Nothing about my patient’s death was his wish, and I keep returning to his story with equal parts sadness and fury. He was diagnosed with squamous cell carcinoma, a cancer, after an asthma flare turned out to be a large mass blocking his airway. He was referred to oncology, and his wife told me that they got as far as the waiting room before being told that their lack of insurance would not get them any further.

By the time I met him in the hospital as his doctor — Medicaid finally in hand — the cancer was far too advanced. “I want to live,” he told me. He was a kind man, the kind who obligatorily stays strong for his family. The next shift, when I was working overnight, I was called to his bedside and found him unable to breathe, clutching his throat in pain. The inevitable was here, and he passed away just a few hours later at the age of 49, leaving behind his devoted wife and young daughter.

Delayed health care, poor follow-up and worsening health in the interim is routine in America’s health systems. According to the Commonwealth Fund, about 26 million people in the United States are uninsured. My patient’s case is no aberration — it’s everyday.

On May 22, 2025, the House of Representatives passed the “One Big Beautiful Bill” gutting Medicaid, the lifeline for 21% of all Americans. The Senate faces a critical choice — stop the bill or strip coverage from 10 million people.

The bill strives to actualize budget savings by making renewal and enrollment processes stricter, decrease the federal matching rate and limit states’ use of provider taxes for Medicaid funding, among others. Another proposed mechanism to reduce the number of people receiving Medicaid is a work requirement for those on Medicaid. However, this was already trialed by the state of Arkansas in 2018-2019 and resulted in coverage loss for 18,000 people with no improvement in employment rates. In reality, health insurance improves health outcomes, letting people work productively — a glaring oversight in this plan. This is a blatant attempt to save money in the most callous way possible — denying care to those who need it most.

Medicaid is indispensable for millions with complex health and social needs, like people with disabilities. Of the 42.5 million Americans with disabilities, 35% rely on Medicaid for medical care, prescription drugs, equipment and other services they otherwise would not have access to. Medicaid also foots the bill for most nursing home, long-term, and home care costs unreachable for most people.

Medicaid also has a critical but overlooked role as the largest payer of mental health and substance use treatment services. The ACA’s expansion made Medicaid provide substance use treatment as an essential health benefit, closing the vital treatment gap for the more than 40 million Americans struggling with substance use — especially powerful in the epicenters of the opioid epidemic like Baltimore. This is paying off; drug-related deaths in 2024 were the lowest since the pandemic. These gains will now only be marred by Medicaid cuts.

Now, at the end of my first year of residency, insurance — or lack thereof — shapes my every clinical decision and my patients’ outcomes. I am often reminded of my dear patient’s passing far too soon because he was not able to see an oncologist in time. Medicaid protects the poor, the middle class, the elderly, those with disabilities, and the 26-year-old who graduated from their parent’s insurance. It is a crucial social infrastructure — and guarding Medicaid is akin to guarding the health of our nation.

The reality is that underinsurance is deadly. Recently, in response to concerns about the Medicaid cuts, Sen. Joni Ernst dismissed anxieties about the gutting of Medicaid by saying, “We all are going to die.” For opposing reasons, I agree.

Bhavya Ancha is an internal medicine resident physician at Johns Hopkins Hospital