Trump’s ‘Big Beautiful Bill’ is an ugly deal for South Dakotans who will face across-the-board cuts in healthcare funding

The U.S. Senate has released its version of the “Big Beautiful Bill” — a massive tax package that gives money directly to the wealthiest Americans while gutting programs that help everyday South Dakotans. If passed, this bill would cause devastating harm through deep cuts to Medicaid, higher health-care costs for those enrolled in the Affordable Care Act, and automatic cuts to Medicare.

This bill will increase the federal deficit, resulting in the Statutory Pay-As-You-Go Act (PAYGO) to kick in. That law requires automatic, across-the-board cuts to programs like Medicare unless Congress intervenes. So not only does this bill extend $1.1 trillion in tax breaks to the wealthiest Americans, it pulls the rug out from under those who rely on Medicare just to get by.

The human cost of this legislation is staggering.

As someone who works directly with people experiencing homelessness, I witness every day what a lack of health care looks like. It's the untreated infections that escalate into emergencies. It's the missed mental health support that results in a crisis. It's the addiction that goes unaddressed because there are no accessible recovery services. It’s the quiet suffering of people who are told — explicitly or implicitly — that their lives are expendable in the name of tax cuts for the rich.

And as a pediatrician, I’ve seen firsthand how children suffer when the health-care safety net is dismantled. I’ve seen children arrive at shelters sick, scared, and in need of urgent care that their families simply couldn't afford. Medicaid covers nearly half of all births in South Dakota and provides essential services like immunizations, developmental screenings, and early interventions that can change the course of a child’s life. Without it, preventable illnesses go untreated, mental health conditions worsen, and families are left with nowhere to turn. Children don’t get a second chance at healthy development — we must protect their access to care now.

Children, people with disabilities, older adults, and rural communities will bear the brunt of this proposal. Medicaid is not just a safety net; it is a lifeline. In South Dakota, Medicaid expansion has helped thousands access preventive care, chronic disease management, and mental health services — often for the first time in their lives. This bill would unravel that progress.

It’s not just individuals who will suffer. This legislation threatens the very institutions that keep our communities alive — hospitals, senior-living centers, and nursing homes. Many of these facilities operate on razor-thin margins and rely heavily on Medicaid reimbursement to stay open. If this bill passes, South Dakota will see closures, especially in rural areas where there is no backup option. When the local hospital closes, people die. When a senior center shuts its doors, families are left scrambling to care for aging loved ones without support.

And for what? To fund permanent tax cuts for the ultra-wealthy. That’s not fiscal responsibility. That’s cruelty disguised as budgeting.

There is still time to act. Congress can — and should — let the Trump-era tax cuts for the wealthiest Americans expire. Congress can still extend the tax cuts for the hardworking middle and low-income earners. These two things are not mutually exclusive.

Instead of the federal government forcing states like South Dakota to shoulder more health-care costs, citizens should have access to the critical programs that keep them healthy — especially our children, whose futures depend on it.

Contact your members of Congress. Tell them South Dakota’s working families, seniors and children should not be sacrificed to continue tax breaks for billionaires.

Dr. Shannon Emry is a pediatrician and clinical professor at the University of South Dakota Sanford School of Medicine with a longstanding commitment to caring for underserved populations. She served 14 years in the U.S. Air Force before shifting her focus to community-based care. In 2023, she founded Midwest Street Medicine, where she leads a volunteer team providing medical and addiction care to people experiencing homelessness. Questions can be directed to shannon.emry@gmail.com. 

Photo: public domain, wikimedia commons

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