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Hello, readers of The Breakdown. It’s been ten months since Donald Trump signed what he called the One Big Beautiful Bill. And it’s been about that long since the law has been a focus of political conversation.
That’s partly because the most visible elements of the law’s unprecedented Medicaid cuts didn’t take place right away—especially the new “work requirements,” which states don’t have to implement until January 1, 2027.
But three states have opted to start early. Today I write about one of them, Nebraska, which officially launched its program on Friday.
This won’t be the last time I write about what’s happening in Nebraska—or in other states—as the OBBB’s cuts take effect. But this kind of reporting takes time, and sometimes travel, too. Covering policy all these years has taught me that reporting is the surest way to highlight both what’s working and what isn’t—and to hold policymakers accountable.
We’re able to bring you this kind of granular, on-the-ground coverage thanks to the support of our Bulwark+ members. Won’t you consider becoming a member yourself? If you click here to sign up, you’ll get fourteen days FREE to try out Bulwark+ and see if membership is right for you:
–Jonathan
Trump’s Big Medicaid Cuts Are About to Get Very Real
Nebraska will be the first test of how many people lose insurance—and who they are.
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OMAHA, NEBRASKA HAS BEEN BUSTLING with activity these past few days thanks to the annual Berkshire Hathaway weekend, when tens of thousands of investors from around the world gather to hobnob with Warren Buffett while they figure out how to maximize their portfolios.
But inside one office, a woman named Amy Behnke has been preoccupied with something very different and much more urgent. She has been furiously working the phones with state officials, trying to figure out how to keep some of Nebraska’s poorest residents from losing their health insurance.
Behnke is CEO of the Nebraska Health Center Association, which represents clinics that provide care to the state’s underserved population. Since 2020, she tells me, the percentage of total patients showing up to member clinics with no insurance at all—the ones who represent the biggest drain on clinic finances—has dropped from half to one-third.
That’s a sign of progress, and it’s no mystery what’s behind it. In October 2020, Nebraska officially became part of the Affordable Care Act’s Medicaid expansion. By taking advantage of federal funding that the state’s GOP officials had long refused—but that voters eventually approved via ballot measure—Nebraska was able to open up its program to any citizen or qualifying legal resident with income below 138 percent of the federal poverty line.
The gang returns to California for two live shows in May. Join Sarah, Tim, and Sam in San Diego on May 20 or in L.A. on May 21 for a night of politics and laughs, and a community built on good faith. Bulwark Live: California is sure to sell out—don’t delay. |
More than 70,000 Nebraskans are now on Medicaid because of the expansion. But as of May 1, they are also subject to new “work requirements” that became law last summer as part of the broader Medicaid cuts in President Donald Trump’s “One Big Beautiful Bill.” That legislation calls on states to impose their work requirements by January 1, 2027. Nebraska decided to go first, thanks to Republican Gov. Jim Pillen, who has said the rules will make sure Medicaid is a “hand up, not a hand out.”
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