\n\t\tbout 10 miles west of the Green Mountains, in North Bennington, Vermont<\/a>, 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.<\/p>\n
\n\tOn 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.\u00a0<\/p>\n
\n\tAt the time, Jack and his parents, James and Rosie \u2014 36 and 35, respectively \u2014 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\u2019s \u201cReturn to In-Person Work\u201d executive order in January, the family had been dropped from the Federal Employees Health Benefits Program rolls.\u00a0<\/p>\n
\n\tNot 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\u2019s hacking cough.\u00a0<\/p>\n
\n\t\u201cHe was so tired that he was barely moving,\u201d says Rosie, \u201cand [without insurance] there was this internal struggle of, as a mother, I shouldn\u2019t have to be weighing the financial cost of [treating] my son with my son\u2019s health. But instead, it was like, \u2018If we take him to the emergency room, it\u2019s going to cost us this much out of pocket, so maybe we\u2019ll just wait another day.\u2019 It was terrifying.\u201d\u00a0<\/p>\n
\n\tOn day five of Jack\u2019s fever, the couple decided they had no choice but to bring him to an urgent care clinic. \u201cRight 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,\u201d Rosie recounts. \u201cSo we didn\u2019t run any tests.\u201d\u00a0<\/p>\n
\t\tEditor\u2019s picks<\/p>\n
\t\t\t\t\t\t![\"\"](\"https:\/\/www.rollingstone.com\/wp-content\/themes\/vip\/pmc-rollingstone-2022\/assets\/public\/lazyload-fallback.gif\")
<\/p>\n
\t\t\t\t\tA hopeful sign outside James and Rosie\u2019s duplex farmhouse in North Bennington<\/p>\n
\t\t\t\t\t\t\t\t\tCourtesy of India Nye Wenner<\/p>\n
\n\tThankfully, Jack \u2014 and, later, Rosie and James \u2014\u00a0got better without complications. And all three were subsequently approved for Medicaid<\/a> coverage. But, with the July 4 passage of the president\u2019s so-called Big, Beautiful reconciliation bill and its $1 trillion in Medicaid cuts, the family found themselves once again bracing for the worst.\u00a0<\/p>\n \n\tThe 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\u2019ve 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\u2019s emergency cushion had all but disappeared.\u00a0<\/p>\n \n\t\u201cThe idea of [losing Medicaid and] having to face what we did again,\u201d James said at the time, his voice trailing off, \u201cI\u2019m not sure what we\u2019re going to be able to do at that point.\u201d<\/p>\n \n\tA SPRAWLING, 870-PAGE document, the One Big Beautiful Bill<\/a> 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<\/a>), and the Affordable Care Act (ACA). Some of these changes \u2014 such as the expanded SNAP work requirements, which took effect Oct. 1 \u2014 have already been implemented<\/a>. Others \u2014 like the Medicaid work requirements, pointedly delayed until after the congressional midterm elections<\/a> \u2014 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.<\/p>\n \t\tRelated Content<\/p>\n \n\tVermont 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<\/a> (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<\/a>\u2019s cuts position it at a dangerous crossroads.\u00a0<\/p>\n \n\tForty-three percent of all federal funding sent to Vermont<\/a>, for example, is for Medicaid<\/a>, 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?\u00a0<\/p>\n \n\t\u201cWe\u2019re 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,\u201d Andrew Perchlik, a Vermont state senator and chair of the Senate Committee on Appropriations, says. \u201cThe concern is that there\u2019s just not enough money in Vermont to make up the kind of loss this bill entails. And if we can\u2019t make up these losses, we will have to cut services. And that will be devastating.\u201d<\/p>\n \n\tSen. Bernie Sanders<\/a> agrees. \u201cIn 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,\u201d Sanders tells Rolling Stone. \u201cPeople 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.\u201d<\/p>\n \t\t\t\t\t\t \t\t\t\t\tDemonstrators protesting Trump administration actions in Montpelier, Vermont, in March<\/p>\n \t\t\t\t\t\t\t\t\tJohn Lazenby\/UCG\/Universal Images Group\/Getty Images<\/p>\n \n\tIN 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. \u201cI want to be a paleontologist when I grow up,\u201d he tells me shyly as his parents, sitting next to each other on a gray couch, look on from across the room.\u00a0<\/p>\n \n\tJames 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\u2019s 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.\u00a0<\/p>\n \n\tBut when the Trump administration barred telework as an option for people like him, the situation became untenable. \u201cI 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\u2019clock at night, just to do it again the next day,\u201d says James. \u201cWhat human is expected to put 40 hours a week into commuting?\u201d asks Rosie. \u201cEspecially with a young kid?\u201d 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.<\/p>\n \n\tWith their Medicaid coverage subsequently hanging by a thread, James and Rosie felt like the government had dealt them a double blow. \u201cAs an American, I grew up believing that the government was there for the people. That all people should be entitled to health care,\u201d says Rosie. \u201cAnd now, to cut the programming that literally supports lives \u2026 It blows my mind to think that it\u2019s even a possibility for a country to do that.\u201d<\/p>\n \n\tAfter spending nearly five months unemployed, James recently secured a job with a Vermont municipality\u2019s zoning division, lifting the family above the threshold for Medicaid. But before then, the couple\u2019s income had fallen below the poverty level \u2014 less than $26,650 a year, barely 20 percent of the median income for a Vermont family of three \u2014 and they had been \u201cgetting pretty desperate to use SNAP,\u201d as Rosie put it in July. Yet with the $187 billion<\/a> that the budget bill tears from the program, they feared that, as with their Medicaid coverage, they would be left empty-handed. \u201cIt feels like we\u2019re chasing after a program,\u201d Rosie said at the time, \u201cthat might support us for a month and then be gone.\u201d\u00a0<\/p>\n \n\tABOUT 45,000 VERMONTERS are expected to lose health care coverage as a result of the budget bill\u2019s changes to Medicaid and the ACA marketplace. About 13,000, due to other changes, may lose SNAP benefits. Meanwhile, amid the federal government\u2019s recent shutdown, none of the roughly 65,000 Vermonters on SNAP will receive their November payments<\/a>.\u00a0<\/p>\n \n\t\u201cWe are going to face a hunger and health crisis and a tragedy on an unprecedented scale,\u201d Anore Horton, executive director of the nonprofit advocacy organization Hunger Free Vermont<\/a>, tells Rolling Stone. \u201cI think it\u2019s going to make what happened during the pandemic look like child\u2019s play by comparison. Cutting these programs together is unquestionably going to kill people. There is no doubt about it.\u201d\u00a0<\/p>\n \t\t\t\t\t\t \t\t\t\t\tWorkers from Service Employees International Union protesting proposed Medicaid cuts in Washington, D.C., on June 23.<\/p>\n \t\t\t\t\t\t\t\t\tJoe Raedle\/Getty Images<\/p>\n \n\tSNAP, 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\u2019 medical services at little to no cost, have by and large received consistent bipartisan support since they were initiated with President Lyndon Johnson\u2019s Great Society legislation in the Sixties. Trump\u2019s 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 \u2014 in effect making the programs harder for people to access and even harder for states to maintain.<\/p>\n \n\t\u201cWhat\u2019s really tricky about the way that Congress is going about these cuts is that they\u2019re making it sound as if these are just little tweaks to specific groups of people,\u201d says Horton. \u201cBut, in fact, the goal is very clearly to force state governments to have to destroy these programs. We\u2019re talking about the Trump administration and Congress setting out to destroy the ability of state governments to take care of people.\u201d<\/p>\n \n\tIt\u2019s 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<\/a> or a parallel online portal to prove their income and eligibility. Applying for SNAP entails a similar protocol.\u00a0<\/p>\n \n\t\u201cThe applications are very long and extensive,\u201d says Horton. \u201cThey 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.\u201d<\/p>\n \u201cAs an American, I grew up believing government was there for the people. To cut programming that literally supports lives \u2026 It blows my mind.\u201d<\/p>\n<\/blockquote>\n \n\tUnder the federal budget bill, the process will become even more onerous.\u00a0Medicaid 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<\/a>.\u00a0<\/p>\n \n\tPerhaps 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<\/a> and eliminates numerous exemptions (such as one for homeless individuals, which more than 1,700 people in Vermont currently receive).\u00a0<\/p>\n \n\tCongressional 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\u2019s SNAP program was a mere 4.74 percent in 2024<\/a>, while the error rate for Vermont\u2019s 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<\/a> by Andy Schneider, a research professor at Georgetown University\u2019s McCourt School of Public Policy, nationwide Department of Justice reports have found that actual fraud is essentially never committed by beneficiaries or the state.<\/p>\n \n\t\u201cThe checks and balances are already extreme in these programs to make sure that only qualified people are receiving benefits,\u201d says Horton. \u201cThe rhetoric of waste, fraud, and abuse [in SNAP or in Medicaid] is simply a way to justify [the GOP\u2019s] actual goal, which is to destroy these programs.\u201d<\/p>\n \n\tIn 2023, 92 percent of Medicaid adults who will now be subject to work requirements were already working full- or part-time<\/a>. A 2023 Congressional Budget Office (CBO) analysis found<\/a> 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<\/a> due simply to the paperwork burdens they present \u2014 not because individuals are actually ineligible.\u00a0<\/p>\n \n\t\u201cWhat work requirements really do is create a paperwork barrier,\u201d says John Sayles, CEO of the Vermont Foodbank<\/a>. \u201cSay you\u2019re 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\u2019s 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.\u201d<\/p>\n \n\t\u201cIf you have multiple jobs, if you\u2019re self-employed, if you have issues with your computer, if you don\u2019t read your mail and understand that you have to respond to notices,\u201d warns Marjorie Stinchcombe, an attorney who works as a helpline director with the Vermont Office of the Health Care Advocate, \u201cit\u2019s not flexible.\u201d\u00a0<\/p>\n \n\tAnd Vermont\u2019s legislators and state agencies \u2014 tasked with building an entirely new technology system<\/a>, conducting hundreds of thousands more eligibility checks, processing immense amounts of paperwork, and supporting thousands of confused and desperate beneficiaries \u2014 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<\/a> 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 \u201cleave the program altogether.\u201d<\/p>\n \n\tAs a preview of the damage, it has been estimated that, taken altogether, the bill\u2019s changes will undo about three-quarters <\/a>of the Affordable Care Act\u2019s 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.\u00a0<\/p>\n \n\tThe bill also freezes updates to the Thrifty Food Plan, the mechanism used to increase SNAP benefit amounts proportional to actual food prices. \u201cThere will be no future increases to account for the cost of inflation,\u201d says Horton. \u201cSo that means the value of people\u2019s SNAP benefits, or how much food your SNAP benefit can buy you, is going to be decreasing every single year from now into perpetuity.\u201d And with President Trump\u2019s tariffs driving up food prices<\/a>, this decrease is sure to be even steeper.<\/p>\n \u201cIf people are going hungry and we\u2019re not able to provide food, or people are sick and we\u2019re not able to provide health care, that\u2019s a moral failure.\u201d<\/p>\n<\/blockquote>\n \n\tThe bill also lets die a large number of ACA marketplace subsidies \u2014 specifically, the enhanced premium tax credits created by President Joe Biden\u2019s 2021 American Rescue Plan Act. These tax credits, which have doubled<\/a> national marketplace enrollment, are set to expire in December and have become the central issue of the federal government\u2019s shutdown. Without them, Americans\u2019 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 \u2014 an increase Vermonters cannot afford.\u00a0<\/p>\n \n\t\u201cIn Vermont specifically, we\u2019ve been such a leader in coverage,\u201d Dr. DaShawn Groves, the commissioner for the Department of Vermont Health Access, which administers the state\u2019s Medicaid and ACA marketplace, says to Rolling Stone. \u201cBut trying to protect that\u2026 we just don\u2019t know yet. There are going to be difficult choices ahead.\u201d<\/p>\n \n\tThe Vermont legislature has set aside<\/a> about $100 million in its budget (in addition to an $118 million \u201cstabilization reserve\u201d and a $100 million \u201cRainy Day Fund\u201d that it can draw from) to cope with the budget bill\u2019s cuts. But: \u201cThese reserves are for short-term, onetime issues,\u201d says state senator Perchlik. \u201cThey don\u2019t fill the hole.\u201d<\/p>\n \n\tPerchlik has come to the conclusion that other state-funded initiatives may have to be brought to the cutting board. \u201cMy fear is that it\u2019s going to create this domino effect throughout the whole budget,\u201d he says. \u201cWhat do you choose? Feeding people, providing medical care, or providing shelter? If people are going hungry and we\u2019re not able to provide food, or people are sick and we\u2019re not able to provide health care, that\u2019s a moral failure.\u201d<\/p>\n \n\tSenator Sanders, who spent months fighting the budget bill\u2019s passage, stays awake at night now that it is law. \u201cThere\u2019s not a day or night that goes by where I do not deal with this stuff,\u201d he tells Rolling Stone. \u201cIt\u2019s 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.\u00a0<\/p>\n \n\t\u201cThey wanted tax cuts, and that\u2019s what they got,\u201d he continues. \u201cAnd they couldn\u2019t care less about the people who are going to die and suffer as a result.\u201d<\/p>\n \t\t\t\t\t\t \t\t\t\t\tSen. Bernie Sanders rushing to the Senate floor during overnight votes at the U.S. Capitol on July 1. \u201cIt\u2019s horrifying, the absolute immorality of what this administration is doing,\u201d he says of the BBB.<\/p>\n \t\t\t\t\t\t\t\t\tAl Drago\/Getty Images<\/p>\n \n\tFOR 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 \u2014\u00a0Addison\u2019s disease, in which the adrenal glands don\u2019t produce enough of certain hormones, and lupus, in which the body\u2019s immune system attacks its own tissues and organs.\u00a0<\/p>\n \n\tIn those pre-ACA years, insurance wouldn\u2019t 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\u2019ve. By age 16, she was diagnosed with stage-five kidney disease; her kidneys were failing. \u201cIf I had just had access to that care, to that surgery,\u201d she says, \u201cI would have never lost my kidneys. None of that would have ever happened.\u201d<\/p>\n \n\tWhen Jane turned 18, she was no longer covered under her parents\u2019 insurance and had racked up a million dollars in medical debt. She spent the next four years traveling the country, securing jobs that had \u201cday-one insurance\u201d and moving when she had capped out each plan\u2019s offerings. Like a traveling salesman, she lived everywhere: San Diego, New Orleans, Nashville, Philadelphia, Maryland, Massachusetts, Maine \u2014 wherever she could find the health coverage she needed to stay alive.<\/p>\n \n\tEventually, 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 \u2014 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.\u00a0<\/p>\n \n\t\u201cI was dying, and they just didn\u2019t care,\u201d she says. \u201cI was disposable. They had the resources to give me the care, and they just wouldn\u2019t.\u201d<\/p>\n \n\tOver 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\u2019s hospital bed to report a story. \u201cIt\u2019s not easy to beg for your life,\u201d she says, \u201cBut it was important to me that people knew the truth about being sick in America.\u201d<\/p>\n \n\tThanks to the bad publicity, Jane\u2019s 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.\u00a0\u00a0<\/p>\n \n\tJane 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 \u2014 without needing to have children, be pregnant, or have a documented disability \u2014 could receive Medicaid coverage. For Jane, this meant that, even when not temporarily disabled by a transplant, she was now eligible for Medicaid \u2014\u00a0she just needed to move to a Medicaid expansion state.\u00a0<\/p>\n \n\t\u201cIt is still one of the best moments of my life,\u201d she says. \u201cI was in my friend\u2019s 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.\u201d<\/p>\n \n\tJane left Florida, which chose not to expand its Medicaid program, \u201cwith one suitcase and a lot of hope\u201d 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. \u201cVermont is the only place that has ever really felt like home,\u201d she says. \u201cIt\u2019s like a hug. There\u2019s something special here.\u201d<\/p>\n \n\tWhen she was again unable to afford her medicine, Vermont\u2019s Medicaid program, as well as the state\u2019s hospitals and community health clinics, welcomed Jane with open arms. \u201cNo one ever looked down on me,\u201d she says.\u00a0<\/p>\n \n\t\u201cEverybody pitches in here,\u201d she continues. \u201cEverybody does some sort of volunteering. People care about each other. People think that Medicaid is poor, lazy people skirting the system. But it\u2019s people who are teachers, who are volunteer firefighters, who are police officers. It\u2019s people that are part of the community. It\u2019s neighbors. It\u2019s people at your kids\u2019 schools.\u201d<\/p>\n \t\t\t\t\t\t \t\t\t\t\tVolunteers 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. <\/p>\n \t\t\t\t\t\t\t\t\tCourtesy of Kate Bryan<\/p>\n \n\tJane 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 \u2014\u00a0without blood thinners, for example, Jane faces a stroke and immediate death. Without her steroids, she faces an Addison\u2019s crisis and a heart attack or coma. And without regular preventative care, she risks a dangerous incongruity within her medical regime \u2014 or, as she puts it, \u201ca slow, painful death.\u201d \u201cIf I don\u2019t have Medicaid,\u201d she says, \u201cit\u2019s game over. It\u2019s a death sentence.\u201d<\/p>\n \n\tIt is the work requirement in particular that Jane fears will rip Medicaid out from under her. Jane works plenty \u2014 she substitute teaches, works on legal cases for the wrongly incarcerated, and is studying to take the bar exam \u2014 but she worries that the new system will not be able to accommodate her unpredictable health crises.\u00a0<\/p>\n \n\t\u201cLet\u2019s say I have a really bad lupus flare and, for a period of time, can\u2019t meet the work requirements,\u201d Jane says. \u201cMaybe I\u2019m supposed to get a temporary exemption, but maybe it takes six months to get through. Maybe it only takes two weeks. But I\u2019m already dead, because I didn\u2019t get my medicine.\u00a0<\/p>\n \n\t\u201cI\u2019ve been fighting these same people my whole life,\u201d she continues. \u201cAnd I just can\u2019t understand why they would want to [do this].\u201d<\/p>\n \n\tJane, 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. \u201cHospitals are gonna get overwhelmed,\u201d she warns. \u201cThey\u2019re not gonna have enough money, they\u2019re gonna run out of supplies and medication, they\u2019re gonna close, and people are going to die.\u201d<\/p>\n \n\tWHEN 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\u2019ve been minor build up into something major. Often, they have no choice but to head to the emergency room.\u00a0<\/p>\n \n\tEmergency 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\u2019ve received via the patient\u2019s Medicaid coverage or federally qualified health plan.<\/p>\n \n\tThis increase in what experts refer to as uncompensated care poses a monumental threat to health providers. And with nine of Vermont\u2019s 14 hospitals (roughly 65 percent) grappling with negative operating margins and steeply declining reserves, Vermont\u2019s health care system is at particular risk. \u201cHospitals can only operate in the red for so long,\u201d warns Owen Foster, who chairs the Green Mountain Care Board<\/a> (GMCB), Vermont\u2019s primary healthcare regulator. And in a state with a majority-rural population, where people are already traveling far to get to a hospital<\/a>, even a single hospital closure would be devastating.\u00a0<\/p>\n \u201cPeople think Medicaid is poor, lazy people skirting the system. But it\u2019s teachers, firefighters, police officers, neighbors. It\u2019s people that are part of the community.\u201d<\/p>\n<\/blockquote>\n \n\tJane, 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 \u201chighly vulnerable\u201d institution. If SVMC were to go under, Jane\u2019s next option for the specialized care her conditions require would be at the Dartmouth Hitchcock Medical Center in New Hampshire \u2014 an almost two-hour drive from her home. For Jane, the difference between driving 30 minutes to take care of an Addison\u2019s crisis versus having to go two hours to Dartmouth, she says, \u201cis death.\u201d\u00a0<\/p>\n \n\tOn 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 \u2014 and experts are not sure if Vermont\u2019s health care system can take it. The state\u2019s 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<\/a> 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\u2019s other, more permanent changes.)<\/p>\n \n\t\u201cThe state is at an inflection point,\u201d says Foster. \u201cProbably more than any other state in the country.\u201d<\/p>\n \n\tFor the past decade, ever since Vermont leaders abandoned a 2011 attempt at universal health care, Vermont\u2019s health care system has slowly but surely spiraled<\/a>. The descent has left Vermont\u2019s primary insurer, Blue Cross Blue Shield of Vermont (BCBSVT), which insures about 66 percent of Vermonters, near insolvency, and most of the state\u2019s medical providers bleeding out.\u00a0<\/p>\n \n\tVermont government and health care leaders, who have spent the last decade pursuing sophisticated reform,\u00a0are stuck adjudicating a standoff between providers and BCBSVT, both of whom have no choice but to keep raising their prices. So Vermont\u2019s health insurance prices have become among the highest in the nation<\/a> \u2014 and they are poised to become even higher under the budget bill\u2019s changes. \u201cIt\u2019s a death spiral,\u201d Jessica Holmes, a GMCB member, says. \u201cAnd it will affect everyone.\u201d<\/p>\n \n\t\u201cPeople tend to think of themselves in special little categories when they think about access to care,\u201d says Mike Fisher, Vermont\u2019s chief health care advocate. \u201cBut we are all part of one system.\u201d<\/p>\n \n\tAT BATTENKILL VALLEY HEALTH CENTER (BVHC) in small-town Arlington, Vermont \u2014 which has been designated by the federal Health Resources and Services Administration both a Medically Underserved Area and a Health Professional Shortage Area \u2014 most conversations among staff members nowadays revolve around the budget bill.\u00a0<\/p>\n \n\tBVHC is a Federally Qualified Health Center, a type of health provider that was created during President Johnson\u2019s \u201cWar on Poverty\u201d 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<\/a> 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. \u201cGrant dollars have not kept up, and the cost to provide healthcare is astronomical,\u201d says Kayla Davis, BVHC\u2019s co-executive director. \u201cThis bill is going to be the tipping point. Eventually if you\u2019re losing money, it doesn\u2019t matter how long the runway is. The runway ends.\u201d<\/p>\n \t\t\t\t\t\t \t\t\t\t\t\u201cThis bill is going to be the tipping point,\u201d says BVHC co-executive director Kayla Davis. \u201cEventually if you\u2019re losing money, it doesn\u2019t matter how long the runway is. The runway ends.\u201d<\/p>\n \t\t\t\t\t\t\t\t\tCourtesy of Kate Bryan<\/p>\n \n\tWhen 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. \u201cBut we have found people that care so deeply about this community and what they do that now we\u2019ve created this small-town care network,\u201d she says. \u201cAnd it\u2019s kind of magic.\u201d<\/p>\n \n\tOn the back wall of the Health Center\u2019s 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. \u201cWe\u2019re a community health center,\u201d says Kate Bryan, BVHC\u2019s director of development and community relations, \u201cand it\u2019s such a beautiful thing. The people the Health Center serves are the people who helped raise me. They\u2019re my teachers, they\u2019re my neighbors, and they\u2019re my friends.<\/p>\n \n\t\u201cThese cuts just break my heart,\u201d Bryan tells Rolling Stone. \u201cAnd it\u2019s really hard for us to be able to support [our patients] when we just don\u2019t know [what is going to happen], and when we can\u2019t make promises that they\u2019re going to be OK. I worry that the people I care about most are going to get sicker and are going to die.\u201d<\/p>\n \n\tA few blocks away is the Arlington Food Shelf, run by Bryan\u2019s parents, Bill and Judy Bryan. Arlington has been classified by the USDA as a food desert<\/a>, an area where at least 33 percent of the local population lives more than 10 miles away from a food market.<\/p>\n \n\tAs 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 \u2014 there is Alex Foley, a tall, brown-haired boy who began volunteering through the local high school\u2019s community service club; Joe Carabello, who wears a bright blue polo shirt, rectangle glasses, and vaguely resembles Mr. Fredricksen from Pixar\u2019s Up; and Carol Fay, who has a bubblegum pink bandana tied around her neck.<\/p>\n \n\tAs 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.\u00a0<\/p>\n \n\tIf you didn\u2019t 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. \u201cWith the cuts to Medicaid and SNAP coming,\u201d Bill says, \u201cwe have already seen the number [of people using the food shelf] triple in anticipation.\u201d\u00a0<\/p>\n \n\tEven 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\u2019 food shelf. But food banks and food shelves \u2014 particularly as the Trump administration concurrently carves money out of support programs<\/a> like the USDA\u2019s Emergency Food Assistance Program, which distributes food to food banks across the country \u2014 cannot meet this demand.<\/p>\n \n\tIN VERMONT, MORE THAN 79,000 people \u2014 over 12 percent of the state\u2019s population\u00a0\u2014 are facing hunger<\/a>. Two in five Vermonters, a 2022 University of Vermont study found, experienced food insecurity<\/a> in the past year. And the USDA has designated<\/a> 40 Vermont census tracts as food deserts.\u00a0<\/p>\n \n\tWhile 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<\/a>. \u201cSNAP is the most efficient and effective anti-hunger program in this country,\u201d Sayles of Vermont Foodbank says. \u201cIt works amazingly well. And it\u2019s just not possible for food banks and food pantries to replace it.\u201d\u00a0<\/p>\n \n\tSayles is worried that the federal SNAP cuts will cause a ripple effect across Vermont\u2019s 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.\u00a0<\/p>\n \n\t\u201cThere\u2019s 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,\u201d Sayles says. \u201cAnd 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.\u201d<\/p>\n \n\tHorton shares Sayles\u2019 fears. \u201cThere are so many small towns here where there\u2019s only one general store where you can get groceries,\u201d she describes. \u201cThe 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.\u201d<\/p>\n<\/p>\n<\/p>\n\n
\n
<\/p>\n<\/p>\n\n
<\/p>\n