The ‘big, beautiful bill’ is poised to cut Medicaid. Here’s what’s at stake for five Philly-area families.

An airport cook in South Philadelphia worries about who will make sure his mother in chronic pain doesn’t fall and hurt herself while he’s at work.

A nurse in Telford fears her daughter could become suicidal again if her benefits are cut.

A mother in Doylestown isn’t sure how she would pay for the $500-per-month insulin her son, who has Type 1 diabetes, can’t live without.

One in four Pennsylvania residents are covered by Medicaid, the federal- and state-funded healthcare program that has become the center of congressional budget reconciliation negotiations. The program provides healthcare for low-income families, children, and people with disabilities.

President Donald Trump’s first major policy package, the “Big Beautiful Bill,” includes more than $900 billion in cuts to Medicaid over the next decade in the Senate’s most recent version under debate Monday morning. That would amount to an unprecedented reduction in the program since its creation in 1965.

New work requirements, twice-yearly eligibility checks, and limiting coverage to certain groups, combined with changes to the Children’s Health Insurance Program, could result in some 11.8 million Americans losing health insurance if the legislation is enacted, according to estimates by the nonpartisan Congressional Budget Office published Saturday.

Pennsylvania officials have estimated 300,000 of the nearly 3 million residents covered by Medicaid could lose coverage.

“The focus is to make the program viable and make sure the program is protecting the people it was designed for, disabled elders, mentally ill … nothing in the legislation is designed to take enrollment away from those folks,” Pennsylvania Sen. Dave McCormick, a Republican who supports the bill, said during a recent phone call with constituents.

But Democrats — and some Republicans wary of what the cuts could mean for their constituents — warn of widespread ramifications throughout the healthcare system, jeopardizing hospital funding, straining the workforce, and leading to higher costs for privately insured individuals, as providers look to make up lost Medicaid funding.

“We’re talking about the largest cuts to Medicaid in U.S. history,” said U.S. Rep. Brendan Boyle, a Philadelphia Democrat and the ranking member of the House Budget Committee, who voted against the House version of the bill. “So the idea that that’s going to happen but that somehow ordinary people who are on Medicaid won’t be affected, that’s just nonsense.”

The bill is still pending in the Senate, where its Medicaid provisions also face procedural challenges. GOP leaders are hoping the Senate will pass the bill early this week, with a goal of the House clearing the final version in time for Trump to sign it ahead of July Fourth.

If it passes, who is impacted might not become clear for at least a year, when the work requirement and spending reductions take effect. In the meantime, hundreds of thousands of Philadelphia-area residents who rely on it are left in the lurch.

They told The Inquirer they’re worried about affording food, whether their children will have to go without needed medications, and how they will pay for mental health services that have been a lifeline.

“It’s terrifying. It’s absolutely terrifying,” said Melissa Rinker, who qualifies for Medicaid because of a disabling tissue disorder. “I would lose any semblance of functionality in my life.”

Here’s a look at the role Medicaid plays in the lives of five Pennsylvanians:

Charles Patton Jr. has been helping care for his mother, Ramona, since 2010, when she was diagnosed with rheumatoid arthritis in her hip and knee and started to take some scary falls.

She left her job as a TSA officer at Philadelphia International Airport as her more health issues spiraled. Afraid of falling, she moved around less and developed diabetes. She has fibromyalgia, a chronic pain condition, and uses a cane to walk short distances and a motorized wheelchair for longer trips.

At first, Charles and his dad took turns taking care of Ramona while the other was at work — Charles works as a cook at the airport. His dad, who died in 2015 of advanced liver cancer, was a baggage handler.

But Charles had to miss cooking shifts, which meant less money coming in to support his family. He got a reprieve when he discovered his mom qualified for Medicaid coverage for a home health aide.

The aide helps Ramona, now 69, with bathing, taking her medications, preparing meals, and getting her to doctors appointments.

Patton Jr., 41, still takes shifts, as does his sister, but the Medicaid program pays for their caregiving, which offsets missed work shifts.

It’s a way to keep his mom, who is mentally fit, at home, where she wants to be living as independently as possible.

And it also allows Patton Jr. to continue working at a job he loves — his grandfather and his mom taught him how to cook with the family’s recipes for smothered pork chops, meat loaf, and fried chicken wings.

Now he cooks turkey Bolognese for his mom.

“It’s been hard at times, very hard,” he said of his years as a caregiver. “A lotta times I can’t, you know, go out with friends and socialize and things. You kind of have to choose what’s more important and she’s my only living parent left and so, it’s like I need to make sure she has as many years as possible on this earth.”

Larissa Hopwood’s son, Rowan, developed Type 1 diabetes when he was 6 years old. Now 16, he sees a dozen different doctors in endocrinology, cardiology, nutrition science, and psychology to help manage the autoimmune disorder that prevents his body from processing sugar.

A $3,000 pump on his stomach delivers insulin that costs about $500 a month.

Fortunately for Hopwood, a single mother who lives in Doylestown, Rowan is covered by Medicaid.

“It’s been an absolute lifesaver. I don’t know what we would do without it,” she said. “That amount of medical care would be absolutely crippling for me.”

Hopwood, who goes by “Lolly” when performing as a children’s musician, struggled to keep working after Rowan’s father passed away a few years ago. She was able to enroll in Medicaid herself under rules enacted under the Affordable Care Act that extend coverage to individuals earning up to 138% of the federal poverty level.

Hopwood credits the Medicaid coverage she had for a few years with helping her take care of herself, so that she could get back to work. She sought help for her mental health and was able to keep up with routine screenings.

“It gave me peace of mind that I could be here as a caregiver for my child,” she said. “It helped me improve my own personal life so that when I no longer qualified for Medicaid, I could still keep a roof over our heads.”

She’s now earning more and able to afford a private health plan through Pennsylvania’s ACA marketplace, Pennie.

Seven months after her daughter attempted suicide, Twanda Eakins is beginning to see her youngest child return to typical school and social activities.

After being admitted to the hospital in November, the 14-year-old was transferred to a mental health facility for intensive treatment. Now back home, Gianna has remained in therapy and continues visits with specialists who are helping her work through her mental health challenges, including depression and post-traumatic stress disorder.

Eakins, a nurse, says Gianna would not have been able to access those services without Medicaid. Eakins doesn’t have health insurance through work and wouldn’t be able to cover the cost out of pocket.

Gianna’s Medicaid coverage had lapsed, but the family was able to get her hospital stay covered because of a rule that allows retroactive coverage for up to three months. The rule is among those being targeted for cuts in federal proposals.

“Honestly, it saved her life,” she said. “Without that, she may very well have had a different turnout.”

Gianna has always been quiet and soft-spoken, but Eakins began to worry about her daughter when she stopped eating, couldn’t get out of bed for school, and didn’t want to spend time with her friends.

With support from her family and a team of medical experts, she’s doing better. Gianna attended a school dance and is showing more interest in social activities. When friends or schoolmates ask about her prolonged absence from school, she tells them about how she has struggled — and how she got help.

Autumn Fingerhood could tell the difference in her son, who has struggled with drug addiction, when he was on his medicine for anxiety and depression and when he wasn’t. He cycled through fewer highs and lows. He slept better. The single mother of two, who is in addiction recovery herself, worried less when he left the house about if he was using.

Medicaid paid for her son’s medicine and therapy, and even a stay in drug and alcohol treatment. But Fingerhood, 48, who works three jobs — as a concessions worker at Citizen’s Bank Park, a suite attendant at the Liacorus Center, and a bartender at Subaru Stadium, took one more job last year as a health care aide. She learned shortly after that it put her monthly salary — about $3,500 — over the limit to qualify for Medicaid.

Fingerhood’s son hasn’t gotten his medicine, which retails for about $500 out-of-pocket, in months.

“I struggle with the fact that I know he wants to do better and be better and he wants to be a member of society where he can contribute but it’s really difficult for him,” she said. “He said to me the other day, ‘I want to talk to someone,’ but all those services were lost and I’m constantly worried he may start using again.”

As someone who had Medicaid and lost it, Fingerhood, who lives in Rhawnhurst, said she worries for people who could be impacted by cuts, particularly those who rely on the program for addiction services. She’s still in a health insurance limbo with her son, contemplating finding a lower-wage job that offers healthcare.

Melissa Rinker tripped on the sidewalk blocks from her Doylestown home while walking her 25-pound Cavalier King Charles spaniel.

An injury that might have resulted in a skinned knee or sore ankle for some left Rinker, who has a connective tissue disorder that makes her vulnerable to injuries, bedbound for four days with a dislocated knee, hip, and shoulder.

For years, Rinker tried to keep the condition, called Ehlers-Danlos syndrome, from interfering with her livelihood, working as a server and bartender to support her passion of being a cellist. But her health began to decline in 2014.

“I had to be carried out or crawl to my car,” she said. “After two years of my family doctor saying it’s time to apply for disability, I finally had to listen.”

She hasn’t worked since 2019, and now relies on Social Security and SNAP, which provides food assistance. Medicaid covers the long list of medications she takes, as well as a home health aide for 48 hours a week.

She worries that she could lose Medicaid if she isn’t able to navigate the proposed new rules for work requirements and twice-yearly eligibility checks. The federal proposal includes exemptions for people with disabilities, but analysts have expressed concern that people may struggle to provide proper documentation to secure such an exemption.

“Are we less than because our bodies aren’t able to function the way able-bodied people can?” she said. “We’re not choosing this. We don’t want to have to be on Medicaid. This is the hand we’ve been dealt, and thank God we have what little help they give us now.”