I’ve done both street-level and systems-level work with—and among—the people who are about to lose their healthcare because of the so-called “Big Beautiful Bill.”

I want to dispel a few persistent myths—about the people most affected by this legislation and about what’s actually happening behind the political spin.

1. The Myth of the Idle Poor

One of the favorite talking points of BBB supporters is that this bill only takes Medicaid away from “able-bodied, able-minded” individuals who simply refuse to work. If only that were true.

In all my experience, I’ve never met a person who actually wants to be homeless, who prefers instability, or who wouldn’t welcome connection to services—most of which only become available once you have a permanent address.

I have met countless individuals who are clearly disabled, yet have not been officially classified as such by the Social Security Administration. Why not? Because the process is deeply flawed.

Homeless people, by definition, have no stable, permanent address. That should be obvious.  It should also be obvious that a safety net that requires an address can’t possibly catch or help the most vulnerable.  Homelessness  makes it nearly impossible to receive correspondence, fill out paperwork, or remain in contact with agencies. And even when those hurdles are somehow overcome, the SSA routinely denies initial applications—sometimes automatically.

I’ve seen cases take years to resolve, even when the person has clear medical documentation and even when highly trained social workers and counselors are doing everything right.

Until now, Medicaid has been a critical lifeline during this liminal period—a bridge that allows people to access care while navigating the slow-moving machinery of disability classification. When the BBB kicks in, that lifeline will be cut.

And when it is, thousands of people stuck in this bureaucratic no-man’s-land will be left with nothing. It’s not just immoral. It’s economically reckless.

2. The Myth of Government Waste

Another popular refrain is that Medicaid is bloated, mismanaged, and wasteful—that it’s a drain on public resources and ripe for cuts. But this argument falls apart when you look at the actual impact of the program.

Medicaid isn’t just a health plan. It’s one of our most cost-effective tools for preventing larger-scale social and economic crises. It keeps people out of emergency rooms, where care is exponentially more expensive. It reduces hospitalizations. It lowers incarceration rates and decreases the burden on mental health and addiction systems. In short, it keeps people stable.

Cutting Medicaid in the name of “fiscal responsibility” is like smashing the brakes on your car to save gas. You may feel like you’re saving something now, but you’re setting yourself up for disaster later. We will pay for these problems one way or another. The only question is whether we’ll do it preventively—with dignity and foresight—or reactively, through crisis management that’s far more expensive and far less humane.

3. The Myth of the Deserving vs. Undeserving Poor

Perhaps the most harmful myth of all is the one that divides people into the “deserving” and the “undeserving” poor. We’ve told this story in American policy and culture for generations. It’s the quiet moral justification behind countless cuts, restrictions, and barriers.

But real life doesn’t fit neatly into those categories. People lose jobs. They get sick. They flee violence. They struggle with trauma, addiction, and mental illness—often without support. These aren’t personal failings; they’re deeply human realities, compounded by structural inequities: underfunded schools, unaffordable housing, generational poverty, systemic injustices that cut across race, gender, and geography. 

To speak of “undeserving” poor is to ignore these realities—and to ignore our own responsibility. It allows us to believe that someone else’s suffering is somehow earned, or inevitable, or irrelevant. The BBB doesn’t punish people for poor choices made with the best of intentions.  It punishes them for circumstances they were born or thrust into.  It punishes homeless veterans, opioid addicts, people in poverty regardless of color, and, ironically, it punishes many of the people who think they support it.

What’s more, many people don’t even realize that the healthcare they rely on is Medicaid—because it goes by different names in different states. In some places it’s called MassHealth, in others, TennCare, or Medi-Cal. These programs may feel local or distinct, but they’re all part of the broader Medicaid system. That means people who support the so-called Big Beautiful Bill may not even realize that they’re voting to gut their own coverage—or the coverage that keeps their parents, neighbors, or children healthy. The disconnect is dangerous, and it’s being exploited.

Where This Leads

The “Big Beautiful Bill” isn’t beautiful. It’s devastating. It punishes the vulnerable while claiming to protect taxpayers. It strips essential care from people already fighting uphill battles against illness, poverty, and bureaucracy. And it does so based on myths that are convenient for those in power—but ruinous for the rest of us.