Juan Paramore is a hypothetical composite based on the real-world impacts of the Republican “One Big Beautiful Bill Act.” His story illustrates how cutting Medicaid to fund tax breaks for the wealthy destabilizes families, communities, and public health.
The Republican Bill’s Crux: Trade Safety Nets for Tax Cuts
The GOP’s legislation, narrowly passed by the House on May 22, 2025, does two things:
1. Slashes Medicaid by $700 billion over a decade, targeting states that cover undocumented immigrants.
2. Permanently extends Trump-era tax cuts for the wealthy, including:
• A $90,000 annual tax break for households earning over $1 million.
• A corporate tax rate cut from 21% to 15%.
• Elimination of taxes on gun silencers and inheritance taxes for ultra-wealthy estates.
The trade-off is stark: Gut healthcare for vulnerable populations to fund tax breaks for billionaires. The Congressional Budget Office (CBO) estimates the bill will:
• Leave 8.6 million more people uninsured by 2034.
• Add $2.3 trillion to the national debt, triggering automatic Medicare cuts of $500 billion starting in 2026.
How This Targets People Like Juan
Juan, a 45-year-old undocumented immigrant with bladder cancer, relies on Illinois’ Health Benefits for Immigrant Adults (HBIA). The Republican bill penalizes Illinois for programs like HBIA by:
• Cutting federal Medicaid reimbursements by 10% (from 90% to 80%).
• Forcing Illinois to choose: End HBIA or lose $3.2 billion annually to maintain Medicaid expansion for 770,000 low-income residents.
Result: Illinois terminates HBIA on July 1, 2025. Juan loses coverage for:
• Chemotherapy ($12,000/session).
• Medications ($450/month).
• Preventive care to catch cancer recurrence.
Meanwhile, the bill’s tax cuts give the wealthiest 1% an average $175,000 annual windfall.
Would the Republican Bill Pass Constitutional Muster?
A key legal question is whether Congress can penalize states for using their funds to provide health coverage to immigrants by reducing federal Medicaid matching rates. The Supreme Court’s most relevant precedent is National Federation of Independent Business (NFIB) v. Sebelius (2012), which struck down the ACA’s threat to withdraw all Medicaid funds from states refusing Medicaid expansion as unconstitutionally coercive. However, the Court left open the door for Congress to attach less sweeping conditions to federal funding.
In this case, the Republican bill does not threaten all Medicaid funding. Instead, it reduces the federal match for the ACA expansion population from 90% to 80% for states that cover immigrants with their own money. While this creates significant financial pressure, courts have generally upheld conditional federal spending as long as states retain a meaningful choice and the penalty is not so severe as to amount to “a gun to the head.”
Some legal scholars and advocates argue that penalizing states for how they spend their funds, outside the federal Medicaid program, may push the limits of Congress’s authority. However, given the Supreme Court’s past rulings, the bill would likely survive a constitutional challenge because it does not cross the line into outright coercion. States could, in theory, repeal their “trigger laws” or end their immigrant coverage to avoid the penalty, meaning the federal government is not compelling them with an all-or-nothing ultimatum.
Bottom line: The measure is harsh and controversial, but the courts would probably uphold it under current law.
No Societal Benefit—Only Harm
Safety net cuts don’t “save money”—they shift costs:
• Hospitals absorb uncompensated care: UI Health’s charity care only covers 40-60% of costs for uninsured patients like Juan.
• Public health risks rise: Delayed care leads to costlier emergencies. Bladder cancer survival rates plummet without early detection.
• Workforce instability: Juan’s $18/hour job installing carpets—critical to his family’s survival—is jeopardized if he can’t treat his cancer.
Tax cuts for billionaires don’t trickle down. Studies show wealthier Americans hoard savings rather than reinvest them.
Meanwhile, Medicaid cuts:
• Strain state budgets (Illinois faces a $815 million annual shortfall).
• Increase poverty: 7.6 million more Americans lose Medicaid, while SNAP cuts leave families food-insecure.
A Political Choice, Not Fiscal Necessity
Republicans claim these cuts target “waste,” but the math reveals the truth:
• $3.8 trillion in tax cuts for corporations and the wealthy.
• $1 trillion in safety net cuts (Medicaid, SNAP, child nutrition).
This isn’t budgeting—it’s wealth redistribution. Rep. Brendan Boyle (D-Pa.) noted that the bill’s debt increase triggers Medicare sequesters, harming seniors to fund tax breaks.
Juan’s Future Without HBIA: What Changes?
With HBIA:
• Chemotherapy is fully covered.
• Cancer monitoring happens every 3 months.
• Juan can maintain his job and keep working.
• He’s able to send money to his kids in Mexico.
Without HBIA (after the Republican bill):
• Chemotherapy costs $12,000 per session—completely unaffordable for Juan.
• He can only get cancer care in emergencies, not for regular monitoring.
• He risks losing his job if symptoms return and he can’t work.
• Medical debt will pile up, and he won’t be able to support his family.
Juan says:
“This bill isn’t about saving money—it’s about sacrificing people like me to make rich people richer. Cutting healthcare won’t fix the debt. It’ll just leave bodies in its wake.”
The Bottom Line
The Republican bill prioritizes billionaire tax cuts over healthcare for vulnerable populations. For every Juan Paramore who loses coverage, millionaires gain $90,000 yearly. Safety nets aren’t “handouts”—they’re investments in stable families, productive workers, and healthy communities. Stripping them away to enrich the wealthy isn’t fiscal responsibility. It’s cruelty disguised as policy.
Juan’s story is fictional but grounded in real data. For sources, see:
KFF Health News: https://kffhealthnews.org/news/article/medicaid-immigrants-one-big-beautiful-bill-house-cuts-uninsured/
KFF (Medicaid Provisions): https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
