The moment we walked into the patient’s room, my partner knew the infection was bad. He, a seasoned emergency medical technician, and I, who had worked on the job on and off for about a year, found the patient, a 55-year-old man, lying down in front of us watching a local news TV station.

We had been called by his rehabilitation facility, in the Bronx overlooking Yankee Stadium, with concerns about an infection on his right hand. It was immediately clear why the staff had concerns: His thumb was tightly wrapped with gauze and cravats. The patient swung his legs over the side of the bed to get ready to go—exposing that his left leg had been amputated below the knee. While he struggled to put his shoe on with his one good hand, I offered to help. He declined, gruffly reminding us that he needed to learn how to do it himself.

The patient, born and raised in Brooklyn, refused any help throughout the transport. It was important for him to practice hoisting himself up with his arms onto the stretcher and important for him to make all his seat adjustments. Before we left, he shouted for us to grab the blue Mets ballcap sitting on his dresser. Even the small action of putting the cap on his head with one hand was a struggle.

His ride to the hospital was paid for by Medicaid. In the years to come, millions of ailing or elderly Americans like this patient could find themselves falling through our already frayed social safety net and left to fend for themselves more than they already are.

On July 4, President Donald Trump signed the federal budget legislation he dubbed the “One Big Beautiful Bill” into law. This bill continued the 2017 tax reductions for wealthy Americans, while, the Kaiser Family Foundation estimates, cutting Medicaid funding by $1 trillion over the next decade. Medicaid, established in 1965 along with Medicare for the elderly and disabled, is the primary health insurance for 71 million low-income people—one-fifth of the country’s population. That number does not include people who are enrolled in specific Medicaid-covered services.

These cuts will be implemented mainly by tightening eligibility requirements. To receive Medicaid, “able-bodied” individuals will have to verify every month that they did 80 hours of work or volunteering, or prove that they are enrolled in school. This is more likely to trap people in a bureaucratic hellscape than it is to weed out people who are “refusing to work.” In 2023, when the state of Georgia implemented similar work-related activity requirements for Medicaid recipients, it led to many people losing insurance—often because the bureaucracy made it too difficult for them to prove that they were complying with the requirements, William Dow, professor of health policy and management at the University of California at Berkeley School of Public Health, said in July. The federal government is off-loading the responsibility of verifying this work requirement to the states, who undoubtedly will have to fill the hole left in healthcare for their residents.

A question that often comes to my mind is how the Trump administration will define “able-bodied.” As an EMT and medical transport, I encounter a wide range of patients and people on Medicaid that require care. Every disability, every sickness, and every injury is distinctive. One day my partner and I will care for a woman experiencing abdominal pain. She has a chronic disease that leaves her hooked up to oxygen and connected with a urinary catheter, and receives 24/7 care from multiple female family members in a cramped ground-floor apartment. Then our next call will be for a 17-year-old psych patient who is asking about what will happen to his insurance when he turns 18 the following week.

The Trump administration says its cuts to Medicaid are part of its larger campaign to rid the federal government of “waste, fraud, and abuse.” But according to Benjamin Sommers, Huntley Quelch professor of healthcare economics at Harvard University’s School of Public Health, “The federal government can’t start to achieve meaningful savings unless it removes people from the program, cuts benefits, or lowers reimbursement rates to healthcare providers, which are already low.”

A study the university did after Arkansas introduced work requirements in 2018 for Medicaid recipients ages 30 to 49 found that more than 95% of the people the policy targeted were already in compliance—working, studying, caring for family, or living with a qualified disability that kept them out of the workforce, Prof. Sommers said. Despite that fact, the study found a significant increase in people dropping out of Medicaid after the work requirements took effect.

The Trump budget will most likely cut costs by slashing enrollment by 7.8 million people, according to the recent analysis by the Congressional Budget Office. That cost will be felt by all participants in the American healthcare system, as health facilities brace for the influx of uninsured patients, which implies more unpaid medical bills, which leads to the facility raising the price of care for everyone else.
The back of an ambulance is often an emotional place for people. Our Bronx patient told us stories of an active life and a son who lives far away. I asked how he lost his leg, and he just replied solemnly, “sepsis.” Sepsis is a life-threatening disorder caused by an infection being left untreated for too long, an inappropriate response from the body’s immune defenses that causes them to turn on the body. That can lead to organ failure.

His medical history showed that when he finally saw doctors about his leg, they could already tell that it was too far gone and endangering the rest of his organs.

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