When the news broke about the sweeping Republican tax and spending bill, signed into law with ceremonial flourish on the Fourth of July, Michelle Lawrence felt it like a physical blow.
“A punch to the gut,” she described it, a grim laugh escaping her lips. “If I don’t laugh, I cry.”
For Lawrence, a resident of Henniker, the bill’s provisions, particularly the cuts to Medicaid, are not abstract policy debates but a direct threat to her existence.
Sixteen years ago, Lawrence was diagnosed with T-cell lymphocytic leukemia, a chronic form of cancer that eventually forced her out of work five years ago.
With her job went her health insurance, leaving her with no affordable options for coverage. Medicaid became her lifeline.
“That has enabled me and a lot of other cancer patients like me to be able to access the treatment needed in the past few years.
I’m here. I’m alive and a contributing member of society,” she explained, her voice tinged with the anxiety of an uncertain future.
“Without Medicaid, I wouldn’t be able to afford my treatments or go to the doctor.”
The bill, christened the “One Big Beautiful Bill Act” by its proponents, introduces a new work requirement for Medicaid recipients, demanding 80 hours of work per month for coverage.
Lawrence currently works 40 hours a month at a nonprofit, assisting people with disabilities – a demanding schedule given her cancer symptoms and treatment side effects.
“Those 40 hours a month are hard for me to do. I have had cancer for 16 years,” she said, her frustration palpable.
“I can’t create a healthier Michelle that’s going to be able to work 80 hours.
If I could, I would have by now, because I’d rather be working.
No one wants to be sick and no one wants to be unable to work.”
While the bill ostensibly includes exceptions for “serious and complex medical conditions,” the clarity on who qualifies remains elusive.
Lawrence’s inquiries to the New Hampshire Department of Health and Human Services, the agency tasked with administering Medicaid, yielded no definitive answers.
“And that’s the scary part,” Lawrence confessed. “It feels like the Wild, Wild West.
So we passed this bill, and now it’s left up to interpretation, and I don’t think that’s reasonable, because what am I supposed to do?
Like, just carry on and wait to find out if or if not I get kicked off? Should I be planning a funeral instead of my next doctor’s appointment?”
This deeply personal struggle illuminates the broader, sweeping changes embedded within the “big beautiful bill.”
Passed by a Republican-controlled Congress and signed by President Donald Trump, the legislation extends a set of tax cuts from the 2017 Tax Cuts and Jobs Act, largely benefiting the nation’s wealthiest.
To partially offset these tax breaks, the bill enacts profound cuts to social services, even as independent bipartisan analysis from the Congressional Budget Office projects it will still add a staggering $3.4 trillion to the federal deficit over the next decade.
The scale of the Medicaid cuts is unprecedented, totaling nearly $1 trillion over the next ten years.
For New Hampshire, this translates to a projected revocation of 18 percent of its federal baseline spending for Medicaid – a loss of $3 billion over a decade.
Currently, Medicaid supports approximately 186,000 individuals in the Granite State.
The new work requirements are a central pillar of these cuts, despite a history of similar initiatives failing at the state level.
New Hampshire itself attempted a 100-hour monthly work requirement in 2018, only to see it falter within a month, with 17,000 people facing loss of coverage before then-Gov. Chris Sununu intervened.
Arkansas and Georgia experienced similar pitfalls, underscoring the bureaucratic nightmares and human costs associated with such mandates.
The state’s Democratic congressional delegation, all of whom voted against the bill, minced no words in their condemnation.
Senator Jeanne Shaheen branded it “the big beautiful betrayal of the American people,” arguing it “takes food and health care away from seniors and families to give trillions of dollars more to corporations and to the wealthiest.”
Representative Chris Pappas echoed the sentiment, calling it “a disaster for the American people” and a “cruel bill” that ignores the will of New Hampshire residents.
Senator Maggie Hassan, who oversaw New Hampshire’s Medicaid expansion as governor, starkly declared it “the largest cut to Medicaid we have seen in our nation’s history.”
Even Republican Governor Kelly Ayotte, while evaluating the bill’s impact, expressed disagreement with the federal reductions to SNAP and Medicaid, vowing to “work closely with DHHS to protect our most vulnerable citizens.”
Her cautious statement highlights the challenging position states now face: either absorb the new funding gaps with state money, a daunting prospect for states like New Hampshire with tight budgets, or cut vital programs.
Beyond healthcare, the bill inflicts significant damage on the Supplemental Nutrition Assistance Program (SNAP), the federal food assistance program.
Laura Milliken, executive director of N.H. Hunger Solutions, labeled the bill “a world of bad,” predicting that 22.3 million families nationwide will lose some or all of their SNAP benefits.
“It just is so, so unnecessary and cruel at a time that we’re all feeling like everything’s expensive,” Milliken lamented.
The bill shifts administrative costs to states, reduces benefits by restricting eligibility factors, caps future increases at inflation, and imposes stricter work requirements, even banning many refugees and asylees from the program.
Food pantries in New Hampshire brace for an overwhelming surge in demand, while the automatic qualification of SNAP recipients for free and reduced-price school meals means federal aid to schools will also be jeopardized.
The tax benefits, the supposed justification for these cuts, are starkly imbalanced.
An analysis by the Institute on Taxation and Economic Policy reveals that the richest fifth of Americans are set to receive roughly 72 percent of the net tax benefits in 2026, while the poorest fifth will receive less than 1 percent.
In New Hampshire, the top 1 percent of households, earning over $894,699 annually, are projected to save an average of $59,170 in taxes.
Meanwhile, the poorest 20 percent of households, earning less than $37,000, will see a paltry $200 in annual savings.
Drew Cline, executive director of the Josiah Bartlett Center for Public Policy, a conservative New Hampshire think tank, champions the extension of the 2017 tax rates for their goals of simplification and growth.
While acknowledging the disproportionate benefits to the wealthy, he argues that the rich already pay the vast majority of income taxes.
Yet, even Cline harbors reservations, particularly about the bill’s new tax exemptions for tips and overtime, which he believes complicate the tax code.
His primary concern, however, mirrors that of fiscal watchdogs across the spectrum: the ballooning federal deficit.
“The bigger story here is that we are spending and we are borrowing at crisis levels when we don’t have a crisis,” Cline warned.
“And that is not sustainable.”
The “big beautiful bill” is far more than a simple tax and spending package; it’s a sprawling legislative leviathan touching nearly every facet of federal governance.
Beyond the colossal cuts to Medicaid and SNAP, it eliminates the IRS direct file program, limits student loans for graduate and professional students, rolls back nursing home staffing regulations, revokes Medicaid funding for Planned Parenthood, and scraps tax credits designed to encourage environmentally friendly practices.
It is a bill that, despite its grand title, promises a future of stark choices and increasing precarity for millions of Americans, nowhere more acutely felt than by individuals like Michelle Lawrence, left to wonder if her next appointment will be with a doctor or a funeral home.
