Washtenaw County health professionals anticipate "devastating" effects of Medicaid and Medicare cuts

Eleven million Medicaid recipients nationwide are now in danger of losing their health insurance, and Medicare is also expected to see major budget cuts, due to the recently passed federal One Big Beautiful Bill Act (OBBBA). So what does all of this mean for Washtenaw County? 

"It’s going to be a real exacerbation for people who rely on those resources to take care of themselves and their families," says Alex Plum, executive director of the Corner Health Center in Ypsilanti.
Doug CoombeAlex Plum.
OBBBA puts into federal law an idea long championed by conservatives: work requirements for Medicaid recipients. The law requires able-bodied Medicaid recipients ages 19-64 to work or perform community service at least 80 hours per month. Through that mechanism and other changes, the Congressional Budget Office (CBO) projects that the bill will reduce federal Medicaid spending by $793 million over a decade. 

"If the estimates of the number of people holds, that’s about 16,000 people in Washtenaw County that will lose Medicaid," says Jeremy Lapedis, executive director at the Washtenaw Health Project and Washtenaw Health Plan. "We’re looking at uninsured rates that will go from 3% or 4% to 8% or 9%. …. We’re looking at a much less efficient Medicaid system." 
Doug CoombeJeremy Lapedis.
Lapedis adds that OBBBA caused fear throughout the population he serves before it even passed. Before the bill's passage, he notes, Medicaid reviewed recipients' eligibility every 12 months. 

"They’re going to have to do that twice a year now, and they’re going to have to verify that people are working," he says. "And I don’t see additional dollars going to Medicaid to support that administrative function, so what is already a complicated and bureaucratic system is about to get more and more difficult."

Lapedis says county residents will "lose coverage – not because they’re ineligible for Medicaid, but because the bureaucratic system doesn’t support them accessing the health insurance for which they are eligible."

In Washtenaw County, 40,948 residents got health insurance through Medicaid as of May 2025. Lapedis predicts that people will skip necessary doctor visits and miss prescription refills as a result of OBBBA's Medicaid changes, leading to "overall worse health" for the county's poorest residents. 

Reshaping health care

Medicaid and Medicare were created in the '60s as part of President Lyndon Johnson’s Great Society legislative agenda. The federal government attempted to fill gaps in the health insurance market by creating Medicare, which covers elderly Americans, and Medicaid, which provides health insurance to the working poor who can’t purchase insurance themselves or get it through their employer. Unemployed or underemployed people can also get Medicaid. Every state has its own Medicare and Medicaid system, all operating under the umbrella of the federal government’s Centers for Medicare and Medicaid Services. 

This government-run part of the American health care system was bolstered when the Affordable Care Act (ACA) was passed in 2010 and took full effect in 2014. It created a highly subsidized system for people to purchase insurance while also expanding Medicaid eligibility. The number of uninsured Michiganders decreased from 13% in 2010, according to Ballotpedia, to 5.4% now, according to a press release from the Michigan governor’s office. 

"We have years of evidence that shows the positive impact that ... Medicare and Medicaid expansion coverage has had in improving [Michiganders'] ability to work, [lowering] their health care costs and medical debt, and lowering numbers of deaths," says Jimena Loveluck, health officer at the Washtenaw County Health Department. 
Washtenaw County Health DepartmentJimena Loveluck.
Loveluck predicts that the OBBBA's effects on Medicaid and the federal Health Insurance Marketplace, coupled with cuts to SNAP food assistance, will create "a population that unfortunately will be much less healthy and much less able to access health care services."

Republicans assert that Medicaid and Medicare are both rife with abuse, including illegal immigrants using the system, and that OBBBA will help to address this issue. 

"Fearmongering about Medicaid or Medicare cuts ignores that they target illegal immigrants and ineligible abusers, not Washtenaw’s needy seniors or disabled," Washtenaw County Republican Party Chair Jason Rogers said in an emailed response to an interview request for this story. "This typical alarmism claims millions will lose coverage ignoring the bill’s $50 billion rural hospital fund and Medicaid reforms that will protect the truly needy. Washtenaw County deserves efficient, not bloated, safety nets."

Loveluck and Lapedis both say they have no knowledge of anyone in the county illegally using Washtenaw County’s health system at any systemic level, though Lapedis does point out that some legal resident immigrants can and do apply for Medicaid if they are without means.

It is true that some Medicaid recipients do not work. But all of the health care professionals interviewed for this article said that most of their Medicaid patients are in fact fully employed but just not making enough to cover health care costs, rather than being unemployed or homeless. Others may not work due to having to take care of a loved one.

Dr. Ray Rion is the executive director of Packard Health, which has four locations in Ann Arbor and Ypsilanti. According to Rion, 22% of Packard Health's patients are on Medicaid, 8% are on the Washtenaw Health Project, and 5% are uninsured. 

"When you do something like this to the biggest primary care network in the country, where you really hit some of their most important revenue streams, it would be devastating," he says.
Doug CoombeDr. Ray Rion.
Rion says the primary care network in general has already been strained over the past 30 years in a way he describes as "shocking." 

"In rural America, one in five patients goes to a federally qualified health center," he says. "… Those rural health centers, which are frankly already laying people off, those are the ones that are really going to be hit hard. That, and some of the urban health centers, have that really high Medicaid rate."

Long-term impacts of Medicaid and Medicare cuts

Washtenaw County health professionals anticipate long-term challenges across the health care system as a result of OBBBA's Medicaid and Medicare cuts. While Medicaid impacts will be more immediately felt, the bill's Medicare changes will take longer to play out. The CBO projects that the bill will trigger about $500 billion in Medicare cuts between 2026 and 2034.

"This is going to affect the health of all of us because health insurance premiums are determined based on health care costs," Lapedis says. "And if folks are not getting primary care, but waiting to get sick and getting into the emergency room, that drives up health care costs, which affects insurance premiums for every single person, not just people who don’t have insurance." 

Medicaid and Medicare also have a major financial impact on the health system overall. The University of Michigan Health system, for instance, got 31% of its revenue from Medicare in 2024, according to an unaudited fiscal statement, and 13% from Medicaid. Similarly, in its 2023-2024 fiscal year, Livonia-based Trinity Health (which operates St. Joseph Mercy Hospital in Superior Township) reported that 42% of its revenue came from Medicare plans and another 17% from Medicaid plans.

"Medicaid is really instrumental for the financial stability of our hospitals and clinics. The more uncompensated care that needs to be provided, the more those costs get shared by everyone, whether you’re on Medicaid or not," Loveluck explains. "It’s important to realize that the impacts are not just for people at risk of losing their Medicaid coverage, but for all of us who access health care services and pay health insurance premiums." 

Plum predicts that losing health insurance will cause even more Michigan households to fall into a category the United Way describes as asset-limited, income-constrained, and employed (ALICE). The United Way uses the term to describe households that are technically above the federal poverty line, and look middle-class at first glance, but could still be knocked into destitution or even homelessness by one major unexpected bill. 

The United Way estimates that 41% of Michigan households are ALICE, which is about triple Michigan’s official 14% poverty rate. The United Way found that while only 14% of Washtenaw County households live in poverty, 24% were ALICE households as of 2023.

"We can expect impacts on health care clinics and providers who do take insurance. There may be closures, there may be reductions in care, [and] maybe premium increases for people with insurance," says Betsy King-McDonald, communications manager for Ypsilanti-based Hope Clinic.
Doug CoombeBetsy King-McDonald.
As representatives of a Christian nonprofit, she adds, Hope Clinic's staff "would urge people to see the inherent worth in our neighbors, to have compassion the way that we would like to be treated, to make the programs available that we would like to have available to us, and ultimately discern the spiritual value of the care that we provide."

"Whether or not you believe you are serving the divine directly, there is certainly a spiritual value in generosity, care for others, and compassion," she says.

What to do if you may lose coverage

If you lose Medicaid or Medicare coverage, health care may still be available to you in Washtenaw County. The Corner Health Center serves 12- to 25-year-olds, including those without insurance. Packard Health also takes patients without insurance. The Washtenaw Health Project also helps people find health care, regardless of their income.

Plum urges Medicaid and Medicare patients to schedule any care they've been putting off now, before OBBBA's full effects are felt.

"If you’re on Medicaid right now, the most important thing to do is make sure that your address and contact information is up to date in the MI Bridges system, or with the [Michigan Department of] Health and Human Services," Lapedis says. "That way, if there are communications about work requirements or any policy changes, the department can get into contact with you and you can receive that communication." 

Photos by Doug Coombe.