Public health expert: Trump’s “big, beautiful bill” will cause misery and death

A government’s budget is about much more than numbers: It’s a moral document that reflects a nation’s values. Chief among those should be providing for the most vulnerable. This includes guaranteeing health care for Americans; shoring up Medicare, Medicaid and the Affordable Care Act; providing food assistance to needy people, including the elderly and children; funding science and medical research; and requiring the very richest to pay their share of taxes.

Within this framework, it’s clear that Donald Trump and the GOP’s One Big Beautiful Bill Act is a moral failure in the making, where values of greed, cruelty and sociopathy masquerade as responsible public policy. In a recent interview with “Democracy Now!,” Rev. William Barber correctly described it as the “Big, Ugly, Destructive, Deadly Bill.”

If enacted, the legislation will further tear apart an already weak social safety net and strip health care from millions of Americans. Medicare, Medicaid and the Affordable Care Act (ACA) will be cut by more than 1 trillion dollars. The massive tax cuts from Trump’s first term will be extended. Hundreds of billions will be spent on defense and the administration’s mass deportation campaign against undocumented immigrants. The legislation will create one of the biggest transfers of wealth in American history: hundreds of billions of dollars — and likely trillions — of dollars will be taken from the poor, working class, and the middle class and given to the wealthiest Americans and corporations. According to the nonpartisan Congressional Budget Office, the bill will cause the federal deficit to explode by at least $3.3 trillion over 10 years.

The very richest Americans already have more wealth than they could reasonably spend in several lifetimes. For example, the top 10 percent of Americans control approximately 70 percent of the nation’s wealth. By comparison, the lower half of the American population controls a pitiful 2 to 6 percent of the nation’s wealth. The amount of wealth owned by the American middle class is less than that owned by the top 1 percent.

Wealth and income are directly correlated with how long a person lives and their quality of life. At its core, the “Big Beautiful Bill” will help the rich to live longer and be happier while everyday Americans will live even shorter and more miserable lives.

In early June, Dr. Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health, joined with other public health and policy experts at Yale and the University of Pennsylvania in signing an open letter to Democratic Sens. Ron Wyden of Oregon and Bernie Sanders of Vermont, both of whom serve on the Senate Finance Committee. The group, in warning about the bill’s potential impacts, predicted the unnecessary deaths of at least 51,000 people each year in the United States.

In a recent conversation, Dr. Galvani explained how public health is directly connected to the health of American democracy and why authoritarian governments cause sickness, death and shorter lives for the people who suffer under them.

America’s democracy crisis is not just one discrete thing. It overlaps with most, if not all, areas of society and life. What do we know empirically about the impact of authoritarianism on public health and well-being?

Authoritarian regimes often suppress scientific inquiry, censor data and discredit experts, which is devastating for public health. Accurate data and open scientific discourse are fundamental for identifying health threats, developing effective interventions and responding to crises (e.g., pandemics). Politicizing science leads to a misinformed public, hindering effective health behaviors.

Resources may be diverted away from essential public services, including health care, toward security apparatuses or to benefit favored elites. Corruption can siphon funds meant for health infrastructure, drug procurement or service delivery.

Authoritarian systems often exacerbate existing social and economic inequalities, which are direct drivers of health disparities. Vulnerable groups may lose protections and access to services.

Science used to be a nonpartisan issue. It’s disheartening that public health has become so politically polarized.

Republican-led red states and regions of the country have much worse health outcomes than Democratic-led blue states and regions. This is a type of experiment where we can literally see how divergent approaches to public health and the social can impact a person’s life.

There’s a clear divergence in health policy choices. “Blue” states generally embrace policies that expand access, such as Medicaid expansion under the ACA, more robust social safety nets, higher minimum wages and stronger environmental regulations. “Red” states, conversely, often resist Medicaid expansion, pursue more restrictive reproductive health policies and may have less stringent environmental or worker protection laws.

These policy differences frequently correlate with significant disparities in health outcomes. States that expanded Medicaid tend to have lower uninsured rates, improved access to care, better management of chronic diseases and reduced mortality from conditions like heart disease and cancer… States with more restrictive policies often see higher rates of uninsured individuals, worse maternal and infant mortality rates and greater burdens of preventable diseases.

Beyond direct health policy, differences in approaches to education, social welfare and economic equity also contribute to health disparities. “Blue” states often invest more in these social determinants of health, which ultimately yield better health outcomes.

What of the much-discussed claims about the “deaths of despair” among “working class” white people (and now Black people and First Nations and other marginalized communities) in the long Age of Trump, and how the country arrived at this point?

Deaths of despair highlight the critical need for comprehensive policies that address economic insecurity, ensure equitable access to quality healthcare (including mental health and substance abuse treatment), rebuild community infrastructure and combat systemic racism and discrimination.

Trump’s “big, beautiful bill” is, like other public policy, something that can be evaluated in terms of its impact on public health and well-being, life chances, life outcomes and literally how long a person will live. What do we know?

The proposed budget prioritizes fiscal austerity and reduced government spending over a robust social safety net and access to health care. It suggests a view where health care is primarily a market commodity rather than a fundamental right, shifting responsibility from collective provision to individual burden.

Loss of health care access is a primary concern, as millions would lose essential health insurance, leading to delayed or forgone care, increased financial hardship and worse health outcomes.

While intended to save money, neglecting preventive and early care often leads to more expensive emergency room visits and hospitalizations for advanced, preventable conditions. Families face devastating medical debt from uninsured care, depleting savings, increasing poverty and perpetuating intergenerational cycles of disadvantage. Families bear an increased burden of care for sick relatives who cannot access formal health care, impacting their own health, finances and ability to participate in the workforce. Cuts to Medicaid and subsidies disproportionately affect those with limited financial resources.

51,000 is a very conservative estimate of the unnecessary deaths that will occur if Trump and the MAGA Republicans’ 2025 budget is enacted. What of shortened lives? Community impact from lost income, wealth, social capital and other resources and supports? Trauma from this type of shock to norms, and the anxiety and extreme stress that will result? These are not just abstractions. We have to connect systems and institutions to individuals.

The 51,000 deaths figure represents outright mortality. However, for many more, the lack of care or delayed treatment would lead to preventable illnesses, chronic conditions getting worse, increased disability and years of life lived in poorer health. This represents a significant loss of healthy life years and a reduction in overall well-being.

Premature deaths mean lost contributions to the workforce and economy. Illness and disability due to a lack of care also reduce productivity and earning potential for individuals and their families.

Iowa Republican Sen. Joni Ernst recently [spoke to] her constituents who were worried about what will happen to their lives if [the bill] is enacted and Medicaid, Medicare and health care more broadly is cut. “We are all going to die,” she told them. What would you tell Ernst if you had a chance to have a conversation with her?

The callous suggestion that cuts to life-saving programs simply accelerate an inevitable outcome ignores the vast body of evidence showing how these services add years of quality life, reduce suffering and allow individuals to contribute meaningfully to their families and communities.

When this vile bill is forced on the American people, what will it mean for the overall well-being and quality of life?

Short-term: Millions would immediately lose health coverage, leading to higher rates of delayed or foregone medical care. Individuals and families would face immediate, drastic increases in out-of-pocket medical costs and medical debt, pushing many into poverty. Widespread fear and uncertainty about health care access and financial security will immediately impact mental well-being. Patients with chronic diseases would see their conditions worsen due to a lack of access to medications and ongoing care. As primary care becomes less accessible, emergency rooms would likely see an increased burden of preventable conditions, which is a far more expensive and less effective way to deliver care.

Mid-term: The 51,000 projected deaths would become an annual reality, steadily increasing the nation’s mortality rate from preventable causes. National health metrics (e.g., infant mortality, life expectancy, rates of chronic disease management) would likely decline. A sicker, less productive workforce, coupled with increased medical debt, could depress economic activity and further strain state and local budgets.

Long-term: Decreased Life Expectancy. The U.S. life expectancy, already lagging behind many peer nations, could further stagnate or decline.

Children who grow up without adequate health care suffer long-term developmental and health consequences, perpetuating cycles of poor health and poverty.

Cuts to scientific research and public health infrastructure would cripple the nation’s ability to respond to future health crises (e.g., pandemics, emerging diseases) and diminish its capacity for medical breakthroughs.