Part 2: The Looming Crisis of Access to Care

by Kim Bergner

This is the second in a multipart series on the Trump administration’s broad attack on Americans’ health. Physician author and Indivisible Weston Co-founder Kim Bergner’s first story explained the rise in preventable diseases. Future stories will examine the current administration’s attacks on women’s healthcare and the rise in environmental hazards. 

Why is this administration dismantling our healthcare infrastructure? 

Knowledge is power. That’s why authoritarian governments want to limit our knowledge and spin their own self-serving narratives. An informed and healthy society is a powerful society. By sowing distrust in science and experts, attacking health care coverage, attacking every system that specifically promotes women’s health, and defunding critical medical research, the Environmental Protection Agency, the Food and Drug Administration and the Federal Emergency Management Agency — the Republicans in the federal government are weakening American society and putting us all at risk. 

Trump 2.0, along with the Republican majorities in Congress and the Supreme Court, have taken regressive actions that endanger everyone’s health and safety, but the impact is most severe for the least privileged sectors of society. While budgets for healthcare are slashed to an unprecedented degree, tax cuts for the wealthy abound. Loss of access to care is one cause of the increased risk of disease in our communities. 

Funding is critical

Without funding for high quality scientific and medical research and with the firing of experts who could apply the results of that research with integrity, we are losing access to life-changing medical advances, preparation for pandemics, and management of the health effects of climate change. 

As the government proceeds with Medicaid and Medicare cuts and the mass deportation of immigrants, our aging parents, neighbors and selves will have difficulty finding high quality care. Without insurance to cover preventive care more people with advanced stages of illness will overwhelm emergency rooms and hospitals where they will treat patients without reimbursement. Meanwhile, hospitals are losing funding for resources that support quality of care and are sometimes forced to close. There will be higher demand for and lower supply of hospitals around the country.

Finally, the changes in health care systems will impact our individual finances as well as the health of businesses and the national economy. 

America’s Affordability Crisis

Republicans’ One Big Beautiful Bill Act (OBBBA), that cuts over $1trillion from health programs, represents the biggest rollback of federal funding for health care in history. Individuals and families that buy their health insurance under the Affordable Care Act or privately will face higher costs stemming from higher premiums, cuts to subsidies, and increased deductibles. Private, ACA, Medicare, and employer-based insurance will be more expensive. Businesses that provide health insurance for employees will see their expenses rise; some will not survive. 

The Center for Medicare Advocacy says that the cuts will result in an estimated 10 million people losing health insurance coverage. They note that the OBBBA “is still projected to add at least $3.4 trillion to the national debt. It also speeds up the timeline for when Medicare’s trust fund (which pays for hospital care) will become insolvent. If Congress takes no additional action, automatic spending cuts will be triggered, reducing Medicare funding by approximately $500 billion between 2026 and 2034.” 

Axios reports that nationally, since the ACA’s enhanced subsidies expired at the end of 2025, “Out-of-pocket premium costs for over 20 million enrollees in the ACA marketplaces will increase by an average of 75%.”

Will employers take up the slack? “Big employers who’ve tried to insulate workers from rising health costs are changing their thinking as they face another year of steep increases in 2026.” according to Axios. “Corporations appear unwilling to eat a third year of higher-than-expected benefit costs.” Workers will have higher premiums while also contending with inflationary pressures. 

The impacts on Massachusetts

The Boston Globe (paywalled) reports, “Approximately 326,000 Massachusetts residents — almost 5 percent of the entire state population — are expected to lose insurance coverage under the [OBBBA], according to the Congressional Budget Office. Massachusetts will lose an estimated $1.97 billion in Medicaid funding in 2029 (once provisions are fully phased in), according to The Commonwealth Fund. State officials said total cuts to Massachusetts’ federal health care funding could be as high as $3.5 billion annually. And the ripple effects of those cuts could raise costs for businesses and consumers, too.”

Trump policy effects are widespread

The pharmaceutical industry is likely to drive up prices due to the trade deals between the US and the EU. Medications for rare diseases will be even less accessible because OBBBA carves out those expensive medicines from pricing caps.

Although disease prevention was also under attack by the Trump administration, theSupreme Court “upheld a key provision of the Affordable Care Act, ensuring, at least for now, that some 150 million people will continue getting many free, preventive services under the act.” However, RFK Jr., whose beliefs and policies are not evidence-based, will still exercise tight control over the U.S. Preventive Services Task Force.

Health care deserts are growing

Because of decreases in Medicaid and Medicare reimbursement, and because of the vast number of Americans who have no choice but to drop their health insurance, many community hospitals will not survive. The remaining hospitals, in more highly populated areas, will be overcrowded and less efficient. Hospitals in nearly every state are affected, and there will be more healthcare deserts around the country.

The Journal of Urgent Care Medicine reports, “In 2024, a total of 25 U.S. hospitals closed … Most of them cited changing community needs, rising operational costs, and evolving care models.” By August 2025, the article continues, 19 more hospitals had closed, “a pace that forecasts more unstable markets and unmet healthcare needs across the United States.”

This includes hospitals not only in rural areas but also in large urban areas such as Chicago, St. Louis, Washington, D.C., and New York City. “Nearly 800 rural hospitals across the United States are struggling financially with as many as 40% facing the immediate threat of closure, according to a recent analysis citing federal data through June 2025,” the Journal adds. 

The Commonwealth Fund states that “a third of all rural hospitals … are currently at risk of closing because of serious financial problems.” 

And the Fiscal Policy Institute says, “70 of New York’s 156 hospitals get over 25 percent of their net patient revenue from Medicaid or government appropriations” and are therefore “at risk of closure.”

Massachusetts has already lost hospitals

Hospitals have already closed in Massachusetts due to unsustainable health care financing. With increasing numbers of uninsured people, lack of access to preventive and primary care, and hospital closures, the remaining emergency departments are likely to be persistently overcrowded.

An editorial in the The Boston Globe says, “Lawmakers will likely face pressure to raise new revenues through taxes or dip into the state’s $8.1 billion rainy day fund to avoid major cuts to MassHealth benefits or eligibility. But the magnitude of the cuts will make it impossible for the State to backfill the entire amount. At the same time, ripples from the Medicaid cuts will affect the entire health care system.” 

The editorial continues, “The organization Third Way estimates Massachusetts hospitals will lose $424 million annually due to Medicaid cuts. That could force some hospitals to stop providing less lucrative services, like obstetrical care or psychiatric treatment. If Medicaid reimbursement declines, providers could turn to commercial insurance to recoup costs, leading to higher premiums for people with employer-based plans.”

According to the Massachusetts Health and Hospital Association, “The Centers for Disease Control and Prevention…informed public health groups across the U.S. that it was clawing back $11 billion in public health infrastructure grants. According to the Healey administration, Massachusetts is expected to lose $100 million from the cuts. Also, the state’s Department of Mental Health is expected to lose federal funding after the Substance Abuse and Mental Health Services Administration also terminated awards.” 

Activists can play a meaningful role

At the federal level

While Republicans control Congress, Democratic members must play a wedge role — partnering with Republicans who are fearful of losing the next election and willing to block the drastic cuts the president seeks. The New York Times (paywalled) notes that, for example, the president sought a 28% cut to Health and Human Services but got less than 1% (see table). It’s expected that the Trump administration will continue its illegal practice of refusing to spend funds appropriated by Congress. 

You can call your senators and congressional representative to encourage their continued action to fight the illegal impoundment of health care dollars by the White House.

At the state level

We are fortunate to live in a strongly blue state, and one that has funds available for emergencies. Lobbying your state senators and representatives is important to keep them focused on your priorities, since many report hearing chiefly from MAGA constituents. There are typically pieces of health care legislation supported by IMC, Progressive Mass and Act On Mass for which you can advocate. Phone calls are important. 

Another critical activity is attending Lobby Days co-sponsored by IMC and other groups. A highly effective technique for reaching state senators and representatives is to bring a personal story that relates to a needed piece of legislation. If you attend a Lobby Day, you will receive coaching from experienced progressive lobbyists, and you will be among many Indivisibles attending for the first time.

At home

If you have health insurance, unless you are experiencing an emergency, you are strongly urged to receive care from your primary care provider rather than going to the emergency room. Increasingly, going to the ER will be the only option for uninsured members of our communities, there will be fewer open emergency rooms, and they are likely to be overcrowded, underfunded, and understaffed. If in doubt, call your provider’s office about whether your condition warrants an ER visit.

Kim Bergner, MD is a pediatrician and co-founder of Indivisible Weston.