A
bout 10 miles west of the Green Mountains, in North Bennington, Vermont, stands a 155-year-old white farmhouse converted to a two-family home. While perhaps unremarkable from the front, it may be recognizable to visitors by the gray wooden arrow stuck in a bed of mulch outside, promising LOVE THIS WAY, or the giggles emanating from the backyard as an excited four-year-old named Jack tumbles down a plastic yellow slide toward his dad.

On a balmy day in mid-July, the blond, curly-haired Jack shows no sign of the child who, just a few months earlier, contracted a viral infection so unforgiving his parents feared for his life. 

At the time, Jack and his parents, James and Rosie — 36 and 35, respectively — had no health insurance. (The couple requested the use of pseudonyms, including for their child, fearing retaliation for speaking to the press.) After James was forced out of his hybrid-style federal position as an environmental compliance officer by President Trump’s “Return to In-Person Work” executive order in January, the family had been dropped from the Federal Employees Health Benefits Program rolls. 

Not long after their son, Rosie and James both contracted the same infection, leaving the family immobilized and their half-duplex quiet, save for the sounds of Jack’s hacking cough. 

“He was so tired that he was barely moving,” says Rosie, “and [without insurance] there was this internal struggle of, as a mother, I shouldn’t have to be weighing the financial cost of [treating] my son with my son’s health. But instead, it was like, ‘If we take him to the emergency room, it’s going to cost us this much out of pocket, so maybe we’ll just wait another day.’ It was terrifying.” 

On day five of Jack’s fever, the couple decided they had no choice but to bring him to an urgent care clinic. “Right off the bat, they said that without insurance it would be [about] 100 bucks, and any testing or anything beyond [a simple checkup] would be additional,” Rosie recounts. “So we didn’t run any tests.” 

Editor’s picks

A hopeful sign outside James and Rosie’s duplex farmhouse in North Bennington

Courtesy of India Nye Wenner

Thankfully, Jack — and, later, Rosie and James — got better without complications. And all three were subsequently approved for Medicaid coverage. But, with the July 4 passage of the president’s so-called Big, Beautiful reconciliation bill and its $1 trillion in Medicaid cuts, the family found themselves once again bracing for the worst. 

The couple still had several sources of income: They rent out the other side of the farmhouse duplex, run a resale shop selling various trinkets they’ve collected, and Rosie works as a local yoga teacher. But James was still out of work, scrambling in a state that currently has its lowest number of job openings since November 2020, and the family’s emergency cushion had all but disappeared. 

“The idea of [losing Medicaid and] having to face what we did again,” James said at the time, his voice trailing off, “I’m not sure what we’re going to be able to do at that point.”

A SPRAWLING, 870-PAGE document, the One Big Beautiful Bill Act (OBBBA) touches practically every aspect of American life. But perhaps most significant are the myriad changes it makes to Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Affordable Care Act (ACA). Some of these changes — such as the expanded SNAP work requirements, which took effect Oct. 1 — have already been implemented. Others — like the Medicaid work requirements, pointedly delayed until after the congressional midterm elections — are set to go into effect on a rolling basis over the next three years. Taken together, they amount to the largest cuts the three programs have ever received.

Related Content

Vermont depends tremendously on this federal aid. The sixth-smallest and second-least populous state in the union, with a population of just below 650,000, it has the largest rural population (nearly 70 percent) of all U.S. states. Amid its beautiful mountain ranges, winding valleyland, and small-town charm, its upscale ski resorts and slew of seasonal second-home owners, the state is facing simultaneous housing, hunger, and health care crises. And though it is a progressive stronghold where legislators have long fought to secure social safety nets for its residents, the Trump administration’s cuts position it at a dangerous crossroads. 

Forty-three percent of all federal funding sent to Vermont, for example, is for Medicaid, and about one in 10 Vermonters receive SNAP benefits. And thanks to Medicaid (which the state chose to expand in 2014 under the Affordable Care Act) and the subsidized ACA health insurance marketplace, Vermont has a remarkably low uninsured rate: Currently, only 3.4 percent of Vermonters, as opposed to the national average of 7.9 percent, lack coverage. But what will happen to Vermont and its people when the OBBB tears apart the federal aid programs they depend on? 

“We’re a state that really prides ourselves on providing insurance to a large percentage [of people] compared to other states, and providing a lot of care for folks that need it,” Andrew Perchlik, a Vermont state senator and chair of the Senate Committee on Appropriations, says. “The concern is that there’s just not enough money in Vermont to make up the kind of loss this bill entails. And if we can’t make up these losses, we will have to cut services. And that will be devastating.”

Sen. Bernie Sanders agrees. “In Vermont, we are a state of many hardworking people, many working-class people, and many low-income people. And as a result of this bill, Vermonters are really going to suffer,” Sanders tells Rolling Stone. “People are going to become much sicker than they should, and in some cases die, simply because they will not be able to afford to go to a doctor when they should.”

Demonstrators protesting Trump administration actions in Montpelier, Vermont, in March

John Lazenby/UCG/Universal Images Group/Getty Images

IN NORTH BENNINGTON, Jack sprints into the room to show me his favorite monster-truck toy, a gray and orange ThunderROARus, which, true to its name, has the teeth and scales of a triceratops. “I want to be a paleontologist when I grow up,” he tells me shyly as his parents, sitting next to each other on a gray couch, look on from across the room. 

James and Rosie, who grew up on opposite ends of New Jersey and both received environmental degrees in college, met while working for the federal government. After living together in Oregon for some years, in 2020, they decided to settle down in Vermont. James, still working for the same federal agency, transitioned to a hybrid role as the pandemic subsided, commuting to Cambridge, Massachusetts, twice weekly to comply with the Biden administration’s in-office requirements for federal workers. Each in-person workday meant an eight-hour roundtrip, but it was worth it to James, who felt deeply fulfilled by the work. 

But when the Trump administration barred telework as an option for people like him, the situation became untenable. “I would have to be waking up at 3 a.m. in order to get out of the house at four and then not getting back home until around 10 o’clock at night, just to do it again the next day,” says James. “What human is expected to put 40 hours a week into commuting?” asks Rosie. “Especially with a young kid?” Unwilling to uproot his family for the job, James felt he had no choice but to leave it, and the family lost their health insurance.

With their Medicaid coverage subsequently hanging by a thread, James and Rosie felt like the government had dealt them a double blow. “As an American, I grew up believing that the government was there for the people. That all people should be entitled to health care,” says Rosie. “And now, to cut the programming that literally supports lives … It blows my mind to think that it’s even a possibility for a country to do that.”

After spending nearly five months unemployed, James recently secured a job with a Vermont municipality’s zoning division, lifting the family above the threshold for Medicaid. But before then, the couple’s income had fallen below the poverty level — less than $26,650 a year, barely 20 percent of the median income for a Vermont family of three — and they had been “getting pretty desperate to use SNAP,” as Rosie put it in July. Yet with the $187 billion that the budget bill tears from the program, they feared that, as with their Medicaid coverage, they would be left empty-handed. “It feels like we’re chasing after a program,” Rosie said at the time, “that might support us for a month and then be gone.” 

ABOUT 45,000 VERMONTERS are expected to lose health care coverage as a result of the budget bill’s changes to Medicaid and the ACA marketplace. About 13,000, due to other changes, may lose SNAP benefits. Meanwhile, amid the federal government’s recent shutdown, none of the roughly 65,000 Vermonters on SNAP will receive their November payments. 

“We are going to face a hunger and health crisis and a tragedy on an unprecedented scale,” Anore Horton, executive director of the nonprofit advocacy organization Hunger Free Vermont, tells Rolling Stone. “I think it’s going to make what happened during the pandemic look like child’s play by comparison. Cutting these programs together is unquestionably going to kill people. There is no doubt about it.” 

Workers from Service Employees International Union protesting proposed Medicaid cuts in Washington, D.C., on June 23.

Joe Raedle/Getty Images

SNAP, which provides monthly payments in the form of an electronic benefit transfer (EBT) card used to purchase food at authorized retailers, and Medicaid, which covers beneficiaries’ medical services at little to no cost, have by and large received consistent bipartisan support since they were initiated with President Lyndon Johnson’s Great Society legislation in the Sixties. Trump’s new cuts, rather than blatantly pulling funds from the programs, take the form of a series of slippery technical changes to the way they are regulated and administered — in effect making the programs harder for people to access and even harder for states to maintain.

“What’s really tricky about the way that Congress is going about these cuts is that they’re making it sound as if these are just little tweaks to specific groups of people,” says Horton. “But, in fact, the goal is very clearly to force state governments to have to destroy these programs. We’re talking about the Trump administration and Congress setting out to destroy the ability of state governments to take care of people.”

It’s already difficult enough to access these federal subsidies. To apply for Medicaid or a Qualified Health Plan on the state marketplace, Vermonters must go through a labyrinthine process beginning with filling out a 20-page form or a parallel online portal to prove their income and eligibility. Applying for SNAP entails a similar protocol. 

“The applications are very long and extensive,” says Horton. “They ask a lot of very detailed and intrusive questions about your assets, your utility and housing costs, everyone in your household, and many other specific pieces of information. There are very harsh, very complex requirements.”

“As an American, I grew up believing government was there for the people. To cut programming that literally supports lives … It blows my mind.”

Under the federal budget bill, the process will become even more onerous. Medicaid beneficiaries will have to renew their eligibility twice annually, as opposed to the current single renewal, for example. Those on Qualified Health Plans will have only one and a half months, instead of two and a half, to select and enroll in their plan for the year, and will no longer be able to do so automatically. 

Perhaps the most significant addition, however, is the work requirements the bill imposes: To receive Medicaid coverage, able-bodied individuals between the ages of 19 and 64 who do not have children will now have to prove they have completed at least 80 hours of work per month. And though SNAP recipients already comply with a similar work requirement, the bill expands the requirement significantly and eliminates numerous exemptions (such as one for homeless individuals, which more than 1,700 people in Vermont currently receive). 

Congressional Republicans have touted these changes as necessary, no-nonsense steps to reduce fraud and abuse they claim are rampant in the programs and ensure that benefits only go to those who work for the assistance, rather than supporting so-called freeloaders. But precedent and experts say otherwise. According to the U.S. Department of Agriculture (USDA), the error rate for Vermont’s SNAP program was a mere 4.74 percent in 2024, while the error rate for Vermont’s Medicaid program, according to the Center for Medicare and Medicaid Services, was just 5.6 percent over the three-year period between 2021, 2022, and 2023. According to an article by Andy Schneider, a research professor at Georgetown University’s McCourt School of Public Policy, nationwide Department of Justice reports have found that actual fraud is essentially never committed by beneficiaries or the state.

“The checks and balances are already extreme in these programs to make sure that only qualified people are receiving benefits,” says Horton. “The rhetoric of waste, fraud, and abuse [in SNAP or in Medicaid] is simply a way to justify [the GOP’s] actual goal, which is to destroy these programs.”

In 2023, 92 percent of Medicaid adults who will now be subject to work requirements were already working full- or part-time. A 2023 Congressional Budget Office (CBO) analysis found that Medicaid work requirements would do nothing to increase employment. And study after study has found that work requirements (along with increased eligibility checks) cause individuals to lose coverage due simply to the paperwork burdens they present — not because individuals are actually ineligible. 

“What work requirements really do is create a paperwork barrier,” says John Sayles, CEO of the Vermont Foodbank. “Say you’re working for a landscaping company and all you get is someone writing you a check every week. It can be really challenging to turn that into the documentation that the government’s going to require for you to continue receiving the benefits that are essential to you and your family and to being able to show up to work.”

“If you have multiple jobs, if you’re self-employed, if you have issues with your computer, if you don’t read your mail and understand that you have to respond to notices,” warns Marjorie Stinchcombe, an attorney who works as a helpline director with the Vermont Office of the Health Care Advocate, “it’s not flexible.” 

And Vermont’s legislators and state agencies — tasked with building an entirely new technology system, conducting hundreds of thousands more eligibility checks, processing immense amounts of paperwork, and supporting thousands of confused and desperate beneficiaries — are also going to be overwhelmed, namely because Vermont faces not just increased administrative burdens, but also less money with which to meet them: The budget bill cracks down on how much states can tax providers like nursing facilities, hospitals, and ambulances, in effect allowing the federal government to strip the state of millions of dollars in Medicaid funds. The bill also changes the way SNAP is financed, reducing the share of administrative costs that the federal government covers from 50 percent to just 25 percent. As a result, the CBO has concluded that some states may be forced to “leave the program altogether.”

As a preview of the damage, it has been estimated that, taken altogether, the bill’s changes will undo about three-quarters of the Affordable Care Act’s progress. And future effects aside, the bill already does serious harm to the programs: It limits Medicaid retroactive coverage (removing coverage, for example, for someone who signed up for the program only after experiencing a major health crisis); makes certain non-citizens (like refugees and asylees) ineligible for Medicaid, SNAP, and ACA subsidies; and requires states to charge certain Medicaid patients co-payments for medical services. 

The bill also freezes updates to the Thrifty Food Plan, the mechanism used to increase SNAP benefit amounts proportional to actual food prices. “There will be no future increases to account for the cost of inflation,” says Horton. “So that means the value of people’s SNAP benefits, or how much food your SNAP benefit can buy you, is going to be decreasing every single year from now into perpetuity.” And with President Trump’s tariffs driving up food prices, this decrease is sure to be even steeper.

“If people are going hungry and we’re not able to provide food, or people are sick and we’re not able to provide health care, that’s a moral failure.”

The bill also lets die a large number of ACA marketplace subsidies — specifically, the enhanced premium tax credits created by President Joe Biden’s 2021 American Rescue Plan Act. These tax credits, which have doubled national marketplace enrollment, are set to expire in December and have become the central issue of the federal government’s shutdown. Without them, Americans’ out-of-pocket share of ACA premiums, according to the nonpartisan health research group KFF, is expected to increase by more than 75 percent on average — an increase Vermonters cannot afford. 

“In Vermont specifically, we’ve been such a leader in coverage,” Dr. DaShawn Groves, the commissioner for the Department of Vermont Health Access, which administers the state’s Medicaid and ACA marketplace, says to Rolling Stone. “But trying to protect that… we just don’t know yet. There are going to be difficult choices ahead.”

The Vermont legislature has set aside about $100 million in its budget (in addition to an $118 million “stabilization reserve” and a $100 million “Rainy Day Fund” that it can draw from) to cope with the budget bill’s cuts. But: “These reserves are for short-term, onetime issues,” says state senator Perchlik. “They don’t fill the hole.”

Perchlik has come to the conclusion that other state-funded initiatives may have to be brought to the cutting board. “My fear is that it’s going to create this domino effect throughout the whole budget,” he says. “What do you choose? Feeding people, providing medical care, or providing shelter? If people are going hungry and we’re not able to provide food, or people are sick and we’re not able to provide health care, that’s a moral failure.”

Senator Sanders, who spent months fighting the budget bill’s passage, stays awake at night now that it is law. “There’s not a day or night that goes by where I do not deal with this stuff,” he tells Rolling Stone. “It’s horrifying, the absolute immorality of what this administration is doing. They think that compassion, and caring about your fellow human beings, are signs of weakness. 

“They wanted tax cuts, and that’s what they got,” he continues. “And they couldn’t care less about the people who are going to die and suffer as a result.”

Sen. Bernie Sanders rushing to the Senate floor during overnight votes at the U.S. Capitol on July 1. “It’s horrifying, the absolute immorality of what this administration is doing,” he says of the BBB.

Al Drago/Getty Images

FOR 46-YEAR-OLD JANE, a resident of Southern Vermont, facing death is nothing new. Starting when she was two years old, the Lakeland, Florida, native was in and out of the hospital with frequent kidney infections. Jane would later learn she had two autoimmune conditions — Addison’s disease, in which the adrenal glands don’t produce enough of certain hormones, and lupus, in which the body’s immune system attacks its own tissues and organs. 

In those pre-ACA years, insurance wouldn’t cover extra tests or specialists for Jane, whose health issues were primarily pre-existing, so she was unable to receive an instrumental corrective surgery when she should’ve. By age 16, she was diagnosed with stage-five kidney disease; her kidneys were failing. “If I had just had access to that care, to that surgery,” she says, “I would have never lost my kidneys. None of that would have ever happened.”

When Jane turned 18, she was no longer covered under her parents’ insurance and had racked up a million dollars in medical debt. She spent the next four years traveling the country, securing jobs that had “day-one insurance” and moving when she had capped out each plan’s offerings. Like a traveling salesman, she lived everywhere: San Diego, New Orleans, Nashville, Philadelphia, Maryland, Massachusetts, Maine — wherever she could find the health coverage she needed to stay alive.

Eventually, Jane went into kidney failure during a window when she had no insurance. Her parents took her to Tampa General Hospital, where she was turned down for dialysis treatment — because she still had some days before her body completely shut down, dialysis was not considered life-saving, and the hospital was not required to treat her. The family turned to Medicaid, which Jane was temporarily eligible for due to her failing kidneys, but they were told it would be a six-month wait for coverage. 

“I was dying, and they just didn’t care,” she says. “I was disposable. They had the resources to give me the care, and they just wouldn’t.”

Over the next few days, her parents went to the president of the hospital, the governor of Florida, and finally to a local news station, which came to Jane’s hospital bed to report a story. “It’s not easy to beg for your life,” she says, “But it was important to me that people knew the truth about being sick in America.”

Thanks to the bad publicity, Jane’s Medicaid application was begrudgingly expedited, her life begrudgingly saved. But her hard-won Medicaid coverage dropped her once her kidney transplant was completed, and a transplant-specific Medicare disability program only covered her for three years post-op. Meanwhile, her transplant medications cost about $10,000 annually. So it was back to wandering.  

Jane was back living in Florida when, in 2010, everything changed: President Barack Obama, armed with a majority in both houses of Congress, passed the Affordable Care Act. Suddenly, in states that opted in, low-income adults earning up to 138 percent of the poverty level — without needing to have children, be pregnant, or have a documented disability — could receive Medicaid coverage. For Jane, this meant that, even when not temporarily disabled by a transplant, she was now eligible for Medicaid — she just needed to move to a Medicaid expansion state. 

“It is still one of the best moments of my life,” she says. “I was in my friend’s restaurant when it passed, with a whole community of people, and we were all sitting around and watching the news and cheering and crying and laughing. It was probably one of the single most important things that had happened to any of us.”

Jane left Florida, which chose not to expand its Medicaid program, “with one suitcase and a lot of hope” and headed to Boston, where she was able, for the first time in her life, to consistently get the care she needed and even to build her own consulting firm. In 2019, the Green Mountains called her name, and she moved to Vermont, to a little white house tucked amongst the trees. “Vermont is the only place that has ever really felt like home,” she says. “It’s like a hug. There’s something special here.”

When she was again unable to afford her medicine, Vermont’s Medicaid program, as well as the state’s hospitals and community health clinics, welcomed Jane with open arms. “No one ever looked down on me,” she says. 

“Everybody pitches in here,” she continues. “Everybody does some sort of volunteering. People care about each other. People think that Medicaid is poor, lazy people skirting the system. But it’s people who are teachers, who are volunteer firefighters, who are police officers. It’s people that are part of the community. It’s neighbors. It’s people at your kids’ schools.”

Volunteers at the Arlington Food Shelf. Bill Bryan, who runs the operation with his wife Judy, says the number of people using the service has tripled in anticipation of the cuts to Medicaid and SNAP.

Courtesy of Kate Bryan

Jane takes a whole host of medications: immunosuppressants to take care of her transplant and combat lupus, steroids to help replace underproduced hormones, and blood thinners to prevent clots, among others. Each is expensive. And each is critical to her survival — without blood thinners, for example, Jane faces a stroke and immediate death. Without her steroids, she faces an Addison’s crisis and a heart attack or coma. And without regular preventative care, she risks a dangerous incongruity within her medical regime — or, as she puts it, “a slow, painful death.” “If I don’t have Medicaid,” she says, “it’s game over. It’s a death sentence.”

It is the work requirement in particular that Jane fears will rip Medicaid out from under her. Jane works plenty — she substitute teaches, works on legal cases for the wrongly incarcerated, and is studying to take the bar exam — but she worries that the new system will not be able to accommodate her unpredictable health crises. 

“Let’s say I have a really bad lupus flare and, for a period of time, can’t meet the work requirements,” Jane says. “Maybe I’m supposed to get a temporary exemption, but maybe it takes six months to get through. Maybe it only takes two weeks. But I’m already dead, because I didn’t get my medicine. 

“I’ve been fighting these same people my whole life,” she continues. “And I just can’t understand why they would want to [do this].”

Jane, who knows how bad things were before the Affordable Care Act, is terrified of what the health care system may become under the Big, Beautiful Bill. “Hospitals are gonna get overwhelmed,” she warns. “They’re not gonna have enough money, they’re gonna run out of supplies and medication, they’re gonna close, and people are going to die.”

WHEN PEOPLE LIKE JANE lose health insurance, they stop going to the doctor for checkups and primary care. They end up sicker, as issues that should’ve been minor build up into something major. Often, they have no choice but to head to the emergency room. 

Emergency room visits are expensive, on average thousands of dollars even for minimal treatment. Without insurance, patients like Jane cannot pay the facility. And since emergency rooms must treat any individual seeking care, regardless of their insurance status or ability to pay, the patient takes on an enormous load of debt, and the hospital loses the money it previously could’ve received via the patient’s Medicaid coverage or federally qualified health plan.

This increase in what experts refer to as uncompensated care poses a monumental threat to health providers. And with nine of Vermont’s 14 hospitals (roughly 65 percent) grappling with negative operating margins and steeply declining reserves, Vermont’s health care system is at particular risk. “Hospitals can only operate in the red for so long,” warns Owen Foster, who chairs the Green Mountain Care Board (GMCB), Vermont’s primary healthcare regulator. And in a state with a majority-rural population, where people are already traveling far to get to a hospital, even a single hospital closure would be devastating. 

“People think Medicaid is poor, lazy people skirting the system. But it’s teachers, firefighters, police officers, neighbors. It’s people that are part of the community.”

Jane, for example, receives medical care at the Southwestern Vermont Medical Center (SVMC), about a 30-minute drive from her home. SVMC currently has a negative operating margin and qualifies as a “highly vulnerable” institution. If SVMC were to go under, Jane’s next option for the specialized care her conditions require would be at the Dartmouth Hitchcock Medical Center in New Hampshire — an almost two-hour drive from her home. For Jane, the difference between driving 30 minutes to take care of an Addison’s crisis versus having to go two hours to Dartmouth, she says, “is death.” 

On top of it all, the federal budget bill, due to its limits on provider taxes, will also reduce the dollar amount hospitals are paid for providing care to the Vermonters able to retain Medicaid coverage — and experts are not sure if Vermont’s health care system can take it. The state’s hospitals already need between $700 million and $2.4 billion in additional revenue over the next five years to break even, along with another $700 million to pay for vital equipment and infrastructure repairs. But the federal budget bill stands to deal them a financial blow of up to $1.7 billion. (A vaguely-worded, last-minute addition to the bill creates a $50 billion rural health fund to be distributed to states over the next five years, but experts have serious qualms about it, particularly as to whether the distribution of the money will be skewed by partisan politics and whether the one-time fund will stand a chance against the bill’s other, more permanent changes.)

“The state is at an inflection point,” says Foster. “Probably more than any other state in the country.”

For the past decade, ever since Vermont leaders abandoned a 2011 attempt at universal health care, Vermont’s health care system has slowly but surely spiraled. The descent has left Vermont’s primary insurer, Blue Cross Blue Shield of Vermont (BCBSVT), which insures about 66 percent of Vermonters, near insolvency, and most of the state’s medical providers bleeding out. 

Vermont government and health care leaders, who have spent the last decade pursuing sophisticated reform, are stuck adjudicating a standoff between providers and BCBSVT, both of whom have no choice but to keep raising their prices. So Vermont’s health insurance prices have become among the highest in the nation — and they are poised to become even higher under the budget bill’s changes. “It’s a death spiral,” Jessica Holmes, a GMCB member, says. “And it will affect everyone.”

“People tend to think of themselves in special little categories when they think about access to care,” says Mike Fisher, Vermont’s chief health care advocate. “But we are all part of one system.”

AT BATTENKILL VALLEY HEALTH CENTER (BVHC) in small-town Arlington, Vermont — which has been designated by the federal Health Resources and Services Administration both a Medically Underserved Area and a Health Professional Shortage Area — most conversations among staff members nowadays revolve around the budget bill. 

BVHC is a Federally Qualified Health Center, a type of health provider that was created during President Johnson’s “War on Poverty” to serve areas with little to no access to adequate medical care. BVHC is required, like emergency rooms, to treat every patient regardless of insurance status or ability to pay. (This, in practice, means charging patients on a sliding scale according to income.) So, like hospitals with emergency rooms, BVHC is particularly vulnerable to the increase in uncompensated care set to occur from the budget bill. “Grant dollars have not kept up, and the cost to provide healthcare is astronomical,” says Kayla Davis, BVHC’s co-executive director. “This bill is going to be the tipping point. Eventually if you’re losing money, it doesn’t matter how long the runway is. The runway ends.”

“This bill is going to be the tipping point,” says BVHC co-executive director Kayla Davis. “Eventually if you’re losing money, it doesn’t matter how long the runway is. The runway ends.”

Courtesy of Kate Bryan

When BVHC first began, a little over a decade ago, it was just seven people with some folding tables and chairs in one big room, Davis describes. “But we have found people that care so deeply about this community and what they do that now we’ve created this small-town care network,” she says. “And it’s kind of magic.”

On the back wall of the Health Center’s main waiting room there is a charcoal and graphite moose, drawn by a seventh grader named Lucas, and, to its left, a painted group of men, women, and children dancing in a circle among autumn trees. “We’re a community health center,” says Kate Bryan, BVHC’s director of development and community relations, “and it’s such a beautiful thing. The people the Health Center serves are the people who helped raise me. They’re my teachers, they’re my neighbors, and they’re my friends.

“These cuts just break my heart,” Bryan tells Rolling Stone. “And it’s really hard for us to be able to support [our patients] when we just don’t know [what is going to happen], and when we can’t make promises that they’re going to be OK. I worry that the people I care about most are going to get sicker and are going to die.”

A few blocks away is the Arlington Food Shelf, run by Bryan’s parents, Bill and Judy Bryan. Arlington has been classified by the USDA as a food desert, an area where at least 33 percent of the local population lives more than 10 miles away from a food market.

As I walk through the doors of what used to be a branch of the Chittenden Bank, I am met by a congregation of volunteers. The mix of people is striking — there is Alex Foley, a tall, brown-haired boy who began volunteering through the local high school’s community service club; Joe Carabello, who wears a bright blue polo shirt, rectangle glasses, and vaguely resembles Mr. Fredricksen from Pixar’s Up; and Carol Fay, who has a bubblegum pink bandana tied around her neck.

As the distribution begins, the sun comes out, the volunteers begin to sweat, and slowly but surely the pile of food grows smaller. Bryan brings out bottled water and iced tea to keep everyone hydrated. The laughs start coming louder; Joe facetiously makes cryptic hand gestures to signal how many bags each car needs, and at some point the onions have begun to be juggled. 

If you didn’t know it was a food distribution event, you might think it was a reunion of some sort. But as Bill Bryan pulls me aside to talk, the federal budget bill rears its ugly head again. “With the cuts to Medicaid and SNAP coming,” Bill says, “we have already seen the number [of people using the food shelf] triple in anticipation.” 

Even though the Arlington Food Shelf is not dealt any direct cuts, when Vermonters stop receiving their SNAP (and Medicaid) benefits and can no longer afford to buy themselves food, they inevitably turn to charitable food sources like the Bryans’ food shelf. But food banks and food shelves — particularly as the Trump administration concurrently carves money out of support programs like the USDA’s Emergency Food Assistance Program, which distributes food to food banks across the country — cannot meet this demand.

IN VERMONT, MORE THAN 79,000 people — over 12 percent of the state’s population — are facing hunger. Two in five Vermonters, a 2022 University of Vermont study found, experienced food insecurity in the past year. And the USDA has designated 40 Vermont census tracts as food deserts. 

While Vermont has a stalwart and committed charitable-food system, what SNAP brings to the state is irreplaceable. For every one meal that a Feeding America food bank like the Vermont Foodbank provides, for example, SNAP provides nine. “SNAP is the most efficient and effective anti-hunger program in this country,” Sayles of Vermont Foodbank says. “It works amazingly well. And it’s just not possible for food banks and food pantries to replace it.” 

Sayles is worried that the federal SNAP cuts will cause a ripple effect across Vermont’s grocery stores and economy at large and create a larger hunger crisis across the board. This is because SNAP benefits act as economic multipliers: For every $1 of benefits spent in Vermont, about $1.70 is generated in economic activity. 

“There’s over 600 authorized SNAP retailers in Vermont, and when SNAP benefits are put on EBT cards at the beginning of the month, over 90 percent of those benefits are spent within 30 days,” Sayles says. “And we have a lot of very small retailers in Vermont, local stores and country stores and small, independent supermarkets, where losing a portion of their SNAP revenue could put them in jeopardy. And losing a local retailer can be catastrophic.”

Horton shares Sayles’ fears. “There are so many small towns here where there’s only one general store where you can get groceries,” she describes. “The closest grocery store is maybe 30, 40 miles away. And these small stores really depend on every dollar they receive. So when they stop receiving as many SNAP dollars, we are going to lose our rural grocery stores.”

The effects of these closures may even go unnoticed, because in September, Trump’s USDA canceled its three-decades-old annual report tracking food insecurity.

“I understand that people have different priorities, and people see the world in different ways,” says Sayles, “But this … it just seems like purposeful cruelty to me, frankly. Hunger is a policy choice. And the cuts are literally going to take food out of the mouths of children and disabled people and older Americans.” 

Bryan, for her part, is worried about how the dual threats to medical care and food access could debilitate the Arlington community. The food shelf and the Health Center are deeply entwined in their twin missions of feeding and treating the residents of Arlington.

A food pantry inside the Battenkill Valley Health Center. Two in five Vermonters experienced food insecurity in the last year.

Courtesy of India Nye Wenner

As I’m about to walk out the doors of the food shelf, Bryan, usually cheerful and enthusiastic to a fault, tells me something she hasn’t yet admitted. “Usually I’m the one giving, but, I mean, I was that mom on Medicaid when I was a single mom at 25 years old trying to raise my kids and keep a roof over my head,” she says. “And had I lost those benefits, 25 years ago, I wouldn’t be able to be speaking to you about this today.”

ON MY LAST DAY in Vermont, I visit the home of Megan Oxendine, 36, who lives in subsidized housing in Bennington County and receives both Medicaid and SNAP benefits.

“If I had one dollar left, I would give it to someone who needed it more than me,” Megan says. On top of raising three small children, “I work 30 hours a week,” she says. “All I want is to make sure my kids get everything they want. But they’re toddlers; they get hurt, they break things, they get cuts, they get headaches, and then they need to go to express care,” she continues. “So what, I’m just gonna not take them, and then on top of that I’m not gonna feed them? Absolutely not.” 

But Megan already rations. As we walk through a nearby Walmart to buy her food for the week, she is all calculations. Dark chicken meat, not white, because it is always cheaper. Romaine lettuce, not iceberg, because it is more nutritional. And small cherry tomatoes, not the large ones, because they are cheapest and go furthest. 

When we check out, Megan pulls out her EBT card to pay. It would look like a standard debit card were it not for the image on the front, a breathtaking still shot of Vermont cropland overlooked by the resplendent, larger-than-life Green Mountains. There is a moment of pause, just long enough for me to hear my breathing, as Megan inserts the card into the machine. Then there is silence, and then the screen flashes a payment confirmation message. All is well: The transaction has gone through, and SNAP has bought Megan and her children food for another week. 

As we walk out the doors of the Walmart and make our way to Megan’s car, the sky starts to darken. Megan and I look up as we feel raindrops dampen our backs. First one drop, then another, and then they are coming down fast and hard and heavy. The clouds have obscured the sun, and the blue is all but gone from the sky. As Megan and I watch the dark weather descend upon the Green Mountains, the air chills, and we both seem to realize one thing: A storm has come to Vermont. And it is not turning around.