One year ago President Donald Trump promised to “love and cherish” Medicaid. Alas, his affection for the public insurance program was short-lived. The so-called One Big Beautiful Bill Act (OBBA) he signed into law on July 4—the most sweeping health care legislation since Barack Obama’s 2010 Affordable Care Act (ACA)—slashes about $1 trillion in federal health care spending, mostly from Medicaid, over the coming decade. The spending reductions fund tax cuts for the wealthy and a surge in spending on immigration enforcement. As an ICU physician at a safety-net hospital system that largely serves publicly insured, low-income communities north of Boston, I may see some of the effects of the law’s cuts firsthand. Around half of our system’s gross patient revenue comes from Medicaid, which covers more than 70 million Americans. What these cuts will mean for hospitals like mine is uncertain: some providers could face severe financial strain or even closure if Medicaid revenues plunge. But for Medicaid enrollees themselves, there is little doubt that the cuts will translate into inadequate care, increased debt, …