The Hippocratic Divide: How the “Beautiful Bill” Fractures American Healthcare

2025 is an odd year for healthcare in America, filled with the have-nots and those who have way too much.

For the well-resourced, there’s a thriving luxury care market. It’s a global complex masquerading as health empowerment and self-care. Adherents can order $300 sleep trackers from their phones and purchase spendy, wearable fertility trackers (often before moving on to $20,000 IVF treatments).

Meanwhile, millions of Americans lack access to basics like pap smears and colonoscopies, even if they did have appointment transportation and the ability to afford their Medicaid copays.

And on the eve of America’s birthday, Congress passed sweeping legislation that curtails healthcare access to millions, amid chants of “USA! USA!”

While healthcare should be an apolitical issue, funding and access have again become a partisan flash point. As we again celebrate and reflect upon America’s founding, it’s worth examining the health of our nation: government, institutions, and people.

Acknowledging the disparities shaping American healthcare access isn’t political, but rather a painful, up-close reckoning of our resources divide.

Also read: Are Physicians Leaving America?

Government Showdown

Few would argue that America’s medical system is underfunded and in need of reform. Yet in recent years, the debate has centered on who the system is underfunded for, and what it will take to fix the shortfall.

President Trump’s signature legislation, the newly passed One, Big, Beautiful Bill, tackles such questions head-on.

The bill passed the House of Representatives on July 3, 2025, by a narrow four-vote margin, just days after it barely cleared the Senate with Vice President J.D. Vance casting the tie-breaking vote.

Among the bill’s healthcare reforms, it expands the access of Health Savings Accounts (HSAs) for seniors on Medicare and married couples, allows HSAs to pay for gym membership and direct primary care, and expands the use of employer clinics. 

The bill also offers deductions for direct primary care fees and long-term care insurance premiums, as well as expanding coverage options for non-ACA plans.

Certainly, millions of Americans will benefit. But as with many of President Trump’s reforms, these changes are designed to promote the interests of “hard-working” Americans. It offers means-tested tax relief for those who have access to gyms, HSA accounts, and employer-sponsored plans.

The recently passed “One, Big, Beautiful Bill” enacts sweeping healthcare reforms with profound implications.

• It eliminates ACA premium tax credits, impacting millions of mixed-status families. By some estimates, 11.8 million Americans will lose insurance by 2034.
• The bill limits care by cutting funds for large abortion providers and restricting Medicaid use for legal migrants and undocumented individuals.
• Food assistance (SNAP) is reduced with new work and eligibility rules, impacting millions.
• Medicaid spending is dramatically slashed by an estimated $1.1 trillion, while provider tax freezes hinder states’ program funding and expansion efforts.
• New work requirements mandate 80 hours monthly for many adult Medicaid beneficiaries to maintain coverage.
• Expansion of “junk” insurance plans (STLDI) that destabilize risk pools and usually exclude pre-existing conditions.
• Increased administrative hurdles, including eligibility checks and paperwork. These threaten mass disenrollments, potentially closing rural clinics.

States face greater burdens with more frequent Medicaid checks and cost-sharing. Uncompensated care will surge, forcing hospitals, especially in rural areas, to cut services, staff, and potentially close.

Supporters claim these changes protect Medicaid for the truly entitled, eliminating “waste, fraud, and abuse” and promoting accountability. Yet, medical providers warn this will harm vulnerable populations and destabilize our healthcare system.

“Wellness” Flourishes, Basic Care Fades

Ironically, at the same time basic care for millions of Americans is being gutted, the wellness industry is booming.

Wellness is big business in America. Among its top players are GLP-1 weight-loss drug companies. Prescriptions for these miracle jabs are seemingly everywhere, yet African Americans, with some of the nation’s highest rates of diabetes, struggle to get Ozempic.

Those with means can hoard in-demand diabetes drugs and clamor for wellness spas offering coffee colonics, cryotherapy facials, and DNA-based longevity plans. Even those who can’t afford spa-level self-care can still buy a smaller “piece” through pills, probiotic sodas, and $150 face creams.

I’ve tried a cacophony of those treatments (never mind which ones) and have a small home pharmacy of supplements and collagen powders.

Because if I’m not trying to live longer and more youthfully, I fear I’m neglecting my body and its fullest potential. It seems like half the country is following this same trajectory, while the other half is dying young from lack of preventive care.

Who Gains from the Gap?

The big winners are private weight-loss clinics, concierge health, and glow-up apps.

The wellness market is a $2 trillion industry, less regulated (if at all) compared to conventional medical treatments, and especially appealing to Generation Z and young millennials.

Everyone is following the money.

This includes medical systems, too. High-reimbursement procedures and private-pay services are more profitable than preventive or chronic care, and insurers often pay more, and faster, for non-preventive care encounters.

Inevitably, this drives administrative decision-making. With the added mess of opaque coding guidelines, approvals, rejections, and stacks of IOUs, it’s easy to see why many providers are turning toward patients with premium coverage or the means to pay out of pocket.

As the American Medical Association (AMA) surmises in its open letter to the Office of Management and Budget, everyone is fighting for survival in a system that penalizes efficiency and rewards high-cost, high-reimbursement procedures.

Physicians already spend countless hours battling insurance, drowning in documentation requirements and swiftly changing mandates. New administrative burdens are death by design. They divert valuable resources from direct patient care into a gridlock that benefits some at the expense of many, including patients and their burned-out providers.

Who Gets Left Out?

The American healthcare system is built on the meritocratic assumption that coverage is for those who work, but makes allowances for a non-working yet deserving minority, such as children and senior citizens.

This set-up works fine, assuming you have a full-time job with benefits and steady wages, and no major life disruptions. This, however, is not the reality for most people.

In terms of medical care, large swaths of the population may get left out, including millions of non-minority, native-born citizens:

• Kids who are not old enough to work
• Older adults not yet eligible for Medicare
• People with disabilities
• Low-wage workers in jobs that don’t offer insurance
• Part-time workers
• Gig workers (i.e., your Uber driver)
• People between jobs or working under the table
• Self-employed people who can’t afford private coverage
• Privately insured, working adults whose employers offer non-ACA (narrow coverage) plans

Virtually all Americans will eventually find themselves vulnerable to insufficient healthcare at some point in their lives, and the impact is sharply racial. African Americans disproportionately hold low-wage, no-benefit jobs, and 56% live in the South where Medicaid eligibility is tighter.

While Medicaid expansion previously reduced uninsured rates, especially for Black and Hispanic populations, the new bill now reverses this progress. It penalizes working individuals whose jobs don’t “count” and adds paperwork barriers.

Arkansas passed a similar work requirement for Medicaid, which led to 18,000 people (25% of participants) losing coverage. The primary drivers were missed deadlines and confusing guidance, not lack of work. If one in four Americans on Medicaid were to lose coverage, it could collapse our system, leading to a severe decline in public health and trillions in unpaid hospital care.

Doctors Are Already Overwhelmed

Doctors, seldom seen as victims, will significantly suffer from this new bill.

Even before this bill was passed, our deeply flawed system burdened patients with complex denials and confusing paperwork, causing them to abandon or delay necessary care. Sicker patients would then flood emergency rooms, which have become de facto primary care clinics for our nation’s poorest.

This outcome has long forced providers to confront grave moral injury.

Already burdened by immense debt and burnout, many sought early exits through FIRE (Financial Independence Retire Early).

Now, the new bill’s added red tape will deepen our system’s ethical and structural failings.

Doctors who do remain will likely become more hardened or disengaged, if only for self-survival, almost certainly leading to suboptimal patient outcomes.

For providers, there are two conflicting calls at play:

1. Get out now, or as early as possible. Work hard, invest, and retire early for sanity and a reasonable quality of life.
2. Public advocacy. There’s a growing call for doctors to become advocates in a push for greater justice and equity in U.S. healthcare.

What Advocacy (Not Activism) Can Look Like

Burnout is the baseline for physicians.

They’re overbooked and vastly underpaid given the workload, expectations, and educational investment. However, as the AMA has pointed out and recent legislation demonstrates, when trusted clinicians disengage from public discourse, insurers, policymakers, and CEOs of the wellness industry fill the void with PR statements and efficiency logic.

Doctors hold influence and respect, with their words shaping the public’s understanding of what is fair, ethical, and worthy of funding. They are uniquely positioned to call out system flaws and contradictions, like one county having no OB care while an IV infusion spa opens down the road.

Thus, increasingly, medical researchers, academics, and clinicians are calling for physician advocacy.

Read more: Working in the Time of a Burnout Crisis

Defining physician advocacy

A Duke Medical School thought piece defines physician advocacy as promoting social, economic, educational, and political changes that ameliorate suffering and threats to human health and well-being, identified through professional work and expertise.

This advocacy takes three core forms:

1. Individual: Helping patients navigate the system
2. Community: Addressing health at a population level
3. Systems and Policy: Influencing laws and practices

Most physicians believe advocating for patients is appropriate, but many abstain out of fear of being ineffective or perceived as political.

Yet, many bodies like the AMA and Duke Medical School assert that physician advocacy is an ethical imperative inherent to Hippocratic justice.

Though medical schools traditionally prioritized clinical skills, there are increasing calls to embed advocacy as a core professional competency.

As of 2021, approximately 77% of U.S. medical schools offer some form of advocacy training, with formats that range from single lectures to year-long tracks. Recent legislation only highlights the growing need for increased participation and more robust training.

Meaningful change doesn’t always require grand gestures. Outside of the classroom, physicians can:

• Speak at town hall meetings
• Write op-eds
• Join health boards
• Attend conferences connecting experts and policymakers
• Contact congressional representatives
• Share personal stories about the bill’s impact on patients and clinicians

The overarching goal is to improve patient access and quality of care, alleviate administrative constraints, and neutralize disinformation (hysteria) that harms public health.

The Hippocratic Oath Wasn’t Means-Tested

For years, access to skilled medical care has been shaped by insurance, ZIP code, and income, thereby widening a class gap in which health is a luxury good.

The recent bill escalates this divide by directly asking doctors to violate their Hippocratic Oath, which mandates care regardless of income, documentation status, or character.

Lawmakers should stay in their lane. Disconnected from direct patient care, politicians are forcing medical professionals into an impossible bind.

This legislation reinforces a system that decides who is worthy of healthcare. It punishes those who fall through the cracks rather than fixing the employment-based model that disproportionately harms the working poor and communities of color.

The passage of this bill is a profound dishonor to our profession. Physicians, as the nation’s conscience, must use their voices to speak up against this bill, reaffirming their ethical commitment and urging leaders to depoliticize healthcare.

A Hospital Doctor’s Perspective: Catastrophe Incoming

Dr. Jorge Sanchez, M.D., a Florida-based hospital doctor, issues a stark warning about how the new bill will dismantle emergency room care. In his own words, here is Dr. Sanchez’s perspective:

On the nation’s birthday, our country has enacted legislation that rations care to millions and tells doctors and hospital administrators how to do their job.

Stunningly, all value-based incentives for healthcare are now shattered. The crushing implications go far deeper than most people realize. The bill quietly dismantles years of progress toward rewarding quality over quantity, and asks physicians to violate everything we have sworn to uphold.

Lawmakers have tasked doctors with becoming instruments of their political will, minions who deny care based on bureaucratic requirements rather than actual medical need.

The Hippocratic Oath doesn’t have a means test, yet Congress is demanding we create one. When millions of Americans lose insurance and we’re drowning in administrative burden, how exactly are we supposed to practice medicine?

The cruel irony is that while we cut basic preventive care for the most vulnerable, the wellness industry is booming for those who can afford $300 sleep trackers and concierge medicine. We’re creating a two-tiered system where your ZIP code and bank account determine whether you get an Ozempic prescription or wait months for a colonoscopy.

New legislation rewards exactly what value-based care was designed to eliminate: high-cost interventions over prevention, volume over outcomes, and profit over patients.

Meanwhile, physicians are burning out faster than ever. Many of my doctor colleagues are planning to retire early rather than participate in this ethical nightmare. When disheartened doctors abandon medicine, public health erodes everywhere, even for the people who “deserve” care.

Practitioners who stay will spend more time fighting insurance companies and less time with patients. We’ll see sicker patients flooding emergency rooms because they lost primary care access, creating worse outcomes for everyone.

I can see the catastrophe coming.

Picture patients at the ER doctor’s doorstep with late-stage colon cancer because they couldn’t obtain a colonoscopy, or $15,000 stroke admissions that could have been headed off with a $150 primary care visit to adjust blood pressure meds.

Value-based care keeps hospitalists sane and patients alive. Preventive care manages treatable conditions so patients don’t crash our ER doors at 2 a.m.

New Medicaid barriers, however, mean millions will skip heart medications, miss dialysis appointments, and avoid cancer screenings. These patients still want preventive care, but are not equipped to navigate the new system.

Every missed preventive visit today becomes an emergency tomorrow, and emergency medicine is the most expensive, least efficient way to provide healthcare. With politicians breaking value-based care, we’re guaranteeing that the sickest, most complex patients will flood our already overwhelmed emergency departments.