Kay Pence is vice president of the Iowa Alliance for Retired Americans.
I’m a retired union representative for the Communications Workers of America living in rural Eldridge with my husband of 50 years. As a union rep I bargained contracts, and health care was always the biggest issue, especially before the Affordable Care Act became law in 2010.
I’m currently the executive vice president for the Iowa Alliance for Retired Americans, which has 4.4 million members nationwide. I’m extremely concerned about how Donald Trump’s so-called “Big Beautiful Bill” (the budget reconciliation package) will force people off their insurance and cause problems for providers. I’m especially concerned about insurance rates for everyone who thinks these cuts to Medicare, Medicaid, and the Affordable Care Act premium subsidies won’t impact them, since their coverage comes through their employer or private insurance plan.
As we approach the 60th anniversary of Medicare and Medicaid, we should be celebrating. Instead we’re mourning—because Republicans have finally found a way to gut these popular programs through the Big Ugly Bill.
It’s no secret that most Republicans opposed the 1965 law that created Medicare for older Americans and Medicaid for low-income people. These programs aren’t perfect, but they’re lifesavers. They’ve improved public health, extended life expectancy, and shielded families from medical bankruptcy. Yet our mix of public and private insurance is too expensive and leaves too many uninsured or underinsured.
As a presidential candidate, Donald Trump promised to lower health care costs. The Big Ugly Bill started by making Trump’s 2017 tax cuts permanent—paid for by cutting so-called “waste” from Medicaid and other safety net programs. As usual, Republicans used the opportunity to shovel even more giveaways to the wealthy and corporations, ballooning the deficit by an estimated $3.4 trillion over ten years, and raising debt ceiling by $5 trillion.
Let’s be clear: both parties have been irresponsible with spending, but this budget reconciliation bill passed with 100 percent Republican votes. Every Democratic attempt to target tax relief toward the working class failed. Just one provision benefiting the top 0.1 percent adds $60 billion to the debt — a tab for our kids and grandkids.
To pretend the budget reconciliation bill was fiscally responsible, Republicans made key provisions for working families and seniors temporary. And to hide the pain, cuts to Medicaid and nutrition programs won’t kick in until after the 2026 elections.
There was hope this bill would finally tackle waste, fraud, and abuse in our health care system. But instead of going after the documented problems in private Medicare Advantage plans—which deny care, restrict networks, and up-charge for profits—Trump and Republicans rewarded them. In 2024 alone, Medicare Advantage plans will cost $83 billion more than traditional Medicare for the same people. Why? Because those billions flow into profits, salaries, and relentless advertising—not care. Administrative costs run 13–18 for Medicare Advantage. Traditional Medicare? Under 2 percent, with no profit motive.
Rather than phase out Medicare Advantage and invest in improving Medicare, the Trump regime increased Medicare Advantage funding by 5 percent and gifted Big Pharma a $5 billion loophole that weakens Medicare’s ability to negotiate drug prices.
Medicaid fraud is also real—providers have been caught double billing or charging for phantom services. But instead of cracking down on scammers, Congress increased bureaucratic hurdles for patients. Most adults on Medicaid already work, but in states that tried work documentation, eligible people lost coverage simply because they couldn’t keep up with the paperwork.
The Big Ugly Bill will also destabilize the Affordable Care Act marketplace. Congress has not extended the 2021 health insurance premium subsidies (which are due to expire at the end of 2025) and made it harder to qualify again in 2026. Without help, premiums could spike 75 percent or more. That means healthy people will drop coverage, sick people will stay, and insurers will flee—because profit-driven companies don’t want to insure the sick.
And if that weren’t bad enough, the bill’s debt explosion could trigger automatic cuts under the PAYGO law—including an estimated $490 billion slashed from Medicare over ten years. Payments to hospitals, doctors, drug plans, and Medicare Advantage plans will all take a hit. Congress could have waived PAYGO. They didn’t. That tells you who they’re really working for.
In the end, the Big Ugly Bill will raise health care costs for everyone—not just people on Medicare or Medicaid, but also private insurance holders who will pay more as the uninsured population grows. And rising national debt means rising interest rates for all borrowers.
Republicans have tried to repeal the Affordable Care Act nearly 70 times. This time, they found a backdoor: shifting health care dollars from patients to profits. So maybe it’s time we call our broken system what it really is: Trumpcare — or more accurately, Trump-doesn’t-care.
Top image is an official White House photo in the public domain, available via Wikimedia Commons.
