Miami-Dade locals react to House GOP's support for $700B in Medicaid cuts
The Miami Times
By Amelia Orjuela Da Silva
This article originally appeared in The Miami Times.
The House-passed bill could strip Medicaid coverage from millions of low-income Americans.
Low-income families, seniors, children, transgender people and those with disabilities face greatest risks
On Thursday, May 22, Republicans in the U.S. House of Representatives passed a sweeping reconciliation bill which would, among other things, extend tax cuts, raise the debt ceiling by $4 trillion, and ramp up immigration enforcement. Still, much of the spotlight has landed elsewhere, on a provision that would cut Medicaid by $700 billion over the next decade.
Despite President Donald Trump’s repeated pledges not to cut Medicare or Medicaid, the bill would indeed affect both, as well as the Affordable Care Act (ACA). It now heads to the Senate, with final passage expected this summer.
Dr. Michelle Powell, a Miami-based family physician who serves low-income and Medicaid-eligible patients through her practice at Powell Health Solutions, criticized the legislation.
Dr. Michelle Powell
(Powell Health Solutions)
“This is about the people being played last,” she said. “It’s a great idea that you balance your book, because I'm a business owner, but it should not be at the expense of health care, which should be a right to every American citizen, as it is in other countries considered first-world countries.”
Medicaid and Medicare
The bill includes imposing work requirements for adults ages 19 to 64, most of who, beginning in 2026, would need to work at least 80 hours per month to be eligible for Medicaid. (For a more in-depth analysis of these work requirements and how they may affect low-income families, check out this week’s Business cover in The Miami Times.)
According to KFF, states would also need to conduct Medicaid eligibility redeterminations every six months starting on Dec. 31, 2026, up from the current 12-month schedule. The bill would further penalize states offering coverage to undocumented residents.
Powell said such changes could disrupt care and destabilize small clinics.
Powell warned Medicaid cuts will only increase the number of uninsured people in Florida and the rest of the nation.
“I might have been treating (someone) for a hypertensive disease, and now I lose them because they no longer qualify,” she said. “Individuals who are getting cancer treatment may potentially lose access midstream.”
The nonpartisan Congressional Budget Office estimates more than 7.6 million people would lose coverage over the next decade if the bill becomes law. In Miami-Dade County, Medicaid covers over 40% of children and 58% of seniors — more than any other county in Florida. Over 50,000 people under 65 with disabilities also depend on it.
“Many people think that Medicaid is just a public benefit program. It's not. It's the basis of the health care safety net,” said Kerlande Ceant, Community Health Organizer at Catalyst Miami, who assists residents with public benefit enrollment.
Catalyst Miami at the Florida Capitol as part of its campaign "Floridians Deserve Health Care."
(Catalyst Miami via Facebook)
One in four Miami-Dade residents relies on Medicaid for preventive care, medication and vital therapies, Ceant noted.
The CBO also projects about $500 billion in Medicare cuts from 2026 to 2034 if the bill is passed.
Uninsured on the rise
Florida already had 2.3 million uninsured residents in 2023. Powell warned that number will only grow.
“When people are uninsured, they delay treatment,” she said. “We will see an increase in deaths from preventable diseases and preventable conditions because we have decided to eliminate access for a large population.”
Catalyst Miami during the "Floridians Deserve Health Care” campaign, highlighting personal stories about health care access and discussing the gap in Medicaid coverage.
Local safety-net hospitals would also face intense strain.
“There will be more ER visits, more strain on local hospitals. Hospitals will be at risk of closure. The facilities will start to downsize as they won’t have enough public health servants to assist,” Ceant said. “And there will be an increase in chronic health conditions amongst our community members.”
“Many people think that Medicaid is just a public benefit program. It's not. It's the basis of the health care safety net." -Kerlande Ceant, Catalyst Miami
Jackson Memorial Hospital, already overburdened, could see longer waitlists and a cascade of effects, Powell added, including increased homelessness.
“If someone gets sick, can’t work, and doesn’t have the income to afford medication or housing, it all cascades. I hate to project that, but it’s a trickle-down effect.”
To mitigate the impact, Powell offers a low-cost membership at her clinic, starting at $49 a year. But she says the fact that such a program is necessary is proof of a broken system.
“I believe people are more important than profits,” she said, “For a provider like myself to have to implement a special program just so my patients maintain their health is unfair and burdensome.”
Who’s most at risk?
Ceant said low-income seniors and people with disabilities could be hit hardest by work requirements and redeterminations.
“For many low-income seniors who are also disabled or suffer from chronic conditions, the proposed work requirements could unfairly penalize those who are unable to work, and it'll jeopardize their Medicaid eligibility,” said Ceant. “Seniors would lose access to long-term care that they depend on.”
Resident Tracey Bowen knows this first-hand.
In October 2022, Bowen lost her job-protected leave while grieving the death of her father. She was diabetic and unwell, with a wound on her toe that would eventually lead to a below-the-knee amputation.
“In the grief, in the mental state, I forgot to take care of myself and wounded my toe, which was healing,” Bowen said.
Instead of receiving comprehensive care, she was Baker Acted and (involuntarily) admitted to a psychiatric facility, where her physical condition worsened. When she finally got to the hospital, she says she didn’t receive timely wound care or accurate information about her coverage.
Bowen was told she didn’t qualify for Medicaid because of her age.
Tracey Bowen reflects on losing her leg after insurance lapses delayed proper wound care.
“That’s Medicare, not Medicaid,” she said. “I was a medical emergency with no insurance.”
By February 2023, Bowen’s infection had progressed so severely that she underwent surgery. Though she received a donated prosthetic, she has spent two years using a socket that was only ever meant to be temporary.
Bowen said she qualified for emergency Medicaid, which didn’t cover her insulin, lab work or mental health care.
“The insulin runs about $100 a pen. I need about five a month, and I need two different ones. So that alone is $1,000 a month.”
She finally qualified for Medicare in March 2025 after being approved for disability. Now, she pays a co-pay of $35 for insulin.
The proposed cuts alarm her deeply.
“For Medicaid to be so critical to the health care needs of so many people… the thought of taking away from that as opposed to expanding it — I never would have imagined I would have been in the situation I was in.”
She paused, then added: “I was taught, get a good job… with benefits. I did that. And so to have all of that come to a screeching halt, and then the system being dysfunctional and ineffective and downright unavailable to me… I literally had to rely on prayer to sustain me.”
Advocates warn the bill could deepen health disparities across vulnerable communities.
Now, Bowen advocates for Medicaid expansion through the Florida Decides Healthcare’s 2026 ballot initiative.
She notes how children, too, could face considerable setbacks if Medicaid is cut.
“They can miss out on critical preventive services, which include regular checkups, vaccines, and screenings,” Bowen said. “Families could lose coverage for therapy and treatments that are vital for the child’s development.”
Gender-affirming care and mental health
The House GOP’s bill also bans Medicaid and Children's Health Insurance Program coverage for gender-affirming care, disproportionately affecting low-income members of the LGBTQ+ community, especially Black and transgender communities or those living with HIV.
The bill bans Medicaid and CHIP coverage for gender-affirming care for both minors and adults, disproportionately affecting low-income members of the LGBTQ+ community
(aclu.org)
Jasmine McKenzie, founder of The McKenzie Project, a Black trans-led advocacy organization in Miami, said the consequences would be catastrophic.
“We have been fighting as a battle to get access to care,” she said. “Black trans people have been doing black market gender-affirming care — whether it’s silicone injections, hormones from off the streets, pumping your face, pumping your bodies.”
Without Medicaid or ACA coverage, essential services like hormone replacement therapy or surgeries become unaffordable.
“HRT requires regular doctor visits, lab work, prescriptions — sometimes costing hundreds of dollars a month. Surgeries like top surgery or facial feminization can range from $8,000 to over $30,000.”
McKenzie said that without Medicaid or ACA coverage, essential services like hormone replacement therapy or surgeries become unaffordable.
Faced with impossible choices, McKenzie said some may turn back to survival sex work or dangerous DIY procedures.
Medicaid is also the country’s largest payer of mental health services.
“If access to gender-affirming care is cut off, the mental health impacts, especially for trans youth, will be immediate, profound, and potentially life-threatening,” McKenzie said. “Denying this care sends a message that trans people, particularly young people, are not meant to exist.”
Clinics like New Horizons Community Mental Health Center, which serves a large Medicaid-reliant population, warn the bill would gut services and lead to more hospitalizations.
“Our children's lives would be greatly affected, especially those already impoverished and marginalized. These are predominantly Black and brown individuals,” said Dr. Joseph Poitier, medical director at New Horizons. “It would be a wipeout of a lot of mental health care in a state which already falls in the bottom tier in per-capita funding of mental health.”
Florida invests just $36.05 per capita in mental health services, far below the national average of $125.90, according to the Florida Policy Institute.
While the bill is on its way to the Senate, Powell ultimately calls for continued advocacy and accountability.
“One of the things Martin Luther King said is that the worst thing is for good people to do nothing.”
By Amelia Orjuela Da Silva
This article originally appeared in The Miami Times.
The House-passed bill could strip Medicaid coverage from millions of low-income Americans.
Low-income families, seniors, children, transgender people and those with disabilities face greatest risks
On Thursday, May 22, Republicans in the U.S. House of Representatives passed a sweeping reconciliation bill which would, among other things, extend tax cuts, raise the debt ceiling by $4 trillion, and ramp up immigration enforcement. Still, much of the spotlight has landed elsewhere, on a provision that would cut Medicaid by $700 billion over the next decade.
Despite President Donald Trump’s repeated pledges not to cut Medicare or Medicaid, the bill would indeed affect both, as well as the Affordable Care Act (ACA). It now heads to the Senate, with final passage expected this summer.
Dr. Michelle Powell, a Miami-based family physician who serves low-income and Medicaid-eligible patients through her practice at Powell Health Solutions, criticized the legislation.
Dr. Michelle Powell
(Powell Health Solutions)
“This is about the people being played last,” she said. “It’s a great idea that you balance your book, because I'm a business owner, but it should not be at the expense of health care, which should be a right to every American citizen, as it is in other countries considered first-world countries.”
Medicaid and Medicare
The bill includes imposing work requirements for adults ages 19 to 64, most of who, beginning in 2026, would need to work at least 80 hours per month to be eligible for Medicaid. (For a more in-depth analysis of these work requirements and how they may affect low-income families, check out this week’s Business cover in The Miami Times.)
According to KFF, states would also need to conduct Medicaid eligibility redeterminations every six months starting on Dec. 31, 2026, up from the current 12-month schedule. The bill would further penalize states offering coverage to undocumented residents.
Powell said such changes could disrupt care and destabilize small clinics.
Powell warned Medicaid cuts will only increase the number of uninsured people in Florida and the rest of the nation.
“I might have been treating (someone) for a hypertensive disease, and now I lose them because they no longer qualify,” she said. “Individuals who are getting cancer treatment may potentially lose access midstream.”
The nonpartisan Congressional Budget Office estimates more than 7.6 million people would lose coverage over the next decade if the bill becomes law. In Miami-Dade County, Medicaid covers over 40% of children and 58% of seniors — more than any other county in Florida. Over 50,000 people under 65 with disabilities also depend on it.
“Many people think that Medicaid is just a public benefit program. It's not. It's the basis of the health care safety net,” said Kerlande Ceant, Community Health Organizer at Catalyst Miami, who assists residents with public benefit enrollment.
Catalyst Miami at the Florida Capitol as part of its campaign "Floridians Deserve Health Care."
(Catalyst Miami via Facebook)
One in four Miami-Dade residents relies on Medicaid for preventive care, medication and vital therapies, Ceant noted.
The CBO also projects about $500 billion in Medicare cuts from 2026 to 2034 if the bill is passed.
Uninsured on the rise
Florida already had 2.3 million uninsured residents in 2023. Powell warned that number will only grow.
“When people are uninsured, they delay treatment,” she said. “We will see an increase in deaths from preventable diseases and preventable conditions because we have decided to eliminate access for a large population.”
Catalyst Miami during the "Floridians Deserve Health Care” campaign, highlighting personal stories about health care access and discussing the gap in Medicaid coverage.
Local safety-net hospitals would also face intense strain.
“There will be more ER visits, more strain on local hospitals. Hospitals will be at risk of closure. The facilities will start to downsize as they won’t have enough public health servants to assist,” Ceant said. “And there will be an increase in chronic health conditions amongst our community members.”
“Many people think that Medicaid is just a public benefit program. It's not. It's the basis of the health care safety net." -Kerlande Ceant, Catalyst Miami
Jackson Memorial Hospital, already overburdened, could see longer waitlists and a cascade of effects, Powell added, including increased homelessness.
“If someone gets sick, can’t work, and doesn’t have the income to afford medication or housing, it all cascades. I hate to project that, but it’s a trickle-down effect.”
To mitigate the impact, Powell offers a low-cost membership at her clinic, starting at $49 a year. But she says the fact that such a program is necessary is proof of a broken system.
“I believe people are more important than profits,” she said, “For a provider like myself to have to implement a special program just so my patients maintain their health is unfair and burdensome.”
Who’s most at risk?
Ceant said low-income seniors and people with disabilities could be hit hardest by work requirements and redeterminations.
“For many low-income seniors who are also disabled or suffer from chronic conditions, the proposed work requirements could unfairly penalize those who are unable to work, and it'll jeopardize their Medicaid eligibility,” said Ceant. “Seniors would lose access to long-term care that they depend on.”
Resident Tracey Bowen knows this first-hand.
In October 2022, Bowen lost her job-protected leave while grieving the death of her father. She was diabetic and unwell, with a wound on her toe that would eventually lead to a below-the-knee amputation.
“In the grief, in the mental state, I forgot to take care of myself and wounded my toe, which was healing,” Bowen said.
Instead of receiving comprehensive care, she was Baker Acted and (involuntarily) admitted to a psychiatric facility, where her physical condition worsened. When she finally got to the hospital, she says she didn’t receive timely wound care or accurate information about her coverage.
Bowen was told she didn’t qualify for Medicaid because of her age.
Tracey Bowen reflects on losing her leg after insurance lapses delayed proper wound care.
“That’s Medicare, not Medicaid,” she said. “I was a medical emergency with no insurance.”
By February 2023, Bowen’s infection had progressed so severely that she underwent surgery. Though she received a donated prosthetic, she has spent two years using a socket that was only ever meant to be temporary.
Bowen said she qualified for emergency Medicaid, which didn’t cover her insulin, lab work or mental health care.
“The insulin runs about $100 a pen. I need about five a month, and I need two different ones. So that alone is $1,000 a month.”
She finally qualified for Medicare in March 2025 after being approved for disability. Now, she pays a co-pay of $35 for insulin.
The proposed cuts alarm her deeply.
“For Medicaid to be so critical to the health care needs of so many people… the thought of taking away from that as opposed to expanding it — I never would have imagined I would have been in the situation I was in.”
She paused, then added: “I was taught, get a good job… with benefits. I did that. And so to have all of that come to a screeching halt, and then the system being dysfunctional and ineffective and downright unavailable to me… I literally had to rely on prayer to sustain me.”
Advocates warn the bill could deepen health disparities across vulnerable communities.
Now, Bowen advocates for Medicaid expansion through the Florida Decides Healthcare’s 2026 ballot initiative.
She notes how children, too, could face considerable setbacks if Medicaid is cut.
“They can miss out on critical preventive services, which include regular checkups, vaccines, and screenings,” Bowen said. “Families could lose coverage for therapy and treatments that are vital for the child’s development.”
Gender-affirming care and mental health
The House GOP’s bill also bans Medicaid and Children's Health Insurance Program coverage for gender-affirming care, disproportionately affecting low-income members of the LGBTQ+ community, especially Black and transgender communities or those living with HIV.
The bill bans Medicaid and CHIP coverage for gender-affirming care for both minors and adults, disproportionately affecting low-income members of the LGBTQ+ community
(aclu.org)
Jasmine McKenzie, founder of The McKenzie Project, a Black trans-led advocacy organization in Miami, said the consequences would be catastrophic.
“We have been fighting as a battle to get access to care,” she said. “Black trans people have been doing black market gender-affirming care — whether it’s silicone injections, hormones from off the streets, pumping your face, pumping your bodies.”
Without Medicaid or ACA coverage, essential services like hormone replacement therapy or surgeries become unaffordable.
“HRT requires regular doctor visits, lab work, prescriptions — sometimes costing hundreds of dollars a month. Surgeries like top surgery or facial feminization can range from $8,000 to over $30,000.”
McKenzie said that without Medicaid or ACA coverage, essential services like hormone replacement therapy or surgeries become unaffordable.
Faced with impossible choices, McKenzie said some may turn back to survival sex work or dangerous DIY procedures.
Medicaid is also the country’s largest payer of mental health services.
“If access to gender-affirming care is cut off, the mental health impacts, especially for trans youth, will be immediate, profound, and potentially life-threatening,” McKenzie said. “Denying this care sends a message that trans people, particularly young people, are not meant to exist.”
Clinics like New Horizons Community Mental Health Center, which serves a large Medicaid-reliant population, warn the bill would gut services and lead to more hospitalizations.
“Our children's lives would be greatly affected, especially those already impoverished and marginalized. These are predominantly Black and brown individuals,” said Dr. Joseph Poitier, medical director at New Horizons. “It would be a wipeout of a lot of mental health care in a state which already falls in the bottom tier in per-capita funding of mental health.”
Florida invests just $36.05 per capita in mental health services, far below the national average of $125.90, according to the Florida Policy Institute.
While the bill is on its way to the Senate, Powell ultimately calls for continued advocacy and accountability.
“One of the things Martin Luther King said is that the worst thing is for good people to do nothing.”
