America’s Healthcare Is About To Get Worse

Written By Leeja Miller

Sources:


Transcript:

You’re tuned into Why, America? I’m Leeja Miller. With the passage of the One Big Beautiful Bill Act, Trump has taken another step in the erosion of our already fraught healthcare system in America. Upwards of 17 million people will lose healthcare coverage, funding for hospitals will be gutted, and this will combine with the other measures Trump has already taken to alienate foreign doctors, gut the VA medical system, disincentivize students from attaining medical degrees, and more, to create a truly hellish picture for the future of medicine in the United States, one that will impact you no matter where you live and what healthcare coverage you have access to. Today, we’re unpacking the impact of Trump’s policies on the US healthcare system and how they’re all working together to absolutely screw us over.

The reality is that the American healthcare system wasn’t impressive to begin with. We allow pharma companies to overcharge us, there are very little protections in place for people with pre-existing conditions, health insurance is a for-profit industry that makes affording medical care nearly impossible, leading to millions of preventable deaths, it can take months to get in to see your regular physician so millions and millions of Americans rely on urgent care and the ER for all their medical issues because getting in to see a regular doctor with any urgency is impossible. Then if you have overlapping conditions forget about it, you’ll get tossed around from doctor to doctor, none of them will talk to each other or coordinate care, and most of the care they DO coordinate will be denied coverage by the health insurance companies doing everything they can to never pay a red cent for anything. So it doesn’t feel great to consider that this could all get WORSE, but that is the reality we are looking at now with the passage of Trump’s big dumb bill. And the issues are compounding, so any one of the problems we’re facing would be difficult to overcome, but laid on top of one another they will debilitate the healthcare industry.

Often, the way news outlets report on a story differs depending on the bias of the publication. Sometimes, the bias is obvious by the silence on an issue from one side of the political spectrum. That is clearly the case when it comes to how Trump’s policies will impact healthcare in America. This headline from The Hill caught my eye “Trump’s megabill will hurt the health of his own voters.” It’s helpful to see in the Ground News browser extension that this publication is pretty centrist, so to get a fuller picture of the story on all sides of the political spectrum I can click on Full Coverage. On the Ground News website I can see that 134 sources are covering this topic, with only 5% of that coverage coming from the right.

Left leaning The Daily Kos uses the headline “The Collapse of Rural Medical Care Caused By the OBBB Has Already Begun” while right leaning publication DNyuz uses the headline “Dingell on BBB: A Lot of Republicans ‘Don’t Understand’ What They Voted For.” But otherwise, right-leaning publications have been mostly ignoring the issue. And the silence is deafening. Depending on where you or your family members get the news, you’re going to get very different takes on the same story, or, if you only pay attention to one side or the other, you might miss certain news entirely.

This is where Ground News comes in - and why I've been using them for over a year. Today’s partner Ground News is an app and website that offers tools to help you critically analyze the news you read, providing context to understand the full picture.

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One of the biggest issues facing the medical profession that has gotten a lot of press is what’s called Brain Drain. Where highly educated people leave a country that is no longer supporting their work. According to reporting from NPR, quote “the number of American doctors creating accounts on physiciansapply dot ca, which is "typically the first step" to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada's most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump.” CanAm Physician Recruiting which has been bringing doctors from the US to Canada since the 90s stated that the pull toward Canada has never been stronger. They’ve seen a 65% increase in American Doctors looking for jobs since the inauguration. Across Canada physicians groups and provinces are reporting a notable uptick in American doctors seeking to get licensed up north. In fact, since the inauguration, Doctors Manitoba, a group from the rural province that has one of Canada’s worst doctor shortages, has been actively advertising in states like Florida and North and South Dakota, trying to get physicians to move north in exchange for quote “zero political interference in the physician patient relationship.” And that’s just Canada, numerous other countries where physicians are more supported and are able to do their work without worrying about dealing with big pharma, health insurance companies, and saddling their patients with life-crushing amounts of debt, are no doubt becoming more and more enticing to US-based physicians who are already experiencing unprecedented levels of burnout thanks to existing shortages, underfunding, administrative burden from dealing with health insurance companies, and the trauma of practicing through COVID. It’s impossible to tell the full extent of the exodus at this point as the consequences of what Trump is doing will take years to reverberate, and people leave the US for a variety of complicated reasons, but it is safe to say that there is a surge of US-based physicians, born, raised, and trained in the US, who are considering moving and practicing abroad as a direct consequence of Trump’s actions and the dysfunctional state of medical care in the United States.

That being said, the number of US-born physicians looking into leaving compared to the number that will actually make the leap is very different and likely makes up a relatively small, though still significant, percentage of the overall physician population in the United States. The bigger issue currently facing the medical profession in the United States is the extent to which we deeply rely on foreign born and trained physicians in this country. The role that foreign-born doctors play in our medical system truly cannot be overstated. The Association of American Medical Colleges projects that the US will likely face a significant physician shortage within the next 11 years. Certain areas of the country are already facing shortages. Up to 90% of rural and underserved counties lack access to basic specialists, like cardiologists and OBGYNs. Currently there are over 1 million practicing physicians in the US. Nearly 25% of them attended a foreign medical school. And there are some specialties that have an overwhelming number of foreign-trained physicians. 41% of critical care physicians are foreign-trained. 52% of geriatric medicine doctors are foreign-trained at a time when boomers, the largest generation in history, are becoming, well, geriatric. 40% of residents in internal medicine are foreign-trained. Internal medical doctors are responsible for treating the conditions that kill Americans at some of the highest rates, like diabetes and heart disease. And foreign-trained doctors make up a significant portion of the new doctors entering practice in this country. According to the New York Times, quote “This year, there were about 40,000 residency positions offered through the national match system, but only 28,000 graduates of U.S. medical schools. Foreign residents fill a crucial labor shortage.”

Additionally, many foreign-born doctors are willing to take jobs in places where US medical trainees tend not to go. For example, 300 resident positions were vacant after the match process was complete–there were no physicians that wanted to work there. Those 300 spots were filled by international medical residents. Residents, for those of you who haven’t watched Grays Anatomy, are the new medical school graduates who are required to complete their training by working for several years under the supervision of more experienced doctors. This is a critical part of the medical training needed for doctors to gain the skills they need to practice. If you’ve ever known anyone who’s gone through the process, it includes unconscionably long shifts, incredible amounts of overworking, often high stress situations, and all for relatively low pay. And medical residents are the backbone of any hospital, they are likely the first doctor you see in the morning when you’re a patient in a hospital, they are vital for the functioning of any hospital especially as more senior doctors leave to start their careers elsewhere. They’re already overworked and underpaid while holding your life in their hands, over a quarter of them are also foreign-trained and likely also now concerned about visa issues, if they manage to even get into the country to begin with. I don’t know about you but that doesn’t exactly give me a vote of CONFIDENCE about any long-term hospital treatment.

These doctors play a formative role in the functioning of our medical system and while some may be choosing to leave like US-born physicians are choosing to leave, because they see practicing in other countries as a better alternative to staying in Trump’s America, many of them want to come to the US to practice, or stay here and practice, but can’t, thanks to anti-immigrant measures taken by the Trump administration that are increasingly hostile to all foreign-born people, regardless of immigration status, regardless of how much they contribute to society, especially if they are associated with institutions of higher learning and/or any of the many countries on Trump’s revived travel ban list of countries, like Afghanistan, Myanmar, Republic of the Congo, Haiti, Iran, Libya, Somalia, Sudan, Yemen and numerous other countries. Medical students are facing academic uncertainty as the Trump regime toys with various schools’ ability to issue student visas. Their first amendment rights are being stripped away and many are remaining silent on issues like the genocide in Gaza out of fear of retaliation that could impact the rest of their lives.

And if they make it through med school to become residents, their futures are still uncertain. Last week hundreds of foreign medical residents were set to begin their medical training, and many of those residents have been delayed due to Trump regime travel and visa restrictions. The Associated Press interviewed one woman who matched to the University of Pittsburgh Medical Center Harrisburg and was set to begin treating patients there this week but had her visa denied because, even though she is highly qualified and a permanent resident of Canada, she is a citizen of Afghanistan. A pause on interviews for J-1 visas for work or study that Trump had initially authorized in May was lifted in mid-June, but numerous US embassies still haven’t re-opened interview slots or have been slow to fill them, and new enhanced vetting procedures for visa applicants include surveillance of applicant social media accounts and other time-consuming procedures, which is derailing the start of careers of numerous foreign-born doctors that wish to practice in the US. An estimated 1000 medical residents were not able to obtain their visas as of mid-June, according to the New York Times. As Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers, told the New York Times, “If international medical graduates can’t start their medical residencies on time on July 1, the ramifications are so far-reaching that it is really unconscionable.” Senior residents leave hospitals in June and go on to start their careers, she noted. Hospitals rely on new residents to replenish their ranks. “If they don’t come on July 1, that leaves a hole in the patient care team,” Ms. Burke said. “Who’s going to pick up the slack?”” The answer? No one, it seems.

But it’s not just a reduction of practicing physicians that hinders the medical field in this country. Thanks to Trump, we are also facing a crisis in reduced funding for research. Thanks to DOGE and other budget slashing measures and anti-DEI initiatives, billions of dollars in medical research funding have been cancelled, with some programs getting terminated right in the middle of the research phase. According to medical news site Medical Xpress, quote “As of July 3, Grant Watch reports 4,473 affected NIH grants, totaling more than $10.1 billion in lost or at-risk funding. These include research and training grants, fellowships, infrastructure support, and career development awards—and affect large and small institutions across the country.” Stephen Jameson, president of the American Association of Immunologists, told Medical Xpress, “"Many ongoing research projects will have to stop, clinical trials will have to be halted, and there'll be the knock-on effects on the trainees, who are the next generation of leaders in biomedical research. So I think there's going to be varied and potentially catastrophic effects, especially on the next generation of researchers, which in turn will lead to a loss of the status of the U.S. as a leader in biomedical research."”

For example, the MOSAIC program was a National Institutes of Health program aimed at providing research funding to underrepresented scientists. This included $100-150,000 for the first two years, then $250,000 per year to launch their own research labs and hire other early career scientists, completing the loop meant to infuse the medical research field with more diverse talent. This was a program launched during the FIRST TRUMP ADMINISTRATION. But since his second term started, the program has been labeled a DEI program, and people in the middle of their 5 year grants, studying things like chronic diseases, are getting their funding stripped, with some programs threatening to attempt to recuperate the already awarded funds. One cancelled grantee was researching specific genes that make people more susceptible to diabetes, an ailment that affects nearly 40 million Americans, and how to find treatments for those who don’t respond well to existing remedies. That is now gone, and furthermore the recipients of the MOSAIC grants and others fear that the grant itself will now be a stain on their resume, something that future employers in the government and at universities will look upon negatively as a “DEI hire” situation or will be too afraid to hire her because of the government’s targeting of any higher institutions or private entities seen as promoting “illegal DEI” initiatives. As NPR reported, quote “Stefano Bertuzzi, CEO of the American Society for Microbiology, which also mentors grant awardees, said the mass termination of MOSAIC and other NIH grants may have a cumulative effect that will stifle scientific innovation for decades. Bertuzzi, who immigrated from Italy in the 1990s because of America's robust funding for science, said scientists will not stay in or flock to a nation where research funding vanishes on a political whim. "We are going to be losing a full generation of scientists," Bertuzzi said. "Other countries in the world will thrive."” Indeed, a March survey conducted by Nature found that fully 75% of US scientists said they were considering looking for jobs abroad, primarily in Europe and Canada. These cuts to research mean we won’t make the medical breakthroughs we otherwise might have, and it means further brain drain as our top research talent leaves or foreign-born talent never arrives, opting instead to work in countries that actually support their work.

Additionally, the attack on institutions of higher learning and student loan options in the US means that a lot of prospective doctors and researchers will never be able to get the training they need to even begin their work. Trump is gutting student visa opportunities and funding, and now the Big Beautiful Bill has created restrictions on access to student loans that are requiring some people to drop out of medical school or forgo it altogether. As we discussed in my episode last week breaking down the One Big Beautiful Bill that was just signed into law, student loan borrowing has new caps and new repayment limitations. This includes caps for professional degrees. Law and medical students are now only allowed to borrow up to $50,000 per year, with a lifetime cap of $200,000 in student loans from the federal government. While no one should ever have to go into that much debt for their degree, the reality is that a lot of medical doctors DO go into over 200,000 dollars of student loan debt to get their degrees and finish their training. Without that funding from the federal government, they will increasingly turn to higher risk private loans or forgo school altogether. And those who do go into large amounts of debt will now no longer have access to deferment for economic hardship and their repayment plans will be limited to either full monthly payments or income-based payments, which is where you pay a certain amount based on your income, and it is often that repayment plan that leaves borrowers paying every month for years and years and somehow still owing MORE than what they originally took out.

These compounding factors will have disastrous consequences for everyone, regardless of who you are or what medical insurance you have, or how much money you have, whether you live in cities or in rural areas. Costs will go up across the board as those who rely on federally funded programs like Medicaid have their coverage slashed. They still need medical care, and their bills will go unpaid, leaving the rest of us to make up the difference in higher costs. Fewer doctors mean even longer waits and lower morale among the doctors that remain who will likely have to function in understaffed, stressful settings. And we’ve been focusing on doctors but of course there is extensive support staff from nurses to admin and so much more that all have to come together to keep hospitals functioning, and they will ALL be forced to operate on smaller budgets, with less staff, with more stressed out, broke patients who don’t have medical coverage, and fighting tooth and nail with the insurance companies of those who do have coverage. This will mean reduced quality of care across the board. But it is truly, as with all of the Trump regime’s policies, the most vulnerable among us that will be hurt the most. People living in poverty will lose their medicaid coverage, upwards of 17 million people. The elderly will have less access to care as doctors and nurses flee the profession, as funding cuts close hospitals and lead to delays in care.

Funding cuts at the VA, the US Department of Veterans Affairs, which was already experiencing extensive issues with funding, hiring freezes, and providing adequate care during the Biden Administration, means that entire hospitals meant to care for our country’s veterans are closing down. Others are seeing mass layoffs of support staff, so even the VA hospitals that remain open are severely restricted in the quality and speed of care they are able to offer patients, and recent reporting indicates morale is incredibly low, leading many of the doctors, nurses, and other support staff that WEREN’T cut in the mass layoffs to decide to leave their work at the VA.

And a recent analysis by the University of North Carolina at Chapel Hill found that more than 300 hospitals, most of them in rural areas, are at risk of closing under Trump’s spending bill. This includes emergency rooms, specialty care, nursing homes, family physicians, and more. Rural Americans will be forced to drive longer distances to receive medical care, which means fewer people will seek that medical care to begin with, and more will die as a result of the distance to the nearest hospital in emergency situations. And when those rural hospitals close, the people who would normally rely on them are then forced to go to the next closest hospital, which may not be prepared for the surge in patient demand. This ripple effect will cause overcrowding at hospitals across the country. And this isn’t an insignificant number of Americans. According to KFF, a nonprofit that studies health care issues, over 20% of Americans, one in five, live in rural areas. And in rural areas, Medicaid covers fully 25% of adults. And despite the provision in the big beautiful bill that provides $50 billion in aid to rural hospitals over the next 5 years, many hospital advocates warn that won’t be enough. For comparison, the bill CUT medicaid by nearly 1 TRILLION dollars. So $50 billion dollars injected back into rural hospitals is just a drop in the bucket in comparison to the overall cut.

And of course there is a sense of schadenfreude that is worth acknowledging–it is in some of the very states that voted for Trump that these cuts will be felt the most. Kentucky alone is set to lose $12.3 billion dollars in Medicaid funding over 10 years. Kentucky has one of the highest poverty rates in the country and fully 1/3rd of its population relies on Medicaid for medical care, including HALF of the state’s children. Kentucky Governor Andy Beshear has warned that the bill will likely lead to the closure of 35 hospitals in his state alone. In the 2024 election, Trump easily won Kentucky with 65% of the vote. Other Trump-voting states that stand to face the largest number of rural hospital closures: Texas, Oklahoma, Kansas, Alabama, Mississippi, and Tennessee. And in Nebraska, a rural hospital based in McCook, Nebraska, has already closed down, citing anticipated federal budget cuts as the reason. Trump won 76% of the vote in the Nebraska county where the now-shuddered hospital is located.

And just 5 days ago, an article was published in the Kerr County Lead with the headline “The Big Beautiful Bill could leave 1,000 Kerr County residents without Medicaid, open gaps for others.” Kerr County is the area in Texas that experienced catastrophic flash floods over the weekend that killed at least 80 and destroyed thousands of homes. Local hospitals in the region will be forced to absorb the unpaid medical bills of those newly non-covered residents, and many rural hospitals may close. The floods this weekend give us a glimpse into the compounding effects of the deteriorating state of this country’s medical care when combined with failure of local and national weather alert systems, also because of budget constraints, and the increased danger of more extreme national disasters because of climate change, which will continue unchecked under the anti-environmental initiatives of the Trump regime. And, once again, some of the worst hit areas will be the ones that voted for Trump, where increased hurricanes, floods, and more will only get worse, and where there will be fewer hospitals available to respond in times of crisis.

But alas the powers of schadenfreude only get you so far, because it turns out we are all interconnected, including with Trump voters, unfortunately. So closures of rural hospitals will have ripple effects across the country, including in blue states and cities, whether it’s nationwide increased cost of care because of lack of federal funding, overcrowding in the hospitals that do survive the cuts, fewer available doctors to seek treatment from, loss of care facilities for our nations elderly, which will then fall on the family members to make up the difference, a loss of future medical research and advancements because it didn’t get funded and the researcher who would have made the discoveries happened to be from Afghanistan, and a further degradation of the United States as a player on the world stage, which has even farther reaching geo-political and economic impacts. The truly catastrophic damage that Trump is doing in the near term and in the long term for the health and wellbeing of everyone in this country is difficult to predict but cannot be overstated. Many people will die, and the most vulnerable people will be hurt the worst.

I like to give some action items so I don’t leave you feeling completely hopeless but even the action items I can think of are mostly only available to able-bodied, economically stable people. I mean at this point its going to be up to states to make up the difference, so everyone can focus on contacting your state and local officials to ask them how they plan to make up the difference–increasing state taxes on the highest income earners, for example. But in the immediate term, I suggest focusing on the things you can control, because that’s all you can do when everything feels out of control. I see this being in two forms: physical and economic. If you have an HSA account through your work, make sure it’s fully funded. Start planning now for how you’ll cover increased health insurance costs–it might not be your insurance, it might be your parent’s insurance that becomes unaffordable. Being economically frugal right now is probably in everyone’s best interest. And then if you are currently physically healthy, practice some gratitude and do everything you can to stay that way. And it’s not in the packaged, heavily marketed health supplements or whatever. It’s making sure you’re doing the basics for preventative health management that so many people neglect: eat fruits and vegetables and legumes to ensure you’re getting enough nutrients and fiber, avoid excess processed food, sugar, alcohol, and smoking, get your 10,000 steps in every day, and prioritize getting 8 hours of sleep per night. No supplement is going to improve your health the way that making sure you’re covering the basics will. I know that it’s SO much easier said than done, believe me I struggle to do all of the above as well, but when you live in a country where healthcare isn’t a right and the government will not provide for your wellbeing, you have to do what you can to take matters into your own hands. It’s not fair but that is what it is. And if you have all those bases covered, consider looking into mutual aid efforts in your area to help others who don’t, whether that’s providing food for meals, helping with childcare or other stressors that prevent people from having the ability to care for themselves, there is so much good that can be done through mutual aid. And if I lived in one of the states where there will be tons of hospital closures, even if I lived in a major city, I would be seriously considering moving to a state with better projected outcomes. Again, this will have ripple effects across the country no matter where you live, but there are a handful of states that have at least promised to try to take care of its citizens in areas where the federal government is failing. Those are, of course, blue states. In Minnesota, Governor Tim Walz has promised to do his best to make up the difference, but said the state just doesn’t have the capacity to fully close the gap. Minnesota state representative Aisha Gomez has introduced a bill that would create a new income tax bracket for high earners as a way to plug the gap. That is something tangible that can be done at the local level, and calling your representatives and pushing for a change locally is much more effective than trying to push for a national change. It’s not a perfect solution, but it is something. Plus Minneapolis has managed to avoid some of the worst rent increases in the country, and the winter really isn’t that bad if you get a good thick coat and some boots, so maybe consider a move up north. All of the states in the union are getting royally fucked over right now, Minnesota is the only state I’d want to be in, but even our legislature is getting overrun with MAGA idiots, so fighting to push for local politics you care about is so important, even if it seems like as a nation we’re screwed.

If you want to support my work, all my videos are completely ad free and uncensored over on Patreon, Patreon dot com slash leeja miller.

Thank you to my multi-platinum patrons Marc, Art, David, R_H, L’etranger (Lukus), Thomas Johnson, and Tay. Your generosity makes this channel what it is, so thank you!

And if you liked this episode, you’ll like the one from last week breaking down the One Big Beautiful Bill.

Leeja Miller
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