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      Trump’s Medicaid cuts are coming for rural Americans: ‘It’s going to have to hit them first’

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      When Hurricane Helene drowned western North Carolina in muck and floodwater last year, it caught folks off-guard.Now, local leaders in places like Asheville expect the Republican-led reconciliation bill – called the “big, beautiful bill” by Donald Trump – to bear down on rural America. And they wonder whether people are missing the warning signs.“It’s going to have to hit them first,” said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood.Medicaid is the single largest health insurance program in the US. The public program covers 71 million low-income, disabled and elderly US residents. It pays for half of all US births and the care of six in 10 nursing home residents.When Trump’s sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare.“This is an extraordinarily regressive bill,” said Joan Akler, executive director and co-founder of Georgetown University’s Center for Children and Families. “This is the largest rollback of healthcare coverage that we’ve ever seen and all in service of an agenda to drive tax cuts that will disproportionately benefit wealthy people and corporations.”Medicaid “expansion” is a key provision of Obamacare, formally called the Affordable Care Act of 2010. The expansion provides largely no-cost health insurance to people earning up to 138% of the federal poverty level, or $36,777 for a family of three. Although Obamacare has been the law for more than a decade, Medicaid expansion proved politically divisive in Republican states, and many only recently decided to accept enormous federal subsidies to cover their residents.North Carolina will lose $32bn in the next decadeThe Medicaid cuts in the bill could have particularly acute consequences in North Carolina, a politically competitive state, where experts said the bill could trigger a “kill switch” to end Medicaid expansion.“If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,” said Kody Kinsley, North Carolina’s former secretary of health and an architect of the state’s Medicaid expansion.North Carolina is set to lose $32bn in federal funding in the next decade, according to an analysis by the office of the Republican senator Thom Tillis, who represents the state. He’s one of just three Senate Republicans who voted against the bill on Tuesday.North Carolina’s expansion only went into effect in December 2023, and in less than 19 months it enrolled more than 650,000 people – all of whom will lose coverage if the program ends.Those North Carolinians are only some of the 17 million people expected to lose health insurance by 2034 across the country, according to estimates from the non-partisan Congressional Budget Office. Nearly 12 million people will lose insurance because of attacks on Medicaid.“Ultimately, Medicaid being cut is going to kill people,” said Molly Zenkler, a nurse at Mission hospital in Asheville. “I deal with people getting their feet literally amputated because they don’t have access to diabetic care. This is just going to get increasingly worse.”The reconciliation bill cuts state funding through a number of provisions. On healthcare specifically, the bill attacks complex financial maneuvers states use to draw down federal funds. It also requires states to spend enormous sums – perhaps tens of millions of dollars per state – implementing work requirements, effectively adding layers of expensive red tape.Congressional Republicans in favor of the bill argue it targets “waste, fraud and abuse”. However, it is already well-known that most Medicaid beneficiaries who can work do, and that Medicaid is one of the most cost-efficient health programs in the US, according to the American Hospital Association.North Carolina is one of a dozen conservative states that wrote a “trigger” law into Medicaid expansion. Not all function like North Carolina’s – the laws are, in the words of an expert with Georgetown University’s McCourt School of Public Policy, a “lesson in federalism” – but they nevertheless underscore the difficult choices state legislators will face because of congressional Republicans’ cuts.One such program that could be on the chopping block is a pilot with Impact Health, which uses Medicaid expansion funds for social needs that affect health – an effort to reduce long-term costs. Stradley gave the example of a Medicaid-covered child with severe asthma who hit the local emergency room three times a week for breathing treatments.Impact’s program used Medicaid funds to replace moldy rugs with laminate flooring in the child’s home, and to buy a vacuum with a Hepa filter. The cost to Impact Health was about $5,000, “but now this child is going to the emergency room a couple times a year instead of a couple times a month. And so, every month we’re saving about $4,500.”The program’s knock-on effects boost the local economy: the work to replace the rug was done by a local carpenter, and the child’s mother isn’t calling out from work, increasing her job stability.“One of the ways that we talk about this program is that it’s a hand up rather than a handout,” she said. “Almost half of the folks that are recipients in our program are children … Then you look at the adults. Most of them are working multiple jobs, and those jobs don’t come with benefits, because they’re working two or three part-time jobs in order to make ends meet.”The enormity of Medicaid means large cuts to the program imperil not only patients, but the institutions that serve them – especially rural hospitals and clinics hanging on “by a thread”, according to Kinsley.One of US residents’ few rights to healthcare is in emergency departments, where hospitals are required to stabilize patients regardless of ability to pay. That makes emergency departments the go-to source for healthcare for the uninsured.An analysis released by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill earlier this year showed that 338 rural hospitals around the country were at risk of imminent closure with the cuts to Medicaid contained in the bill.‘Hospitals will be forced to restrict services, or close’Rural states such as Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky’s 4.5 million residents comprise about 1.3% of the US’s population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky’s cabinet for health and family services. The program benefits about 478,900 adults.The situation is similarly dire in Arizona, another battleground state, which also has a trigger law on the books. Although the reconciliation bill may not “trigger” a rollback of Medicaid expansion, it does undermine a key financing mechanism for the state’s program called a “provider tax”.“We estimate Arizona’s healthcare system would lose over $6bn over the next seven years,” said Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association, in a statement.“In other words, more than 55% of Arizona hospitals would be operating in the red,” she said. “Hospitals will be, at best, forced to restrict services such as obstetrics, behavioral healthcare and other complex services, and at worst, will close their doors altogether.”Another issue is the potential for Republicans’ cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance.In addition, rural healthcare providers worry the water will be muddied by the sheer complexity of US healthcare. Private companies have a hand in managing – and therefore branding – state Medicaid programs.“A lot of our rural voters may not even realize that what they have is Medicaid, because there are so many names for it,” said Stradley. However, the precarious situation is already worrying people whose lives have been stabilized because of Medicaid.Amanda Moynihan is a single mother of three children – ages nine, 12 and 16 – living in Kuna, Idaho. Medicaid expansion has helped her become a “functioning human in society”, she said. Routine medical care for herself and her children, along with other assistance programs, has meant the difference between grinding poverty and a shot at the middle class.Idaho, one of the most politically conservative states in the union, expanded Medicaid in 2018 with an overwhelming ballot-referendum vote of 61-39. Even if Idaho’s “trigger law” does not go into effect, the state could face similar fiscal challenges to Arizona.“Back two years ago, before I started school, I was just in fight-or-flight, just trying to pay the bills there. I didn’t ever see a future of what I could do. And then I just started with one class,” she said.Moynihan has completed an associate degree in psychology and is starting the social work bachelor’s degree program at Boise State University in the fall. For now, she’s working part time with the Idaho Commission for the Blind and Visually Impaired and planning to pick up work at a gas station because it has a college scholarship benefit.But without stability to pursue higher education, her future “would be making the minimum wage, which is about $15 an hour, barely paying rent in a low-income household”. More

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      In Trump’s Bill, Democrats See a Path to Win Back Voters

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      Top party officials consider the president’s sweeping domestic policy bill to be cruel and fiscally ruinous — and they’re betting the American public will, too.Demoralized Democrats who have denounced President Trump’s sweeping domestic policy bill have landed on a silver lining. It is so unpopular with voters, they say, that it could win them back one, if not both, chambers of Congress in next year’s midterm elections.Top officials in the party, who see the bill as cruel, fiscally ruinous and the single biggest wealth transfer in American history, expect that they can blame Republicans who voted for the loss of health care coverage, nursing home care and food security for millions of Americans in order to extend the 2017 tax cuts that favor the wealthy.And they have plenty of quotes from Republicans like Senators Josh Hawley of Missouri, Thom Tillis of North Carolina and Lisa Murkowski of Alaska denouncing their own bill that, Democrats say, will make the argument that much more potent.“There’s going to be some powerful ads,” said Senator Chuck Schumer of New York, the chamber’s Democratic leader, before rattling off potential scripts for advertisements that are set to begin airing as early as next week. “‘My daughter had cancer. She was doing fine. Well, all of a sudden, her health care was blown up.’ ‘I worked at this rural hospital for 30 years. I put my heart into it because I wanted to help people. I was fired.’ Stuff like that is going to really matter.”It may take a while for people to feel the full effects of the bill because Republicans front-loaded some temporary tax cuts for working people, like no taxes on tips, that were engineered to appeal to working-class voters. The cuts to Medicaid are not set to be implemented until after the midterm elections.Still, there were some immediate effects. A clinic in southwest Nebraska announced this week that it was closing, blaming anticipated cuts to Medicaid. And Democrats said they expected millions of people to feel the impact from the bill’s allowing credits from the Affordable Care Act to expire. It will be up to Democrats over the next year to drive home the argument that these policies are the fault of Republican lawmakers.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      What’s in Trump’s major tax bill? Extended cuts, deportations and more

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      Senate Republicans on Tuesday passed Donald Trump’s massive tax and spending bill after spending all night voting on amendments. The bill, which the GOP has dubbed the One Big Beautiful Bill Act, now returns to the House of Representatives, which passed their version last month, before a Friday deadline the president has imposed for the legislation to be on his desk.Here’s what’s in the Senate’s version of the bill:Extending big tax cutsAfter taking office in 2017, Trump signed the Tax Cuts and Jobs Act, which lowered taxes and increased the standard deduction for all taxpayers, but generally benefited high earners more than most. Those provisions are set to expire after this year, but the “big, beautiful bill” makes them permanent, while increasing the standard deduction by $1,000 for individuals, $1,500 for heads of households and $2,000 for married couples, albeit only through 2028.Cutting tax on tips or overtimeThe bill has an array of new tax write-offs – but only while Trump is president. Several of the new exemptions stem from promises Trump made while campaigning last year. Taxpayers will be able to write off income from tips and overtime, and interest made on loans to purchase cars assembled in the United States. People aged 65 and over are eligible for an additional deduction of $6,000, provided their adjusted gross income does not exceed $75,000 for single filers or $150,000 for couples. But all of these incentives expire at the end of 2028, right before Trump’s term as president ends.Money for mass deportations and a border wallAs part of Trump’s plan to remove undocumented immigrants from the country, Immigration and Customs Enforcement (Ice) will receive $45bn for detention facilities, $14bn for deportation operations and billions of dollars more to hire an additional 10,000 new agents by 2029. More than $50bn is allocated for the construction of new border fortifications, which will probably include a wall along the border with Mexico.Slashing Medicaid and food stampsRepublicans have attempted to cut down on the bill’s cost by slashing two major federal safety-net programs: Medicaid, which provides healthcare to poor and disabled Americans, and the Supplemental Nutrition Assistance Program (Snap), which helps people afford groceries. Both are in for funding cuts, as well as new work requirements. The left-leaning Center on Budget and Policy Priorities estimates the Medicaid changes could cost as many as 10.6 million people their healthcare, and about eight million people, or one in five recipients, their Snap benefits.Cuts to green energyThe bill will phase out many tax incentives created by Congress during Joe Biden’s presidency meant to encourage consumers and businesses to use electric vehicles and other clean-energy technology. Credits for cleaner cars will end this year, as will subsidies for Americans seeking to upgrade their homes to cleaner or more energy-efficient appliances. While a draft of the bill targeted wind- and solar-energy projects with a new excise tax, senators voted to remove that at the last minute.State and local tax relief (Salt)One of the thorniest issues the bill addresses is how much relief to provide from state and local taxes (Salt), which many Americans must also pay in addition to their federal tax. Several House Republicans representing districts in Democratic-led states withheld their support from the bill until the Salt deductibility cap was raised from $10,000 to $40,000, but Senate Republicans made clear they would change that. The Senate’s version keeps the $40,000 cap, but only through 2028.Raising the debt ceilingThe bill will increase the US government’s authority to borrow, known as the debt limit, by $5tn. The US treasury secretary, Scott Bessent, has predicted the government will hit the limit by August, at which point it could default on its debt and spark a financial crisis.More benefits for the rich than the poorWealthier taxpayers appear set to receive more benefits from this bill than poorer ones, according to the Budget Lab at Yale University. Taxpayers in the lowest-income quintile will see a 2.5% decrease in their incomes, largely due to the Snap and Medicaid cuts, while the highest earners will see their incomes grow by 2.4%, the Budget Lab estimated. The impact could change based on which amendments the Senate adopts.A huge price tagDespite the GOP’s attempts to use the bill as a vehicle to rein in government spending, the bill would increase the deficit by $3.3tn through 2034, according to the non-partisan Congressional Budget Office. Most of that price tag is the extension of the 2017 tax cuts. The heavy budgetary impact could complicate the bill’s chances of passing the House, where fiscal hardliners have demanded budget-deficit reductions. More

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      Taking From the Poor and Giving to the Rich Is Not Populism

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      “I love the poorly educated,” President Trump declared during the 2016 campaign. His intense support for the “big, beautiful” $4.5 trillion tax-and-spending bill now before Congress shows that he has a unique way of demonstrating his affection.Republicans are on the verge of enacting Trump’s upwardly distributive fiscal policy measure, which has become an extreme test of the loyalty of his more downscale MAGA supporters, who not only oppose the bill but stand to bear the brunt of its negative consequences.In its current form, which is changing by the hour, the measure, known popularly as B.B.B., would provide the upper classes, including Trump’s allies and donor base — corporations and the rich — with tax cuts worth approximately $4.45 trillion over 10 years. The measure would offset the cost with the largest reductions in safety net programs in recent decades, if not all time, for those on the lower tiers of the income distribution.This pared-back social spending would adversely affect a large bloc of rural and exurban Republicans who played a crucial role in putting their party in control of the House and Senate, and Trump in the White House.“You can very safely say,” Bobby Kogan, senior director of federal budget policy at the liberal Center for American Progress, told The Washington Post, that “this is the biggest cut to programs for low-income Americans ever.”Many of the details of the legislation remain in flux as the Senate continues to vote on amendments. If the Senate approves the legislation, the House and the Senate will still have to come to agreement on a final version for the measure to become law.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump May Get His ‘Big Beautiful Bill,’ but the G.O.P. Will Pay a Price

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      And so will many voters.There will be many short- and long-term consequences if Republicans succeed in passing President Trump’s signature policy bill, as they aim to do before the July 4 holiday, David Leonhardt, the director of the Times editorial board, tells the national politics writer Michelle Cottle in this episode of “The Opinions.”Trump May Get His ‘Big Beautiful Bill,’ but the G.O.P. Will Pay a PriceAnd so will many voters.Below is a transcript of an episode of “The Opinions.” We recommend listening to it in its original form for the full effect. You can do so using the player above or on the NYT Audio App, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts.The transcript has been lightly edited for length and clarity.Michelle Cottle: I’m Michelle Cottle and I cover national politics for Times Opinion. So with the July 4 weekend looming, I thought we’d talk about a different kind of fireworks: that is, President Trump’s “big, beautiful bill” and as always, I hope the air quotes there are audible for everybody.But that bill looks like it is on track for passage. From Medicaid cuts to tax breaks for the rich, it is a lot. Thankfully with me to talk about this is David Leonhardt, the fearless director of the New York Times editorial board, who has some very pointed thoughts on the matter. So let’s just get to it. David, welcome.David Leonhardt: Thank you, Michelle. It’s great to be talking with you.Cottle: I’m so excited, but warning to all: We are recording on Monday midday and even as we speak, the Senate is brawling its way through to a final vote. So the situation is fluid and could change the details by the time you all hear this.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Republican senator denounces Trump’s ‘big, beautiful bill’ in fiery speech

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      “It is inescapable this bill will betray the promise Donald Trump made,” Thom Tillis, the North Carolina Republican senator, said on Sunday night, sandblasting the Senate version of the “big, beautiful bill” that is meant to codify the president’s agenda.Tillis made his speech on the Senate floor on Sunday night, a few hours after announcing he would not seek re-election in politically competitive North Carolina. Observers described it as “fiery” and “savage”. But Tillis carefully avoided direct criticism of the president as he denounced proposed cuts to Medicaid, a lack of rigor in the legislative process and the Senate’s headlong drive to an artificial deadline.Instead, in one of the most forceful Republican denunciations of the bill, Tillis attacked “amateurs” advising the president who have “no insight into how these provider tax cuts are going to be absorbed without harming people on Medicare”.Tillis’s office published an analysis concluding that the Senate budget would have a $32bn impact on the North Carolina healthcare system and threaten insurance coverage for 663,000 Medicaid expansion beneficiaries in the state – about one in 16 North Carolinians.“What do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there any more, guys?” Tillis said in his floor speech.It has become increasingly difficult for lawmakers in the Republican party to break ranks with the president without facing withering blowback from conservative media, “Maga” diehards and Trump himself on social media.“Tillis is a talker and complainer, NOT A DOER! He’s even worse than Rand ‘Fauci’ Paul!” Trump posted on Truth Social after announcing his opposition to the bill. Trump pledged to back a primary challenger to Tillis. When Tillis subsequently announced he would not seek re-election, Trump called it “good news”, and threatened primary challenges against other Republican fiscal conservatives standing in the way of the bill’s passage.Arguments critical of conservative doctrine on healthcare would fall on deaf ears. Instead, Tillis’s rhetoric emphasized the political threat to Republican lawmakers and the president himself if the bill passed in its current form.“I’m telling the president that you have been misinformed,” he said. “You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid.”Tillis referred back to Trump’s promise not to cut Medicaid while campaigning for president.skip past newsletter promotionafter newsletter promotion“The last time I saw a promise broken around healthcare, with respect to my friends on the other side of the aisle, is when somebody said “If you like your healthcare, you could keep it. If you like your doctor, you could keep it,” Tillis said. “We found out that wasn’t true. That made me the second Republican speaker of the House since the civil war.”Tillis signaled he would be willing to support the House version of the reconciliation bill.The procedural vote passed 51-49 Sunday. Budget reconciliation bills are not subject to cloture and the 60-vote threshold limiting debate. Trump has repeatedly pushed a 4 July deadline for passage. More

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      Senate Bill Would Make Deep Cuts to Medicaid, Setting Up Fight With House

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      The proposal would salvage some clean-energy tax credits and phase out others more slowly, making up some of the cost by imposing deeper cuts to Medicaid than the House-passed bill would.Senate Republicans on Monday released legislation that would cut Medicaid far more aggressively than would the House-passed bill to deliver President Trump’s domestic agenda, while also salvaging or slowing the elimination of some clean-energy tax credits, setting up a fight over their party’s marquee policy package.The measure, released by the Senate Finance Committee, contains the core provisions of that chamber’s version of the legislation that Republicans muscled through the House last month and are hoping to speed through the Senate and deliver to Mr. Trump’s desk by July 4. But its differences with that bill are substantial and are all but certain to complicate the measure’s path to enactment, casting doubt on that timetable.Most notably, the proposal would take a slower and less sweeping approach to phasing out clean-energy tax credits created during the Biden administration, and cover part of the cost of doing so by imposing deeper and more expansive cuts to Medicaid.While the House measure would add a new work requirement to Medicaid for childless adults, the Senate proposal would expand its application to the parents of older children. It also would crack down even harder than the House bill on strategies that many states have developed to tax medical providers and pay them higher prices for Medicaid services.In making the case for the bill, Republicans focused on another, far more politically popular element of the measure: its extension of tax cuts that were enacted in 2017 and are set to expire at the end of the year.A $7,500 tax credit for buyers of electric cars would phase out immediately within 180 days of the bill passing into law.Lauren Justice for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump’s ‘big, beautiful’ bill is built on falsehoods about low-income families | Brigid Schulte and Haley Swenson

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      As they race to deliver Donald Trump’s “big, beautiful” tax bill, Republicans in Congress are using familiar tropes to justify massive cuts to the safety net that will leave millions of low-income children and families without healthcare or sufficient food. The programs, they argue, are rife with waste, fraud and abuse, and the people who use them just aren’t working hard enough. So work requirements are necessary to force the obviously lazy “able-bodied” people to get to work.Here’s the reality check: a majority of those receiving this aid who can work are already working. More than 70% of working-age people who receive nutrition benefits or Medicaid, the health insurance program for low-income children and adults that covers one in five Americans, are already working, according to the Government Accountability Office. Those who aren’t working, research shows, are mostly ill, disabled, caring for a family member, or in school.Take the story of Ruaa Sabek. When the Covid pandemic hit in 2020, she and her husband worked at a fast-food restaurant in Philadelphia. Both their hours were cut, but they didn’t qualify for unemployment benefits because they remained employed. With two young children at home, their carefully managed budget began to crumble under rising prices and reduced incomes.What saved them wasn’t extraordinary luck or family wealth. It was the streamlined and expanded government support programs that turned what economists predicted would be a financial apocalypse into a springboard toward financial stability for some families.One analysis of Medicaid work requirements by KKF, a health policy research organization, found that most working people with low enough incomes to qualify for Medicaid typically work for small companies or in sectors, like agriculture, that don’t offer employer-sponsored health insurance, or the rates are unaffordable. In other words, their jobs don’t pay them enough to afford basics, don’t offer benefits, and they have no other choice but Medicaid.There’s no doubt that safety net programs like Medicaid could be improved. They’re rife not so much with waste, fraud and abuse, as conservative lawmakers say – though there is some – but confusing red tape; disincentives to upward mobility, because benefits cut off sharply as soon as incomes start to rise; and cumbersome, punitive rules designed to dissuade people from applying for benefits in the first place.Fueling the Republican drive to slash public benefits is a long-held belief among many conservatives that the reason most people live in poverty is because they don’t work, or don’t work hard enough, and are instead lazing about, dependent on government largesse, and robbing Americans of their hard-earned tax dollars.That view features prominently in Project 2025, the playbook for the Trump administration authored by the conservative Heritage Foundation. The foreword reads: “Low-income communities are drowning in addiction and government dependence.”And it was clearly on display in recent House congressional hearings on how to slash $1.5 trillion from the federal budget in order to pay for extending Trump’s 2017 tax cuts. “That little gravy train is getting ready to run out,” one Republican lawmaker said of federal safety net programs like Medicaid and food and nutrition aid for people living in poverty. “The spigot is getting ready to be turned off.” The billionaire Elon Musk, charged with cutting federal spending, has even posted a meme calling people who rely on federal spending the “Parasite Class”.Here’s another reality check: Three in 10 Americans, more than 99 million people, rely on some form of federal aid to live. That includes nearly half of all children in the United States. Another 52 million households, 41% of all US households, make too much to qualify for public safety net benefits but still not enough to survive. Nearly 40% of Americans would struggle to cover a $400 emergency expense.There is a problem with making policy decisions based on the unfounded belief that poverty is about people with bad moral character making bad choices, or on debunked racial tropes of undeserving “welfare queens.” (In fact, white people make up the largest group receiving public food and healthcare aid.) Shaping policy around false stereotypes, rather than the complex reality, prevents policymakers from working together on real solutions.In fact, if you talk to people living in poverty, what they say they want tracks nearly exactly with what Project 2025 aims to foster: “empowering individuals to achieve economic independence.”“If I earn good money, I’m not going to be looking for benefits. I’ll take care of my bills,” said Blessing Aghayedo, a licensed practical nurse in Minnesota. Instead, she earns barely more than the federal minimum wage, which has been stuck at $7.25 an hour since 2009.Breathing roomIn the Sabeks’ case during the pandemic, expanded Medicaid and enhanced nutrition benefits helped weather health emergencies and soaring grocery prices. Rental assistance prevented them from losing their housing when they fell behind on payments. Stimulus checks and the expanded monthly child tax credit provided crucial cash that covered essential expenses like milk, diapers, children’s clothing, utility bills, and car repairs when they needed a new transmission.Perhaps most significantly, public subsidies for childcare and the Head Start program reduced their childcare expenses from an overwhelming $1,300 per month to $120, enabling Ruaa Sabek to continue working part time and enroll in a banking training program. “I feel like, ‘Oh my God, peace of mind,’” she said of the breathing room the public benefits gave her and her family. As a result, she landed a full-time position in 2023 as a personal banker that pays $45,000 annually with benefits – a dramatic improvement from her previous part-time $12-an-hour cashier job with irregular hours and no benefits.The family is now thriving without public assistance, aligning with decades of research. “You can’t actually figure out how to get to flourishing until you’re in a stable and secure situation,” said Megan Curran, director of policy at the Center on Poverty and Society Policy at Columbia.Research shows that when families have a stable foundation, they are healthier and live longer. Adults are more likely to keep working, and children are more likely to stay in school, graduate, get better jobs, and pay taxes as adults. Even babies’ brain development is improved.And the stability pays for itself: the Child Tax Credit, for instance, returns $10 for every $1 spent every year. The United States remains the only wealthy country with no national paid maternity leave, yet the return on investment for paid family leave is 20:1. For childcare, it’s 8:1.Meanwhile, rather than saving taxpayers a ton of money, as Musk promised, slashing safety-net support ignores the real problem that keeps families from economic independence: 44% of the workforce in the United States, the wealthiest country on earth as measured by GDP, is low-wage, a share far higher than in many economic peer countries.Squeezing families already struggling financially could increase the share of those already waking up hungry, homeless, or worried they soon might be. The United States already has one of the highest rates of child poverty among wealthy countries. The National Academies of Sciences, Engineering and Medicine estimates that high poverty rate costs as much as $1tn a year in lost adult productivity, increased crime and poor health.Childcare is keyIf lawmakers are serious about adding work requirements for safety net programs, then ensuring families have access to affordable childcare is critical. Compared with other advanced economies, the United States invests the least in childcare. That means childcare costs are second only to mortgage or rent for most families who have to pay out of pocket. And federal childcare subsidies for low-income parents come nowhere close to covering those eligible.The lack of affordable childcare sent Kiarica Schields, a college-educated hospice nurse and single parent in Georgia, spiraling into a cycle of joblessness, eviction, instability, and poverty. “Childcare. That’s my issue,” she said.Trump has said he wants families to have more children. Yet surveys show that young people aren’t having children, or having as many as they’d like, because they can’t afford childcare.Kel, a divorced parent of four, wants lawmakers to think of public benefits for families like hers as a short-term investment with long-term benefits. Kel, who asked not to use her last name, fled an abusive marriage, struggles to pay bills, though she works as much as she can, and relies on Medicaid for life-saving physical and mental health treatments for her and her children. “Lifting me and people like me up will have a cascading effect on so many lives in a positive way,” she said. “We will give back to our communities tenfold, a hundredfold. It’s worth that investment in us. We’re a really good investment.”

      Brigid Schulte is the director of New America’s work-family justice program, Better Life Lab, a Pulitzer Prize winning journalist, and the author of Over Work: Transforming the Daily Grind in the Quest for a Better Life and the New York Times bestselling Overwhelmed: Work, Love and Play when No One has the Time. Haley Swenson is a research and writing fellow for the Better Life Lab More