By Keith Senkow
July 2025
While interning with The Global Switchboard, I have been reviewing the Universal Declaration of Human Rights (UDHR). This declaration, although not a legally binding treaty under international law, sets a global standard for fundamental human rights. One of these rights, as outlined in Article 25, is the right to healthcare.
The right to healthcare has long been recognized internationally. Ironically, the origins of this right are here in the United States. Healthcare was listed in the Second Bill of Rights drafted by Franklin Delano Roosevelt. Sadly, FDR’s death kept this Second Bill of Rights from being implemented. Eleanor Roosevelt, however, took his work to the United Nations, where it was expanded and clarified. She became the drafting chairperson for the UN’s Universal Declaration of Human Rights. That committee codified our human rights, including, at Article 25, the essential right to health. The United States, together with all other nations of the UN, adopted these international standards (American Bar Association, 2018).
Even though the United States played a significant role in helping to shape the international standard for human rights, including the right to healthcare, the United States has yet to fully commit to these ideals at home. The U.S. falls short of fully upholding the economic and social rights outlined in the UDHR, particularly the right to health care, education, housing, and social protections. This gap becomes especially clear when examining domestic policy decisions that threaten existing health and social safety nets. One such example is H.R. 1 the so-called “One Big Beautiful Bill” which proposes sweeping changes that could undermine essential programs like Medicaid and jeopardize access to care for millions.
Why This Big Bill Is a Big Problem
We all probably know someone who’s used Medicaid or SNAP (Supplemental Nutrition Assistance Program). Maybe it was a friend who needed help covering healthcare costs during a tough time. Maybe it was a family member who needed support while recovering from surgery or caring for a child. These safety net programs are lifelines and for many, they mean the difference between stability and crisis.
Now, a new piece of legislation H.R. 1, also known as the “One Big Beautiful Bill” is threatening to take that lifeline away.
Despite the name, there’s nothing beautiful about this bill for millions of Americans who depend on Medicaid or gender-affirming care.
The passing of this legislation could roll back critical protections and access to care and introduce harmful policies like Medicaid work requirements. Here’s why that’s dangerous.
Medicaid Saves Lives
There’s no debate Medicaid works.
A recent study from the National Bureau of Economic Research found that expanding Medicaid enrollment led to a 2.5% reduction in mortality among low-income adults. That’s a 21% drop in the mortality hazard for new enrollees (Meyer & Wu, 2023). In simple terms: more people had access to care, and more people lived.
Medicaid isn’t just for people who are unemployed or disabled. Most people covered by Medicaid work, and Medicaid finances about 40% of all births in the United States. These aren’t fringe benefits for a small group—Medicaid is foundational healthcare for a significant percent of the population.
Medicaid Cuts Hurt Everyone
What happens if we cut Medicaid? Experts predict devastating outcomes.
The Keck School of Medicine warns that reducing access to Medicaid could increase deaths and cause financial hardship, especially for those who gained coverage through Medicaid expansion. Millions could delay or avoid necessary care, not because they want to, but because they’ll no longer be able to afford it.
And if you think the proposed Medicaid work requirements will improve anything, think again. "92% of adults under 65 who receive Medicaid and don’t also receive Social Security are already working—without any government-mandated requirement" (Tolbert et al., 2025). This is a solution in search of a problem.
Both CBPP and The Wall Street Journal confirm that "work requirements in these states did not raise employment but increased administrative burdens and coverage loss. For Arkansas, this led to approximately 18,000 disenrollments, and Georgia experienced extremely low enrollment and significant red tape" (Tolbert et al., 2025).
In practice, work requirements don’t help people get jobs they just make it harder to keep healthcare. Arkansas and Georgia have already tried this experiment. Thousands of people lost coverage, not because they stopped working, but because they couldn’t navigate the red tape or prove they met the requirements in time.
Gender-Affirming Care Saves Lives, Too
Another critical aspect of H.R. 1 is its chilling effect on gender-affirming care, a type of care that is both medically necessary and proven to save lives, especially for transgender and nonbinary youth.
A 2022 study in JAMA Network Open found that transgender youth receiving gender-affirming hormone therapy were 60% less likely to experience moderate or severe depression and 73% less likely to report suicidal thoughts (Turban et al., 2022). Those numbers are staggering—and they reflect what countless people and families already know: access to this care matters.
According to The Williams Institute (2022), approximately 1.3 million adults in the U.S. identify as transgender, and about 276,000 of them are enrolled in Medicaid
This isn’t fringe medicine. Every major medical organization in the U.S. including the American Medical Association, the American Academy of Pediatrics, and the American Psychiatric Association supports gender-affirming care as evidence-based, essential, and lifesaving.
As AMA board member Dr. Michael Suk put it: “Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.”
For those out there wondering about their tax dollars funding gender affirming care;
- Total U.S. population: ~330 million
- Adults who identify as transgender: ~ 1,300,000
- Transgender individuals on Medicaid: ~ 165,600
- Estimated individuals receiving gender-affirming care: ~30,360
- Of those, Medicaid-covered: ~7,720
- That’s approximately 0.0023% of the total U.S. population receiving gender-affirming care through Medicaid.
30,360 x (165,600/1,300,000) = 7,720
7,720/330,000,000 = 0.000023 =0.0023%
The Bottom Line
- The “One Big Beautiful Bill” may have a cute name, but it’s packed with harmful policies.
- It slashes Medicaid coverage, threatens gender-affirming care, and undermines critical protections for vulnerable communities.
- This bill endangers the health and rights of working families, people with disabilities, LGBTQ+ youth, and those seeking reproductive care.
- Years of progress are at risk—and real lives are on the line.
- Healthcare is not just a political issue; it's a matter of human dignity and survival.
What You Can Do Now
- Demand repeal or amendments to the most harmful sections by contacting your state and federal lawmakers.
- Support local organizations that provide direct services to communities impacted by the bill.
- Donate to legal advocacy groups challenging the bill in court.
- Share your story on social media or with local media to raise awareness.
- Vote in upcoming elections for candidates who will prioritize inclusive, equitable healthcare policy.
References;
American Bar Association. (2018, November 19). The right to health care: A constitutional and human rights perspective. https://www.americanbar.org/groups/crsj/resources/human-rights/archive/health-care-human-right/
Tolbert, J., Cervantes, S., Rudowitz, R., & Burns, A. (2025, February 18). 5 key facts about Medicaid work requirements. KFF. https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-work-requirements/
Center on Budget and Policy Priorities. (2023). Pain but no gain: Arkansas’ failed Medicaid work-reporting requirements should not be expanded. CBPP.
ProPublica. (2025). Georgia’s Medicaid work requirement blocks its most vulnerable. ProPublica.
Wright, J. D., Chen, L., Suzuki, Y., Matsuo, K., & Hershman, D. L. (2023). National Estimates of Gender-Affirming Surgery in the US. JAMA Network Open.
The Williams Institute. (2022, December). Medicaid coverage for gender-affirming care (Dec. 2022 Report). UCLA School of Law. Retrieved from https://williamsinstitute.law.ucla.edu/publications/medicaid-trans-health-care/
Meyer, B. D., & Wyse, A. (2025). Saved by Medicaid: New evidence on health insurance and mortality from the universe of low-income adults (NBER Working Paper No. 33719). National Bureau of Economic Research. Retrieved from NBER.
United States Congress. House. (2025). One Big Beautiful Bill Act (H.R. 1, 119th Cong.) [Text]. Congress.gov. Retrieved July 22, 2025, from https://www.congress.gov/bill/119th-congress/house-bill/1/text