On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act into law—establishing a critical safety net that continues to support seniors, low-income individuals, and families across the country. These programs have endured for nearly six decades.
Medicaid in particular has been a steady source of coverage for vulnerable communities through some of our country’s most difficult periods, from the War on Poverty to the Great Recession and the COVID-19 pandemic, helping millions access the care they need. And it continues to support those who may otherwise be uninsured.
As we approach Medicaid’s 60th anniversary, Congress is considering legislation that would threaten the progress we have made to support people in need.
The budget reconciliation package, also referred to as the “One Big Beautiful Bill Act,” would abruptly create some of the most significant changes to the U.S. healthcare system in years. The bill would harm foundational components of Medicaid, prompt funding cuts and coverage loss, and cause millions of working Americans to lose their private health plans obtained through the Affordable Care Act (ACA) Health Insurance Marketplace.
As the President of Ascension, one of the nation’s largest nonprofit health systems, I recognize the need for reform that improves care delivery and lowers costs. Guided by our mission, I also believe that protecting access to affordable coverage and care, especially for the poor and vulnerable, must remain a national priority.
Supporters of the bill and a recent proposal from the White House state that the changes are intended to address waste, fraud, and abuse. While that is an important objective, the approach risks weakening elements of Medicaid that are essential to the stability of the program and the broader health care system.
Here is the reality: Medicaid makes it possible for one in five Americans to access affordable medical coverage, notably supporting 63% of nursing home residents, nearly half of all children, and 44% of non-elderly disabled individuals. Roughly 20% of patients who receive care at an Ascension facility are Medicaid beneficiaries, including more than 41% of the roughly 75,000 babies we deliver each year, or are uninsured.
It is important to note that Medicaid already does not cover the full cost of care. Even with state-directed payments, Ascension is reimbursed only 66 cents on the dollar for Medicaid patients. In our last fiscal year, this resulted in a $1 billion shortfall. This is not a challenge unique to Ascension—it affects every provider that cares for the more than 70 million Medicaid beneficiaries across the country.
The proposed changes to Medicaid and the ACA marketplace would shift significant costs onto state taxpayers, providers, and most importantly, patients. The current legislation would limit essential financing tools that states rely on to reduce Medicaid shortfalls—tools that help hospitals deliver needed care while maintaining financial stability. The White House’s proposal would push these restrictions even further, worsening the financial strain on hospitals nationwide.
The end result, regardless of the stated goals, would be millions of Americans losing their health coverage, setting back our collective efforts to make healthcare more accessible and affordable.
Sudden, substantial cuts would increase the number of uninsured and cause more patients to delay care until their conditions worsen, crowding emergency rooms and hurting health outcomes. These cuts would also strain provider finances and increase the risk of service reductions and closures, severely impacting access to quality care not only for Medicaid beneficiaries, but for everyone. Hospitals in underserved areas like rural communities would be hit hardest, as they often rely on Medicaid payments to cover essential care costs.
Ascension is a mission-driven health system, rooted in our Catholic identity and called to care for all, regardless of ability to pay or coverage status. Last year, we provided $2.1 billion in care to people living in poverty and other community benefit programs. Like many nonprofit health systems, we routinely experience low reimbursement rates from government programs that don’t cover the full cost of care.
The proposals under consideration in Congress would place Ascension and similar health systems in extremely challenging scenarios and severely compromise our collective efforts to expand healthcare access, reduce the cost of care, address chronic illness, and help people stay out of hospitals. Ultimately, they would negatively impact the communities that have relied on us for their care for years, if not decades.
More than two-thirds of Americans oppose cuts to Medicaid. It is no surprise that leaders from both parties have expressed their desire to protect the program from cuts and make sure vulnerable people don’t lose their coverage. Unfortunately, the proposals in the current version of the bill do not meet that standard. Medicaid has a long and meaningful legacy—and it deserves a brighter future.
Eduardo Conrado is the President of Ascension, one of the nation’s largest faith-based, nonprofit hospital systems.
