An ugly, disgustingly unhealthy new law

Last Friday, on July 4, we celebrated “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Those words lost their meaning, however, when President Trump triumphantly signed H.R. 1 — the law he calls the “One Big Beautiful Bill Act” — into law.

H.R. 1 is certainly big — it is 887 pages long — but it is in no way beautiful because of the threats it poses to the more than 67 million people enrolled in Medicare plans, the over 71 million people enrolled in Medicaid and CHIP (Children’s Health Insurance Program), the more than 45 million people enrolled in Marketplace or Medicaid expansion coverage under the Affordable Care Act, the nearly 38 million people served by the nation’s rural hospital system, the approximately 42 million people who benefit from the nation’s food stamp program known as SNAP (Supplemental Nutrition Assistance Program), and the estimated 6.31 million people out of 11.8 million people who are eligible who are helped by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

This “beautiful” law is ugly in so many respects. The claim that it will significantly reduce government spending would be a joke if the potential for great tragedy did not lurk within those 887 pages. H.R. 1 will add $3.3 trillion to the national debt over the next 10 years, according to the nonpartisan Congressional Budget Office, whose objectivity and rigorous methodology are widely respected by economists and academics.

H.R. 1 primarily benefits those in the top six income brackets. Those in the one percent bracket are projected to receive an average annual tax cut of $70,000. Those in the next five highest brackets are projected to receive average annual tax cuts of nearly $21,000. For the rest of us in the other 94 brackets, the tax cuts range from negligible to nonexistent. For some, it may also have a serious impact on their health and well-being. (This column discusses that aspect. I hope to examine other things wrong with H.R. 1.in a future column.)

H.R. 1 could result in up to 12 million Americans losing their health insurance by 2034, according to the CBO’s estimate, primarily due to its significant cuts to Medicaid, the ACA, and other programs. Cuts to Medicaid, which could total nearly $1 trillion by 2034, could significantly increase out-of-pocket healthcare costs for low-income people enrolled in Medicare Advantage plans, as they would lose crucial Medicaid assistance for premiums and cost-sharing.

Consider the looming threat posed to the nation’s rural hospital system, which often operates on very small profit margins and serves a high percentage of Medicaid patients; many of its facilities already are struggling financially. Medicaid covers 25 percent of adults in rural areas, but its payments do not adequately cover the actual cost of care.

H.R. 1’s Medicaid cuts will only make that worse. The American Hospital Association predicts a $50.4 billion reduction in federal Medicaid spending on rural hospitals over the next 10 years, resulting in 1.8 million people in rural areas losing their Medicaid coverage by 2034.

If these hospitals close, patients might have to travel for hours to get basic or emergency care, severely limiting access in areas that are already underserved. An analysis by the University of North Carolina at Chapel Hill’s Cecil G. Sheps Center for Health Services Research estimates that more than 300 rural hospitals are now at risk of closing because of H.R. 1.

While the new law includes $50 billion to help fund these facilities over the next five years, this amount is significantly less than the federal Medicaid cuts that are predicted for rural areas.

The health of women and children also is at risk because H.R. 1 also imposes sweeping changes to programs they depend on.

The Supplemental Nutrition Assistance Program, often referred to as food stamps, is regarded as one of the most effective federal programs from various perspectives, which is why Congress has historically resisted attempts to cut its funding. Under H.R. 1, SNAP is estimated to lose roughly $295 billion through 2034. The new law also restricts future updates to SNAP’s Thrifty Food Plan, which the U.S. Department of Agriculture uses to calculate SNAP benefits. This will prevent benefits from keeping pace with rising food costs, eroding the purchasing power of SNAP recipients over time.

The law also calls for expanded work requirements for SNAP, which contradicts why the program exists. It was intentionally designed in 1964 to alleviate hunger among the poor and disadvantaged, many of whom cannot find steady employment or are unable to work due to physical or mental challenges. Under the changes, more people will be required to demonstrate that they are working, attending school, or participating in a training program to qualify for SNAP, including an expansion of the age range for work requirements.

Cuts were also made to the Special Supplemental Nutrition Program for Women, Infants, and Children, which offers specific, nutritious foods, nutrition education, and health referrals to pregnant, postpartum, and breastfeeding women, as well as infants and children up to age five who are at nutritional risk. In 2021, Congress increased WIC’s Cash Value Benefit to allow families to buy more foods with the critical nutrients they need. According to Georgia Machell, president and CEO of the National WIC Association, parents can now “afford a healthier diet” for their children and themselves, “all thanks to the CVB.”

Thanks to H.R. 1, that progress is certain to go into a tailspin.

Let us be clear about this: Halachah, Jewish law, is quite outspoken about our role in aiding those in need.

“Do not stand idly by your neighbor’s blood,” the Torah decrees in Leviticus 19:16. This means that we must be proactive in looking out for the welfare of everyone in our community — Jews and non-Jews. (See the Babylonian Talmud tractate Gittin 61a.)

Seeing to the needs of the poor, and especially the hungry among them, is one of the oft-repeated mitzvot in the Torah. Thus, for example, farmers are required to leave some of the gleanings of their harvest “for the poor and the stranger.” (See Leviticus 19:9-10, Leviticus 23:22, and elsewhere.)

In Deuteronomy 15:11, God tells us that caring for the needy among us is our responsibility.

Starting with the prophets, such laws were interpreted broadly.

Ezekiel 18:7 says that it was one reason why a person is called righteous. Not to do so, says Isaiah 32:6, is pure wickedness.

Dire consequences can result from ignoring the hungry. In BT Taanit 21a, for example, Rabbi Nachum of Gimzo explained why he had become blind and lame, and why his body was covered in boils. It was because he told a poor person who was desperate for some food and drink to wait until he finished the work he was doing. When that person died before him, he begged heaven to afflict him with these ailments.

Our Sages of Blessed Memory had little use for people — and governments — who do not feed the hungry, even if they are deemed able-bodied. Thus, we read in a midrash of a man who scolds someone who asked for help. “Why don’t you go to work and get food to eat? [You surely are able-bodied.] Look at those hips! Look at that fat body. Look at those lumps of flesh.” God, says the midrash, decreed that the man would himself became destitute as a result. (See Vayikra Rabbah 34:7.)

Among the things Isaiah said God demands of us (see chapter 58) is “to share your bread with the hungry.”

God’s Torah demands no less from all of us than that we must demand that our legislators ignore all such food-funding cuts. It also demands that we donate to Mazon and other organizations on the front lines in the war against hunger — and that we should do it as often as we can.

The same is true regarding cuts to Medicare, Medicaid, the Affordable Care Act, and other so-called social safety net programs. The Torah demands action on our part. True, Exodus 15:26 has God saying, “I am the Lord, who heals you,” but it is also true that God does that healing through our physicians. (See BT Bava Kamma 46b.) The Talmud in BT Brachot 60a considers the physician to be God’s agent, based on Exodus 21:19. God, says the Talmud, gave the physician “permission” to heal. The Shulchan Aruch, the authoritative code of Jewish law, goes further. A physician is commanded to do so (see Yoreh De’ah 336:1).

From Exodus 21:19, the Talmud also derives a rule very relevant regarding the rural hospital situation: “It’s forbidden to live in a city where there is no physician,” because “if the physician is a long way off, the eye will be blind.” (See BT Bava Kama 85a.) In other words, if medical help is too far away, that help probably will not arrive in time to be of any help.

That is why, in addition to attending to the needs of the poor and the disadvantaged, it is up to us to ensure that everyone has adequate and proper medical care. Because we depend on the government, acting as our agents, to do that, our task is to ensure that the government either does so in every way possible or that it pays the price on the next Election Day.

That price must be paid in November 2026. After all, we are forbidden to stand idly by our neighbor’s blood.

Shammai Engelmayer is a rabbi-emeritus of Congregation Beth Israel of the Palisades and an adult education teacher in Bergen County. He is the author of eight books and the winner of 10 awards for his commentaries. His website is www.shammai.org.

Opinion

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