The One Big Beautiful Bill Act Will Decimate Medicaid

 

The One Big Beautiful Bill Act (OBBBA), President Trump’s Tax and Spend mega bill, recently passed Congress. It will strip billions of dollars from essential health programs while paying for billions of dollars in tax cuts for the rich, expand mass deportation programs, and continue to harm reproductive justice. Madeline Morcelle, Senior Attorney at the National Health Law Program, sits down to talk with us about OBBBA and how it’s going to particularly impact Medicaid.

Medicaid, the largest public health insurance program for people in the United States, including those of low incomes, currently provides coverage for over 71 million people. Medicaid is a critical line for people to access sexual and reproductive health care. OBBBA ushers in the most sweeping Medicaid cuts in U.S. history—specifically, $990 billion dollars in Medicaid cuts over the next decade and ending health insurance coverage for over 10 million people. Among other cuts, OBBBA imposes mandatory, nationwide work requirements on Medicaid expansion and partial expansion beneficiaries aged 19-64.

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Follow the National Health Law Program on Bluesky and Facebook.

Keep an eye on and engage in your state’s legislative sessions and their implications for sexual and reproductive health and rights.

If you are a federal advocate, engage in administrative advocacy, comment writing, or meetings with Office of Management and Budget. If you are a state advocate, work with your state Medicaid agency to mitigate damage. You can also check out the Medicaid Advisory Committee.

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hey rePROs, how's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, I am recording this on Wednesday before the holiday weekend. I took an extra-long weekend, and honestly, if you're listening to this on Tuesday, I am still out. I just thought it would be really nice to just take a step away and get recharged before everything this fall ramps up. I just am feeling a little overwhelmed with all the things in the world and work and just thought you know what I have the time to take off, let's take some time and enjoy a nice holiday weekend and honestly got really lucky because the weather in D.C. is supposed to be gorgeous this weekend. Normally this time of year, it's really hot and humid and sticky and you don't want to go outside but it has been gorgeous the last couple days in DC, and it's supposed to be gorgeous all weekend. I've had my windows open; I would have them open right now if it were if I weren't recording so you all don't hear all the background noise. My cats are living their best lives with the windows open. So, I'm very much looking forward to this nice weekend and to go out and spend some time outside, probably do some reading. I don't know if I have anything that I've, like- I want to read this book but I'm still working on trying to read down my TBR list. I was doing so good on it earlier this year, y'all. Like, so good. But then there was a sale at Barnes & Noble that was like the triple stamp, 25% off pre-orders, and da-da-da-da-da-da. And so, I did damage. I bought a lot and did all of the work I had been doing to read down my TBR. But that's okay. There are worse problems to have. And I'm an e-reader, so that means I'm at least not living in a house of books. I mean, I have a lot of books, but, like, I can have a huge TBR list on my e-reader and it's just my iPad so it's no big deal. But yeah, so my goal is to do work on reading some of that and spend some time outside and just try to get away from everything and tune everything out and just take a step back, get offline and just try to relax. And I know that's going to be a little hard because, again, I'm in Washington, D.C. That means there's all these federal troops and they're in my neighborhood. I mean, I haven't seen the National Guard in my neighborhood, but there's a lot of other federal police in my neighborhood. So, it's hard to get away from all of that. But I'm going to do my best to try to just take this weekend and recharge and be ready to go for the fall. I just am feeling like I need that a little bit. I think all of the things are starting to get to me and wear me down and I know that's what authoritarianism thrives on is to wear you down to make you want to give up, so I don't want to give up. So, I'm going to take a weekend to recharge and refresh and be ready to jump back into the fray. So, that's where I'm at right now. I hope y'all had a good holiday weekend and did something fun. Let's see what else. Let's maybe do some housekeeping. I feel like it's maybe been a little bit since I've done some... I don't know. I'm really bad at keeping track of that. First, if you have any topics, you would like us to talk about, I always am open to suggestions. I want to make sure we're covering things you all want to hear about, so please feel free to shoot me an email, jennie@reprosfightback.com, or you can reach out to us on social media. We're at rePROs Fight Back on Facebook and Bluesky and @reprosfb on Instagram. I'm mostly on Bluesky if you want to find me, so that is @JennieInDC. If you love the podcast, it would really help if you could subscribe, rate, and review us on whatever podcast platform you are on— it helps other people find the podcast— and make sure you don't miss an episode if you haven't subscribed. So, highly recommend all of that. And if you really love the podcast, make sure to check out our merch store. We have fun merch on Bonfire. We'll have the link in the show notes so it's really easy for you to get to. I finally ordered the things that I had been having my eye on; I got two t-shirts and a bag. They have not arrived yet, but I am very eagerly awaiting them. I'm sure I will get some more things, probably a coffee mug, maybe a water bottle, some of the other designs. We'll see, but they're really fun designs. Liberal Jane did the majority of them, but also our in-house artist did some. So, I am just very excited. I love all of our stuff. And if you want to rock rePROs Fight Back merch, check out the merch store in the show notes. Okay, y'all. With that, let's turn to this week's interview. We are going to talk about the "One Big Beautiful Bill" that passed earlier this summer. It has going to have a really big impact on Medicaid, but also on some parts of the Affordable Care Act. And so, we're going to do a deep dive talking about all of that today. And I couldn't think of a better person to have that conversation with than Madeline Morcelle, who is with the National Health Law Program or NHELP. She is going to break it down for all of us. And it was a great conversation. I hope you enjoy it. So, let's go to my interview with Madeline.

Jennie: Hi, Madeline. Thank you so much for being here today.

Madeline: Thank you so much for having me, Jennie.

Jennie: Before we get started, would you like to take a second and introduce yourself and include your pronouns?

Madeline: Sure. My name is Madeline Morcelle. I'm a senior attorney at the National Health Law Program. My pronouns are she/her, and I lead the National Health Law Program or NHELP's work bridging federal health care reform and sexual and reproductive health advocacy.

Jennie: Okay, y'all. First, an apology. I have a cat who is laying right here and has, like, the world's loudest purr. So, if you hear weird noises in the background, that would be Luna. And I am sorry, but she is very stubborn and will not leave my desk. So, you're going to have to deal with it. My apologies. Okay, I am really excited to have you on here. There was the "One Big Beautiful Bill" that passed, and honestly, I feel dumber every time I say it, but let's talk about it. And we're going to talk mostly on its impacts on healthcare, but before we can get to that part, what is the "One Big Beautiful Bill"?

Madeline: So, the pretty disturbingly named "One Big Beautiful Bill Act," or OBBBA, which is also known as a big ugly bill, is President Trump's tax and spend mega bill recently passed by Congress. This new cut in access to essential health services and other essential services for the working class by thousands of billions of dollars and expansion of the national debt by $4.1 trillion aims to pay for hundreds of billions of dollars into tax cuts for the mega rich, expanded mass deportation operations for ICE, and some of the other Trump administration priorities that are really harmful to reproductive justice. These cuts will phase in over the coming years with some of the biggest cuts to essential programs that help families access health care, food, and other basic human rights, coming in 2027.

Jennie: So, I know we've had you on here a number of times to talk about Medicaid, and that is one of the areas that is going to be really impacted by this bill. But just in case people are not familiar, let's take that step back real quick and talk about: what is Medicaid?

Madeline: Yeah, absolutely. So, Medicaid is our country's joint federal and state health insurance safety net program for low-income communities. It currently covers over 71 million people. That's one in five people in the United States, including almost half of adults in poverty and a critical mass of people of reproductive age because of structural barriers to wealth. It covers a higher share of people of color and people with disabilities. The federal government has general rules that all state Medicaid programs must follow, but states are responsible for administering the program and generally have a good deal of flexibility around how to do that. Medicaid covers a wide range of services, including preventive services, prescription drugs, outpatient and inpatient care, long-term care, treatments for people with disabilities, and is also a critical lifeline for sexual and reproductive healthcare. It's the primary payer of family planning services, pregnancy-related services in the United States, and also provides coverage for critical care screenings, diagnosis for conditions such as HIV, reproductive cancers, STIs, really the gamut of sexual and reproductive health needs are covered through Medicaid. It also provides narrow coverage subject to the Hyde Amendment for abortion, including coverage for abortions resulting from rape and incest, and also abortions that are needed because a pregnant person's life is in danger by virtue of the pregnancy.

Jennie: Okay, so like I said, one of the places that the big ugly bill…attacked, went after is Medicaid. So, what does this bill do to Medicaid?

Madeline: So, this new law ushers in the most sweeping Medicaid cuts in U.S. history. It cuts Medicaid by $990 billion over the next decade, ending health insurance coverage for over $10 million. people. It cuts Medicaid eligibility through a number of tactics, which thus cuts access to sexual and reproductive health care for low-income and underserved communities. First, it ushers in a health care access feature that advocates have fought to prevent for years, mandatory nationwide Medicaid work requirements for Medicaid expansion beneficiaries and folks in states that have partially expanded Medicaid ages 19 to 64. To be clear, these are Medicaid cuts by another name. They constitute a third, more than a third of the law's total Medicaid cuts and once implemented will end health insurance coverage, including sexual and reproductive health care access for 5.3 million people just on their own, just the work requirements. And I can talk more about the work requirements in a bit. The next, eligibility cut...and I'm just going to touch on some of these; there's so much in this bill, but there are some things that I want to lift up, particularly for their implications for sexual and reproductive health. The U.S. has always severely restricted immigrants' eligibility for public benefits. From the inception of these programs, including Medicaid, racist notions of worthiness have shaped eligibility policy. And before OBBBA, only green card holders, refugees and asylees, Cuban and Haitian entrants, and compact of free association migrants, a very narrow set of non-citizen immigrants could enroll in Medicaid, often after a five-year waiting period called the five-year bar, depending on the category of immigration status, which resulted in numerous and really widespread immigrant coverage gaps. But OBBBA widens this coverage gap by kicking refugees and asylees, people forced to leave their countries of origin to escape war, persecution, natural disaster out of the program altogether. And because of OBBBA, these communities will be forced to go without affordable sexual and reproductive health care access. This is a profound reproductive injustice. OBBBA also reduces Medicaid's retroactive eligibility. This is a policy that ensures that Medicaid eligible individuals can receive reimbursement for health care expenses incurred up to three months before their application date for Medicaid, as long as they met all the eligibility requirements during that period before the application. This is a really important enrollment protection for families that protects them from medical debt, ensures that providers, including sexual and reproductive health care providers, are paid for the care that they deliver. And it's especially important for pregnant people, because it covers essential prenatal care received before applications are processed and prevents harmful delays in care that can impact intergenerational health and make pregnancies more dangerous. And so this bill, this law now, restricts retroactive eligibility from three months to just one, which will result in increased medical debt and barriers to care for families. This law, beyond the eligibility provision, It also contains a provision that excludes certain abortion providers from participation in the Medicaid program over the next year, beginning on July 4th, the summer, which was the date that OBBBA was enacted. This provision, often referred to as the abortion provider "defund" provision, prohibits Medicaid reimbursement to entities that are tax-exempt, 501c3s, that are essential community providers primarily engaged in family planning services, reproductive health, and related healthcare services that provide abortions beyond the Hyde Amendment's narrow exceptions, and who received more than $300,000 total in federal and state Medicaid funding in fiscal year 2023. This provision locks Planned Parenthood providers as well as some independent providers such as Maine Family Planning out of the Medicaid program and will have a devastating impact not only on access to abortion, but also on access to other sexual and reproductive health services as well. This law also makes changes to Medicaid financing, making cuts and imposing restrictions that will impact states' abilities to finance their own share of Medicaid funding because Medicaid is a federal and state partnership. And so, both the federal government and state governments are responsible for putting up shares of total Medicaid spending in each state. And in order to cut federal Medicaid spending through a sort of backdoor approach, Congress decided to restrict states' abilities to raise funds. And some of these levers have specifically allowed states to increase reimbursement rates, for example, for family planning services in states such as Washington and California. These are policies called state-directed payments. And there are really severe restrictions going forward on state-directed payments as well as provider taxes as a result of this bill, which will result in increasing, as with all of these cuts, increasing budget holes for states that they're just not going to be able to make up. It's worth noting that OBBBA's Medicaid cuts may force states to drop optional sexual and reproductive health benefits and eligibility categories beyond what is in the law. Federal Medicaid funding comprises the largest source of federal funding for states. It finances just under one-fifth of states' total spending. The amount of federal Medicaid funding that states receive hinges on actual program expenditures. So if states cover fewer people, say, because of the largest eligibility cuts in US history for the Medicaid program, then they're going to receive less funding from the federal government. And coverage losses from policies such as work requirements, retroactive eligibility, the cuts to immigrant eligibility, and other cuts in this law will cut the federal funding that states receive by hundreds of billions of dollars nationwide. States aren't going to be able to fill such a gaping hole in their budgets as I said before. And many may pursue state-level Medicaid cuts in order to make up the difference. And so, this is one of the reasons, you know, a lot of states are convening special legislative sessions right now to figure out how they're going to deal with these budget shortfalls. And it's really important that sexual and reproductive health advocates have eyes on those special sessions to watch what's happening and engage. Such cuts could directly or indirectly impact sexual and reproductive healthcare access for Medicaid beneficiaries, including not just those enrolled in some of the eligibility categories we've talked about, such as Medicaid expansion, but states may also choose to make up these shortfalls by dropping optional categories, such as pregnancy coverage extensions, family planning coverage expansions. The Immigrant Children's Health Improvement Act has options to cover lawfully residing immigrants who are pregnant or children, which many states have adopted. All states have adopted optional coverage under the Breast and Cervical Cancer Treatment Program. Some states may go as far to reverse Medicaid expansions altogether. And as well, states may pursue benefit cuts or waivers of benefit protections under federal law. For example, they may drop or place limits on optional benefits such as prescription drugs, which are critical for a wide range of sexual and reproductive health needs. All 50 States currently cover prescription drugs, but that's not a requirement. It's optional. States may drop doula coverage, which we've seen a great increase in recent years, but it's not required. They may drop state-funded coverage of abortion beyond the Hyde Amendment's exception. 17 states cover abortions beyond Hyde exceptions for Medicaid beneficiaries through a totally state-funded separate program. We may see states pursue waivers of federal requirements, such as the really comprehensive benefit for children and youth that provides access to a lot of sexual and reproductive health services, or protections such as the mandatory non-emergency medical transportation benefit, which helps beneficiaries who face transportation barriers access sexual and reproductive health care. So, all of this is to say that beyond the specific cuts that are in the bill, there are also going to be downstream budgetary impacts that could spiral to only cause barriers to sexual and reproductive health care for Medicaid beneficiaries and entire communities to just really soar.

Jennie: Okay, so before we talked, I knew it was terrible and that the cuts to Medicaid were really bad and going to have really severe impacts. Somehow it was so much worse than I thought. There were definitely parts that I hadn't necessarily heard about. Again, I'm not in the weeds on Medicaid, so there were areas that I was not as familiar with that we could see impacts on. Unfortunately, there is so much that is bad in this bill related to health that we can't dig deeper on multiple areas, but let's talk about work requirements. I think that is one of those areas that the right is so good at framing where they don't sound like they are heavy lifts or like aren't going to be devastating and you can have those really basic I mean we're just asking people to work and so if you don't know all the details or get deeper into it may seem reasonable so let's talk about why this is such a problem.

Madeline: Yeah, so you know, work requirements have existed in other public benefit programs for decades now. We've also seen work requirements tested during the first Trump administration in Arkansas. This is a reality. Nationwide Medicaid work requirements is a reality that advocates have fought to prevent for years. These, like I said, are truly Medicaid cuts by another name. And I mentioned this before, but these mandatory nationwide non-waivable work requirements will apply to Medicaid extension beneficiaries 19 to 64 and also people with partial Medicaid expansion coverage under a waiver in states such as Georgia and Wisconsin. States have to implement these work requirements by January 1st, 2027, notably after midterms. And they may implement them earlier if they receive approval from the Centers for Medicare and Medicaid Services or no later than January 1st, 2028, if they request and CMS grants them a one-time extension. So, decades of research demonstrate that public benefit work requirements do not improve employment outcomes, their purported purpose. Most Medicaid beneficiaries who can work already do so. Instead, these are Medicaid cuts by design. They force people to overcome a litany of barriers to show that they're already working or qualify for an exemption. The Congressional Budget Office estimated that nationwide Medicaid work requirements will account for OBBBA's largest Medicaid cut, both in terms of federal funding cuts and also increases to the number of uninsured individuals. Again, just this cut will increase the number of uninsured individuals nationwide by 5.3 million people. Under the new work requirements, applicable individuals will have to prove that they complete 80 hours of qualifying work-related activities per month, which is quite high, or meet exemption criteria in order to enroll in and maintain their Medicaid coverage. The law does not permit states to waive these requirements, and many people will be unable to meet the monthly minimums due to no fault of their own. Low wage workers' hours are infamously variable and out of their own control. My brother works for a grocery store, and he is now a full-time employee, but it took him years to get there. And for years, he just wouldn't get the hours he needed because the manager didn't want to pay more full-time employees benefits and so would purposely keep hours low. And this is a reality that so many working class people face across the country. Numerous studies on public benefit work requirements show disproportionate sanctions, these are things like termination of benefits for Black people and people with physical and mental health conditions. And at a minimum, states have to verify these qualifying activities or exemptions during both the month before application and at least one month between eligibility redetermination. So at least every six months, they can impose more onerous verifications. Just to really stress what this does, like the TLDR is that: the way that this is structured is it actually shuts the front door on coverage. So, you need to prove that you’re already meeting the requirements before you can enroll. And just to really stress how backwards this is: we know that health insurance improves health outcomes. And without health insurance, people face increased work barriers because they are facing barriers to health care that supports their health and are less healthy. We're really, really making it hard for people to enroll in coverage as a result of these requirements. The law ostensibly exempts certain populations from the work requirements, such as people who are eligible for pregnancy-related Medicaid coverage or would be if they're already enrolled in Medicaid expansion, some people with disabilities or chronic conditions, and parents, guardians, or caretaker relatives of disabled individuals or dependent children 13 or under. However, nearly three decades of research on and experience with public benefits work requirements has demonstrated that these exemptions consistently fail, sparking widespread improper eligibility denials. Exemption processes are notoriously confusing, riddled with complex paperwork and administrative requirements, and poorly publicized. Oftentimes, the systems we've seen have held weird hours. So, you can only access websites at certain hours. That was true in Arkansas. And applicants and beneficiaries also often experience significant power differentials with program caseworkers who have a lot of discretion over whether to grant exemptions and often arbitrarily deny them. And we also have concerns about whether states and the Trump administration will comply with privacy protections while handling applicant and enrollees exemption-related data with regards to, for example, pregnancy. And that's a major area of focus for my work right now. These work requirements, in short, are Medicaid expansion cuts that are only going to serve to further decimate access to affordable sexual and reproductive health coverage for people with low incomes and underserved communities in the 41 states, including D.C., that have fully implemented Medicaid expansion. It has profoundly improved sexual and reproductive health access for millions of people during their reproductive years and menopause thereafter. Dozens of studies demonstrate the Medicaid expansion improves sexual and reproductive health outcomes and reduces inequities. And if Congress allows these work requirements to go into effect, millions of people nationwide will lose access to this sexual and reproductive health care access lifeline.

Jennie: I feel like it's also important. I feel like we talked about this briefly last time we talked about Medicaid, but just a reminder that a lot of people may not know they're on Medicaid because it gets rebranded at the state level. I'm from Wisconsin. So in Wisconsin, if you're on BadgerCare, that is Medicaid. And so, there are a lot of people who may not understand that these cuts are going to impact them.

Madeline: Yeah, that's right. Medicaid goes by a number of names across the country. That's part of what is so confusing. So, when I was in grad school, I was covered by MassHealth. That's Medicaid. In Massachusetts, Wisconsin, as you said, calls Medicaid, BadgerCare. Tennessee calls it TennCare. California calls it Medi-Cal. And there are other state-specific names too. So, if you're not sure, Google what your state calls Medicaid, because it's very likely that someone, if it's not you that's covered by Medicaid, somebody in your circle is. And it's going to impact them.

Jennie: Unfortunately, Medicaid isn't the only area where we're going to see health impacts in OBBBA. What else are we going to see?

Madeline: Yeah, so we're also going to see a lot of cuts to affordable private health insurance coverage under the Affordable Care Act. We expect to see an additional 4 million people lose coverage due to these cuts, these Affordable Care Act cuts. We expect to see some of the cuts that are in OBBBA in the private insurance space, for example, include removing eligibility for affordable health coverage for lawfully present immigrants who are under the federal poverty line. We see limits on the special enrollment periods in the marketplace. For example, there's a low-income special enrollment period that helps individuals who turn back and forth between Medicaid and marketplace coverage enroll in marketplace coverage mid-year outside of open enrollment if they suddenly become ineligible for Medicaid. And that is a really critical enrollment protection for people with low incomes. And there are a number of other changes to private insurance coverage that will impact people. We're also going to see the end of extended premium tax credits at the end of this year that have helped millions of people access affordable coverage. And so, health insurance coverage is about to get a lot less affordable for many, many people in the working class across the United States.

Jennie: Well, I'm glad you brought up who's going to be impacted because I think that's a really important consideration we need to think about: who is going to be the most impacted by all of these changes?

Madeline: Yeah, I want to be perfectly clear that this is an assault on the working class. We expect that in the coming years, 10 million people with low incomes will lose Medicaid coverage, that number 4 million people for marketplace coverage, and with this coverage, affordable access to sexual and reproductive health care. And the down effects of losing health insurance coverage is going to cost many members of the working class their lives. A joint Yale School of Public Health and University of Pennsylvania study estimated that OBBBA's health care cuts together to Medicaid and private health insurance access will cause over 50,000 deaths a year nationwide once these provisions are implemented. And we can expect these impacts to disproportionately impact low-income care communities of color, people with disabilities, immigrant communities, and other underserved communities. And again, I want to be perfectly clear what these cuts are paying for. This was not a bill that saved taxpayers money. It increased the national debt by trillions by both increasing the national debt and cutting these essential programs in order to finance tax cuts for the ultra-wealthy, expanded mass deportations by ICE and other administration priorities such as the federal takeover and militarization of D.C. and other democratic states that we're seeing right now. That's what this bill is really about. We are also going to see an escalation in sexual and reproductive health care providers shutting their doors due to increases in uncompensated care from this bill, including hundreds of labor and delivery units that have been closing in recent years. That number is just going to increase nationwide as a result of this law. Particularly in rural communities, maternal health care apartheid means that people must drive hours, sometimes crossing state lines, to access pregnancy-related care, intensifying the risk of complications. Medicaid expansion has had a protective effect on provider budgets, helping keep their doors open for the communities that they serve. And this isn't just, you know, Medicaid beneficiaries, but also locals in these communities that are served by these health care institutions. So if you think like, well, I don't have Medicaid, I checked and I'm not covered by Medicaid and I'm not covered by these affordable subsidies under the ACA that are being gut by this bill, don't think that this bill is not going to impact your healthcare access because by really attacking the budgets of sexual and reproductive healthcare providers, including labor and delivery units, this is going to impact your access as well. You know, we see that Medicaid expansion has helped keep doors open also for individuals in neighboring non-expansion states who travel across state lines to access care. So if you're in a non-expansion state and think this isn't going to impact me, that's not true either, especially if you're in a rural area, especially if you're near a state border. Expansion decreases uncompensated care. It increases revenue. It improves provider operating margins, especially for providers and particularly hospitals in rural communities. And all of these cuts, work requirements and more will undermine these benefits. Coverage losses from this big ugly bill are going to drive up the rates of uncompensated care, narrowing operating margins and forcing many to shutter their doors. For example, our friends at the National Partnership for Women and Families recently found that 140 rural labor and delivery units nationwide are at risk of closure or service cutbacks due to the Medicaid cuts. So it is a lot. This law is so far reaching. I think it's so much worse than the vast majority of the public is aware. And I would say that's by design. Democrats brought up a resolution to President Trump and kept saying there are no Medicaid cuts in this bill. There are no Medicaid cuts in this bill. And Democrats raised a resolution and tried to get Republicans to vote on a resolution agreeing that there would be no Medicaid cuts through this bill. And out of the other side of their mouths, they said, no, we're not going to do that. We're not going to vote on this resolution, but there are no Medicaid cuts in this bill. Well, there are $990 billion in Medicaid cuts in this bill. And that's the reality that now the U.S. public is going to have to live with.

Jennie: Yeah, I really think about, I mean, so much of what you said but, like, you know, tying it to, like, personal thinking; I grew up in rural Wisconsin, my mom still lives in rural Wisconsin, the hospital I grew up going to is considered a rural hospital, and thinking of how much further my mom would have to go to access care if that hospital were to close... like, these are real impacts on people's lives and it so often just gets lost and talking about the numbers and stuff is like these are people who are going to struggle to find access to health care and when they lose their coverage. Okay, so now that the bill has been passed, people may feel like there's nothing they can do, but I'm sure that's not true. What can our audience do to get involved in this?

Madeline: There are so many important ways to engage. One of the ways right now, many states are convening special legislative sessions to really figure out what they're going to do to make up budget shortfalls and start implementing these. And so, keeping an eye on those sessions and their implications for sexual and reproductive health is really, really critical. And engaging in the process is really, really critical. If you are a federal advocate listening in, a lot of these policies are going to have to go through CMS to be implemented. So, engaging in administrative advocacy in the coming years, engaging in comment writing, engaging in meetings with the Office of Management and Budget, and just really fighting as hard as we can to ensure that these provisions are implemented in the least harmful way possible. If you are a state advocate working with your state Medicaid agency to mitigate damage, including making sure that some of the notices that will go to beneficiaries informing them of these changes are clear. Meet federal requirements. Meet best practices. That's going to be really critical. Partnering with community organizers and across a wide range of stakeholder groups on outreach to really get the word out so that people understand how they can keep their coverage if they, in theory, could keep their coverage. If they're going to be kicked out of coverage, it's really important that people are aware when that's going to happen so that they can go and get the services they've been putting off sooner rather than later. So, outreach is really, really important. There are also really important levers for getting involved in state Medicaid administrative policy. One of these is the Medicaid Advisory Committee, which is a space that advocates can get involved to inform state Medicaid policy. There are also beneficiary advisory committees for Medicaid beneficiaries to help shape Medicaid policy in their states. All of this is really, really important. And NHELP is committed to ensuring that the broader sexual and reproductive health rights and justice movement has the tools it needs to work together to really do as much damage mitigation as we can here. And so if you are interested in getting involved, please reach out. You can also, if you're listening in and are interested in getting involved in advocacy in general, you can learn more and sign up for NHELP's listserv for our advocacy resources and alerts and also access pre-existing resources at www.healthlaw.org. We also have a landing page for our OBBBA implementation damage mitigation resources, which is growing, including an incredible chart that one of my colleagues put together with all of the implementation dates, because these cuts are going to be hitting at different points. And that chart is so valuable for creating a work plan of what needs to happen in the coming years in the states and at the federal level.

Jennie: That's going to be so useful to have.

Madeline: Yeah.

Jennie: Madeline, thank you so much for being here today. I had so much fun talking to you about such terrible things.

Madeline: Thank you so much for having me Jennie and holding space—I know that you know these cuts are deeply personal to so many of us and it's a really horrifying reality to face and I really believe that we have it in us to fight to hold the line on as much as we can for as long as we can and ensure that these are implemented in the least damaging way to sexual and reproductive health rights and justice possible. Thank you.

Jennie: Okay, y'all. I had a great conversation with Madeline. I hope you enjoyed it and have a wonderful rest of your week, and I will see everyone next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at rePROs Fight Back on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all.

 
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