My patient had a full-body rash. Her lips were swelling. She was scared she couldn’t breathe. If the swelling continued, her tongue could obstruct her throat, and she would suffocate.

But what truly terrified her was the cost.

She worked at another ER — part-time, no benefits. She picked up Uber shifts to make ends meet. She’d applied for Medicaid but was denied. She earned just enough to disqualify her.

And now she was in our ER, sick and uninsured.

On July 4, 2025, Congress passed — and Trump signed — the One Big Beautiful Bill Act.

According to the nonpartisan Congressional Budget Office, it strips 17 million Americans of their health insurance. That’s the largest single loss of coverage in U.S. history.

I’m an ER doctor, I’ve treated thousands of patients on Medicaid, and thousands of patients who are uninsured. I know exactly what will happen as a result of this bill.

The 17 million Americans who lose their coverage will still come to the ER. And because doctors swore an oath to help people, we will still give them care.

The difference? Without insurance, they won’t be able to pay.

Emergency rooms will still provide care, but won’t get paid for a lot of it. Patients will pay more for the care they can get. Many will go deeper in debt. Hospitals will close. Rural clinics will shut down. And, in the ER, wait times will get worse. Whether you are on Medicaid or not, the cost of medical care and health insurance will increase — for everyone.

A deadly policy

This isn’t just bad policy. It’s deadly.

The ER isn’t a safety net; it’s a last resort. And it’s where uninsured patients end up. Without insurance, patients skip doctor visits. They stop their medications. People get sicker. Some die.

We have the data: Health insurance saves lives. But instead of expanding access, this bill creates more red tape, more suffering, and more death — especially for seniors and low-income families.

And the financial devastation is just as cruel: more medical bankruptcies, destroyed credit, wiped-out savings.

Not about waste

This bill was never about waste.; it was about wealth.

Why did the Republicans pass this? To give tax cuts to the ultra-wealthy. Period.

This bill adds $3.3 trillion to the national debt over 10 years. Yet somehow, it still manages to gut care for working Americans, increase taxes for working class Americans, and hand out an average of $66,000 annually to the top 1%.

Many who rely on Medicaid voted for Republicans. They believed in Trump’s promises to lower costs. And they were repaid with a bill that takes their health care coverage, raises their costs, and risks their lives.

That’s a big reason even conservative Republicans spoke out against this bill:  Sen. Josh Hawley, R-Mo., said, “We can’t be cutting health care for working people and poor people in order to constantly give special tax treatment to corporations,” and called the cuts “morally wrong.” Sen. Susan Collins, R-ME, said it would “hurt people” and voted against it.

A moral failure

The patient I saw that night? She got better. She walked out of the ER alive — and grateful. But she also walked out with a massive hospital bill that may destroy her finances.

Now that this bill is law, this will be the story for 17 million more Americans – the system will punish you for being sick, then blame you for being poor.

I and my colleagues in health care entered this field to help people. We know how vital coverage is. And we know what happens when patients are forced to go without.

Arizona Rep. David Schweikert and the congressional Republicans in Washington, D.C., who turned this bill into law either don’t know what will happen, or don’t care.

Either way, they should be removed. Because this bill isn’t just bad policy. It’s logistical failure, professional betrayal, a moral outrage and a national disgrace.

Let’s call it what it is: abuse.

Dr. Amish Shah is an emergency room physician, a former Arizona state representative, and a Democratic candidate for Congress in Arizona’s  1st Congressional District.

Editor’s note: Rep. Schweikert’s team denied an opportunity for response.