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Never before in the history of this nation has such a large redistribution of income been directed upward, for no reason at all.
One of my objectives in this daily letter is to equip you with the facts you need. As the Senate approaches a vote on President Donald Trump’s giant “big beautiful” tax and budget bill, I want to be as clear as possible about it.
First, it will cost a budget-busting $3.3 trillion. According to new estimates by the nonpartisan Congressional Budget Office (CBO), the Senate bill would add at least $3.3 trillion to the already out-of-control national debt over a decade. That’s nearly $1 trillion more than the House-passed version.
Second, it will cause 11.8 million Americans to lose their health coverage. The Senate version would result in even deeper cuts in federal support for health insurance, and more Americans losing coverage, than the House version. Federal spending on Medicaid, Medicare, and Obamacare would be reduced by more than $1.1 trillion over that period—with more than $1 trillion of those cuts coming from Medicaid alone.
All told, this will leave 11.8 million more Americans uninsured by 2034.
If the bill now being considered by the Senate is enacted, 11.8 million Americans will lose their health insurance, millions will fall into poverty, and the national debt will increase by $3.3 trillion, all to provide a major tax cut mainly to the rich and big corporations.
Third, it will cut food stamps and other nutrition assistance for lower-income Americans. According to the CBO, the legislation will not only cut Medicaid by about 18%, it will cut Supplemental Nutrition Assistance Program (food stamps) by roughly 20%. These cuts will constitute the most dramatic reductions in safety net spending in modern U.S. history.
Fourth, it will overwhelmingly benefit the rich and big corporations. The CBO projects that those in the bottom tenth of the income distribution will end up poorer, while the top tenth will be substantially richer.
The bill also makes permanent the business tax cuts from the 2017 legislation, further benefiting the largest corporations.
Finally, it will not help the economy. Trickle-down economics has proven to be a cruel hoax. Over the last 50 years, Congress has passed four major bills that cut taxes: the 1981 Reagan tax cuts; the 2001 and 2003 George W. Bush tax cuts; and the 2017 Trump tax cuts. Each time, the same three arguments were made in favor of the tax cuts: (1) They’d pay for themselves. (2) They’d supercharge economic growth. (3) They’d benefit everyone.
All have been proven wrong. Here’s what in fact happened:
(1) Did the tax cuts pay for themselves?
No. Rather than paying for themselves, the Reagan, Bush, and Trump tax cuts each significantly increased the federal deficit. In total, those tax cuts have added over $10.4 trillion to the federal deficit since 1981 compared with the Congressional Budget Office’s baseline projections.
(2) Did the tax cuts supercharge economic growth, create millions of jobs, and raise wages?
Absolutely not. Rather than growing, the economy shrank after passage of the Reagan tax cuts. And unemployment surged to over 10%. Following the enactment of the Bush and Trump tax cuts, the economy did grow a bit, but at rates much lower than their supporters predicted.
(3) Did the tax cuts benefit everyone?
Heavens, no. Rather than benefiting everyone, the savings from the Reagan, Bush, and Trump tax cuts flowed mainly to the richest Americans. The average tax cut for households in the top 1% under the Reagan tax cut ($47,147) was 68 times larger than the average tax cut for middle-class households ($695). The Bush tax cut for households in the top 1% was 16 times larger than the average tax cut for the middle class. The 2017 Trump tax cut for households in the top 1% was 36 times larger than for middle-class households.
Summary: If the bill now being considered by the Senate is enacted, 11.8 million Americans will lose their health insurance, millions will fall into poverty, and the national debt will increase by $3.3 trillion, all to provide a major tax cut mainly to the rich and big corporations. There is no justification for this.
Never before in the history of this nation has such a large redistribution of income been directed upward, for no reason at all. It comes at a time of near-record inequalities of income and wealth.
What you can do: Call your senators and tell them to vote “no” on this calamitous tax and budget bill. Congressional switchboard: (202) 224-3121.
Beyond this, help ensure that senators who vote in favor of this monstrosity are booted out of the Senate as soon as they’re up for reelection.
To eliminate impending Medicaid cuts and other threats to coverage, enact a national, single-payer healthcare system free from all profit, including in the provisioning of care.
In January, 2025, following the shooting of United Healthcare CEO Brian Thompson, National Single Payer and single-payer activists across the country responded to the righteous anger of the people rising against the health insurance industry by writing a “Manifesto,” which included these four demands:
We called for people across the country to join us in the street on May 31 to raise the demand and put single payer on the nation’s agenda, a reference to the Congressional Progressive Caucus’ 2025 Proposition Agenda released last year which conspicuously omitted a national single-payer program from its agenda (or support for a cease-fire in Gaza).
Over 140 local, state, and national organizations, from central labor councils to social justice organizations, from political parties to physicians’ groups, endorsed the four demands, and more than 30 cities in 17 states held actions demanding that single payer be put on the nation’s agenda.
Endorsing organizations representing 28 states plus the District of Columbia were predominately social justice organizations, whose primary mission is not healthcare. Down Home North Carolina, an organization that mobilizes rural communities in North Carolina to improve the lives of working families, endorsed. So did EX-Incarcerated People Organizing in Wisconsin, which works to end mass incarceration. As did the Kentucky Alliance Against Racist and Political Repression, founded to mobilize people of color and whites to take action against racism in their community. Large organizations such as the California Alliance of Retired Americans, representing 1 million members in California, and small ones such as Pride on the Patio, a community that creates safe and welcoming spaces for LGBTQ+ individuals in Frederick, Maryland, endorsed. The call to put single payer on the nation’s agenda is popular beyond single-payer activists.
Together, let’s build a movement as massive as “No Kings Day,” so formidable that it cannot be denied or ignored.
More than 30 actions were held across the country, including in “Trump country” states such North Carolina, Florida, Texas, Kentucky, West Virginia, Michigan, Pennsylvania, Arizona, and Missouri. Whether from red or blue states, people organized to demand that a single-payer healthcare program free from profit be put on the nation’s agenda.
Notably missing from the list of endorsers were faith groups (only two), “big” labor (aside from the Kentucky State AFL-CIO), and “big” national single-payer organizations.
They still need to be convinced that making a demand of the Democratic Party is acceptable and has broad support.
If the demonstrations on “No Kings Day” are any indication, people are furious with the current administration, but they are no less tired of the Democratic playbook. “No Kings Day” rallies, while enthusiastic and well attended, lacked a central bold demand.
In contrast, activists on May 31 made bold demands, refusing to believe the wealthiest country should have a separate healthcare system for the poor, or that we should wait until we are 65 to access a public healthcare system into which we pay all our working lives. On May 31, activists demanded an end to a system where health insurance CEOs, who worry more about “disappointing investors” than patients, control our health. On May 31, we demanded the end of a system where insurance companies get to make trillions of dollars in earnings and spend millions on federal lobbying to influence government officials who write the laws to benefit the owners and not the people who suffer under it.
In times like these, the best defense is a good offense. To eliminate impending Medicaid cuts; to stop imposing work requirements; to end overpayments to Medicare Advantage and the privatization of Medicare; to prohibit narrow networks, prior authorizations, and delays and denials of care; to end deductibles, medical debt, and bankruptcy, and to negotiate at the bargaining table for higher wages: enact a national, single-payer healthcare system free from all profit, including in the provisioning of care.
National Single Payer and other organizations are going on the offensive, working with labor unions to fight for single payer and mobilizing members of Congress, especially those who have endorsed Medicare for All legislation, to make national single payer a publicly visible fight by asking them to commit to:
On May 31 activists from local organizations gathered to demand the healthcare system this nation deserves.
Moving forward, let’s demand our elected officials speak out, support, discuss, write, talk, and improve current Medicare for All legislation. Together, let’s build a movement as massive as “No Kings Day,” so formidable that it cannot be denied or ignored, a movement of millions in the street and in the workplace to put single payer on the nation’s agenda and heal this country once and for all.
Transgender Americans—like all Americans—deserve Medicare coverage; nevertheless, their access to healthcare is at risk.
The U.S. House of Representatives passed a budget bill that promises a sweeping dismantling of critical public programs that millions of people rely on, including food stamps, Medicaid, and federal education loans. Buried inside the bill’s thousand-plus pages are provisions that specifically target healthcare for transgender people, including an outright ban on Medicaid coverage for transgender people of all ages.
These provisions are the latest escalation of the immense and overwhelming political attacks on transgender people in America over the last several years, which already include a ban on transgender military members, limitations on participation in sports for children, and openly spreading falsehoods about transgender youth and the healthcare they receive. Instead of focusing on the stigma, violence (which is disproportionately experienced by Black transgender women), and discrimination transgender people face every day that results in severe health disparities, higher rates of poverty, and premature deaths, legislators all over the country are enacting policies that perpetuate these very issues.
Between this congressional budget legislation and the Trump administration’s assaults on transgender youth, military service members, and veterans, concern is growing that this administration’s war on transgender people will soon include efforts to strip transgender Medicare beneficiaries of essential medical coverage. Medicare was created with the intention of ensuring that American adults have access to vital healthcare services as they age and can no longer work, and it has grown to become one of the most well-supported and positively viewed government programs of our time. Weaponizing the Medicare program to impose a political agenda in place of expert medical standards of care would be a deeply concerning development with serious ramifications not just for transgender Medicare beneficiaries but for the practice of medicine in America as a whole.
The issue policymakers should be tackling is not banning medical care for transgender youth or adults but rather ensuring that all people, including Medicare beneficiaries, can access the medical care they need.
According to expert standards of care in transgender health, medical care for transgender people is carefully tailored to align with the recommendations of healthcare providers and each person’s individual needs. To examine the frequency and trends of one particular form of care—gender-affirming surgical procedures—for Medicare beneficiaries, my team and I recently published a study using Medicare claims data. While these surgical procedures are not part of the routine standard of care for transgender youth, they are a medically necessary and important part of care for many transgender adults.
We found that gender-affirming surgeries are exceptionally rare in the Medicare program and that transgender Medicare enrollees in the South are less likely to receive surgery compared to those in the Northeast with similar characteristics (e.g., race, ethnicity, age). These findings stem from discriminatory policies that result in inaccessibility. Medicare beneficiaries face barriers to receiving gender-affirming surgeries because of a lack of access to surgeons, inconsistent and unclear coverage policies, coverage denials, and high out-of-pocket costs. These barriers represent structural forms of stigma that may be particularly elevated for racial and ethnic minoritized populations due to racism. Thus, the issue policymakers should be tackling is not banning medical care for transgender youth or adults but rather ensuring that all people, including Medicare beneficiaries, can access the medical care they need.
Transgender people are under political, social, and legal attack with such intensity that it is easy to lose sight of who—and how many people—are actually directly impacted. To put our study’s findings into context: In 2019, 37.9 million people received their Medicare benefits through Traditional Medicare (our study focused on those with Traditional Medicare and excluded those with private plans, known as Medicare Advantage). Of these nearly 38 million people, we were able to identify about 35,000 transgender adults, which is 0.09% of the Traditional Medicare population. Of this small number of Medicare beneficiaries who are transgender, 1.4% received a gender-affirming surgery in 2019. In other words, less than one one-hundredth of a percent—or 0.001%—of this Medicare population was transgender and received gender-affirming surgery.
Not only is the number of transgender Medicare beneficiaries small and the number who received gender-affirming surgeries much smaller, we also observed a decrease in the number of transgender Medicare beneficiaries who received gender-affirming surgeries over time. This downward trend is unique to the Medicare program, further highlighting access issues for transgender people with Medicare coverage.
To put an even finer point on it: We included a cisgender, or non-transgender, cohort in our study because the same surgeries transgender people need are also often received by cisgender people (e.g., hysterectomies). Overall, each year, about 0.5% of our cisgender cohort underwent procedures that could be considered gender-affirming for transgender people. Our team wanted to see if transgender Medicare beneficiaries face any disadvantages in receiving needed surgical care compared to cisgender beneficiaries. We found that, unlike transgender people, there were no significant differences in the receipt of surgery based on where cisgender people lived. In other words, a cisgender person residing in New York was just as likely to receive a surgery they need as another cisgender person in Texas with similar characteristics. Our findings indicate that transgender adults with Medicare may be uniquely unable to access needed care both because of who they are and where they live.
It is timely and crucial to highlight the facts about gender-affirming care and the Medicare program: Our study suggests that transgender Medicare beneficiaries already face unique access issues when seeking medically necessary care. Just like all Medicare beneficiaries, transgender people are deserving of Medicare coverage. Just like everyone else, transgender people should have the ability to access the care that they need from providers they trust without politically motivated, anti-science barriers imposed by the federal government. Yet transgender people continue to be singled out in political attacks that deny them access to care and services that remain accessible to non-transgender people. This issue has already made its way to the U.S. Supreme Court—which could have dire consequences for the health of transgender people of all ages.
The amount of effort, time, and resources being used to target (and scapegoat) such a marginalized group—and to limit their ability to access medically necessary care, no less—is harmful, imbalanced, and malicious. It is also anti-science. Gender-affirming care is cost-effective, associated with improved mental health outcomes, and considered medically necessary by every major medical organization in the U.S., including the American Medical Association, the American Psychological Association, and the American Psychiatric Association. Polling shows most Americans do not want policymakers to focus on the transgender community. With severe federal budget cuts looming, policymakers should, instead, do something useful and positive: They should act to ensure that all people, including transgender people, can get the healthcare they need.