in very rural areas, and really the cyber platform is maybe the only time they have access to occupational therapy, any other service," Cyktor said. "So if that gets cut, these kids are going to be losing out on these vital services and doing this really important development at such a young age."

Cyktor works with students in kindergarten through 12th grade on fine motor skills, such as handwriting and typing, as well as executive functioning skills like daily activity scheduling. Without those skills, it will be difficult to enter the workforce, she emphasized.

"If they're cut now, the future impacts are going to be huge for them," she said.


Anna Gustafson wrote this article for the Pennsylvania Independent.


get more stories like this via email

As Congress reviews budget slashes to health care in President Donald Trump's "One Big Beautiful Bill Act," a new evaluation from the nonpartisan Congressional Budget Office projects 16 million Americans, including 1.8 million Medicaid and Healthy Indiana Plan recipients, would go without health insurance.

If the bill passes as is, said Josh Bivens, chief economist at the Economic Policy Institute, a nonpartisan think tank, health providers would see a sharp increase in what is known as uncompensated care, when people without coverage get sick but are unable to pay.

"And it means hospitals and doctors no longer receive that income stream from Medicaid payments," he said. "And lots of them are going to be forced out of business, and there's going to be closures of hospitals, especially in rural counties."

Republicans question the Congressional Budget Office projections, believing that cutting $715 billion from Medicaid eliminates fraud. They want to add specific work mandates for healthy working-age adults. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

According to the research site KFF, nearly 569,000 Hoosiers are enrolled through the Affordable Care Act's Medicaid expansion.

Bivens said he fears that if the bill becomes law, he sees the measure as a transfer of income from vulnerable families to already wealthy Americans. He noted that the average cuts to Medicaid, which would take effect after the 2026 midterm elections, would be more than $70 billion per year.

"And then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," he said. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety-net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.


get more stories like this via email

As Congress considers cuts to safety net programs in what Republicans are calling the "One Big Beautiful Bill Act," a new analysis from the nonpartisan Congressional Budget Office estimates 16 million Americans, including 140,000 in Colorado, would lose Medicaid health insurance.

Josh Bivens, chief economist at nonpartisan think tank the Economic Policy Institute, said if the bill passes as-is, health providers would see a steep increase in what is known as uncompensated care, when people without coverage get sick but cannot afford to pay their medical bill.

"It means hospitals and doctors no longer receive that income stream from Medicaid payments," Bivens pointed out. "Lots of them are going to be forced out of business and there's going to be closures of hospitals, especially in rural counties."

Republicans have cast doubt on the Congressional Budget Office projections and claimed cutting $715 billion from Medicaid by eliminating fraud and adding work requirements for adults would not reduce coverage. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

Bivens stressed if the bill becomes law, it would result in what he describes as the direct transfer of income from vulnerable families to the richest Americans. He noted the average cuts to Medicaid, which would kick in after the 2026 midterm elections, would be more than $70 billion a year.

"Then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," Bivens explained. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.

While headlines about the latest Trump-Musk feud may catch more people's attention, Bivens added the bill will have the biggest effects on Coloradans.

"I think the fact that six Nobel Prize winners said, 'This is important enough for me to try to draw attention to the implications of this bill,' should make people realize the stakes are really large," Bivens emphasized.


get more stories like this via email

A New Mexico coalition is stressing an urgent need for the state to adopt the strongest possible heat risk standards for indoor and outdoor workers.

New Mexico is the sixth-fastest-warming state in the nation, according to the Union of Concerned Scientists, fueled by climate change which makes heat waves more common.

Carlos Matutes, community advocate for the environmental group GreenLatinos, said 80% of those working in agriculture are Latino, as are 64% of those working in the building trades. He added Latino workers are overrepresented in oil and gas production and need to be protected.

"Depriving them of paid rest periods, of shade, of water during the summer months is unconscionable," Matutes asserted. "We're trying to make sure New Mexico Environment Department establishes these rules as quickly as possible."

Two states, Texas and Florida, have passed laws limiting local governments' ability to require employers to provide water breaks to outdoor workers. In contrast, California adopted protections in 2006. Matutes noted the Environmental Department has already announced the process to consider a heat-protection rule has been delayed and will not take effect before workers endure this summer's heat.

It is not just workers who suffer from extreme heat but also kids in school classrooms.

Whitney Holland, president of the American Federation of Teachers-New Mexico, said the days of putting a box fan in a classroom window on hot days are long past and the number of sweltering days increases each year.

"Thinking through a student's day, from the time they get on the bus, with buses that don't have air conditioning, in the cafeteria, in the library, all of those places," Holland outlined. "If they don't have proper ventilation and good air quality, research shows students feel fatigued, they are unable to focus, all of those things."

As might be expected, Holland added late afternoon, following the lunch break, is when students are most miserable, which disrupts the learning environment. This summer's forecast calls for hotter-than-normal temperatures from coast to coast, according to NOAA's Climate Prediction Center.


get more stories like this via email