Cutting the Social Safety Net

By Sue Coyle, MSW

With the passage of the One Big Beautiful Bill Act, social workers must be aware of what lies ahead for the communities, families and individuals they serve.

In the weeks prior to the passage of the One Big Beautiful Bill Act, communities and individuals throughout the country protested and campaigned against it. Of biggest concern were the planned cuts to Medicaid and SNAP (Supplemental Nutrition Assistance Program). As of March 2025, more than 78 million people were enrolled in Medicaid and Children’s Health Insurance Programs (CHIP), and in 2023, an estimated 42.1 million individuals participated in SNAP each month. Advocates were concerned about how the changes detailed in the bill will significantly impact the availability of and access to both programs.

Even the lawmakers pushing the bill forward had little to defend it with. Their reasoning for voting in favor of it ranged from apathetic to flippantly dismissive and cruel. Republican Sen. Mitch McConnell of Kentucky, for example, was quoted as saying, “But they’ll get over it,” while Sen. Joni Ernst, R-Iowa, responded, “We all are going to die” when a constituent told her cuts to Medicaid would end lives.

Nonetheless, after passing in the Senate and the House, President Donald Trump signed the bill into law on July 4, ushering in what have been deemed the largest cuts to the social safety net in this country since the social safety net was created. While the cuts will not occur immediately or all at once, social workers in all sectors must be aware of what is coming and how it will impact their clients, their communities and the programs within them.

Health Care

The One Big Beautiful Bill Act aims to cut spending on Medicaid and CHIP by $911 billion over the next 10 years through eligibility restrictions and requirements, limiting types of coverage, and eliminating state incentives for expanding Medicaid through the Affordable Care Act, among other changes. For instance, the act requires all adults between the ages of 19 and 64 to be working, completing community service, or completing work training for a demonstrated 80 hours a month. There are exemptions for specific populations, including those with children under 13 and individuals with serious medical conditions. These changes will go into effect no later than Dec. 31, 2026. Currently, Medicaid eligibility does not hinge on work requirements.

It is expected that the changes will result in more than 10 million individuals, including children, becoming uninsured by 2034. This estimate includes those who will lose insurance simply because of paperwork errors — not an uncommon occurrence—that will likely increase in the coming years.

The Kentucky Center for Economic Policy, for example, which reported that from 2022 to 2024, 39% of Kentucky adults covered by Medicaid were working full-time and 12% were working part-time, notes that the burden of proving eligibility often leads to disenrollment. “A recent national example is the 2023 unwinding of the Public Health Emergency, which required most Medicaid enrollees across the country to prove their eligibility for the first time in three years,” says an article at kff.org. “This resulted in millions losing Medicaid, and up to 79% of the total disenrollments were due to paperwork errors rather than true verification of eligibility.” The impact of so many losing health insurance will be severe.

“Medicaid is often the bridge that makes health care possible for many Mainers, especially children, older adults, and people living with disabilities,” describes Chris McLaughlin, MSW, LCSW, lead consultant and owner of Inspired Consulting Group, LLC, in Maine. “More than half of children in Maine are covered by MaineCare, our name for the Medicaid program here in Maine. Cuts to Medicaid threaten to widen the existing gaps in access and leave our most vulnerable residents, including over 130,000 kids, without the basic care they need to survive, let alone thrive.”

The same is true in New Mexico, the state with the highest percentage of individuals covered by Medicaid. “With nearly 40% of our population relying on this coverage, even small reductions can create ripple effects across the entire health care system,” says Lauren Gomez, LCSW, CEO and clinical director of High Desert Healing, chief clinical officer at the Pines Institute, and executive director of NASW-New Mexico. “These cuts will likely result in decreased access to preventative care, behavioral health services, and specialized treatments, particularly in rural and underserved areas. For a state like New Mexico, where poverty, substance use, and health disparities are already significant, these changes threaten to reverse years of progress.”

Everything from routine care to life-saving procedures will be affected. Jeremy Arp, MSW, ACSW, executive director of NASW-Washington State and interim executive director of NASW-Hawaii, points to the numbers to highlight how these cuts will affect something as universal as birth. He cites a report from Washington Gov. Bob Ferguson’s office that 45% of all births in the state are covered by Medicaid, for example. That number rises to 70% in the rural areas.

Arp adds that cuts to the Medicaid programs will impact not only the well-being of those covered by the insurance but also put additional financial strain on caregivers, as they attempt to pay for routine, preventive and necessary medical procedures and events.

It’s not just coverage that will impact the well-being of Americans. The Medicaid cuts could lead to changes in the patients who providers are able or willing to see, as well as the closure of medical facilities, particularly those in rural areas. Many hospitals rely on Medicaid funds to stay afloat, as a significant number of their patients rely on Medicaid for their health care coverage. In rural areas, the closure of a health care facility may mean the widening of what is already a health care desert.

“In rural areas, losing just one provider can mean patients are driving hours for treatment, which, for many living in rural areas, means missing days of school or work,” McLaughlin says.

Brenda Rosen, MSW, CSW, ASCHP-SW, executive director of NASW-Kentucky, adds: “People from the smallest, most rural areas who don’t have medical care or who need something like a CT scan or an ultrasound [already] have to come three to four hours each way. These smaller hospitals are lifelines to people in our regions who don’t have access to medical care.

“Even if Medicaid is cut, people are still going to show up in the ER. They’re still going to get treated, and there’s going to be no funds there. So basically, what this horrific regime is doing is cutting their nose to spite their face,” she says. “It’s just horrible.”

Outside of hospitals, the bill could also affect access to long-term care. “We’re anticipating one out of every four skilled nursing facilities [in Kentucky] will close,” says Rosen. “You’re going to have people who were already of limited-to-no resources with no place to go.”

Food Security

The cuts to SNAP are anticipated to be similarly impactful, particularly given how important SNAP is. “While our state has pockets of community-based resources like food pantries or take-home meal programs, SNAP is by far our most widespread food assistance program. SNAP is more than a program, though. It’s truly a public health intervention supporting thousands of Maine people,” McLaughlin says.

The Act reduces SNAP spending by approximately $186 billion by 2034. This is less than what was anticipated with the first version of the bill but still significant. As with Medicaid, work requirements will change, and states will be required to pay a larger percentage of benefits and administrative costs. It is expected that these changes will lead to lower participation in SNAP by two to three million individuals. Without SNAP, people—including children of all ages—will be forced to look to other community resources for support. However, many of those supports are already at maximum capacity.

“Unfortunately, the need has drastically increased,” says Amy Beros, president and CEO of the Food Bank of Central & Eastern North Carolina, one of the largest food banks in the country. Its main distribution center is located in Raleigh. “Right now, we have about 607,000 people facing hunger each day in our 34 counties, and that number has increased (in recent years). Just two years ago, it was 450,000.” She notes that in the past year, the food bank has distributed approximately 115 million pounds of food.

Supply, however, has not increased with demand. “We have an inverse situation right now. We have declining resources at the same time of increasing need and looming federal cuts ahead, like the SNAP cuts, that we know will increase the need even more,” explains Beros. In North Carolina, the state budget had not yet passed at the time of Beros’ comments, meaning the food bank was facing federal funding cuts while also unsure if it would face cuts at the state level. “We just keep seeing hits on both the state and federal levels at the same time as this drastically increasing need and projections for it to be even greater,” she says.

This is not an isolated situation but rather something that is happening throughout the country. “Our food banks are tapped. They are beyond tapped,” says Rosen.

The Ripples

It’s not only health care and food security/insecurity that will be affected by the cuts to Medicaid and SNAP. The increased cost to states could lead to reallocated funds. And the lack of stability and well-being for individuals and families could change how they interact with their community.

McLaughlin cautions, “Cuts like these never exist in a vacuum. When people can’t access health care, they’re less able to work, parent or participate in their communities. When families go hungry, kids can’t focus at school, and chronic stress skyrockets. That ripple effect shows up everywhere in places like school districts, workforce programs, the criminal justice system, and in emergency departments already inundated with trying to manage the needs of those experiencing mental health crises.”

Gomez agrees. “These cuts will strain nearly every support system in New Mexico; schools, shelters, food pantries, and behavioral health clinics. Local nonprofits and social service agencies will see increased demand without the corresponding increase in funding or staffing.”

Unemployment could go up as well. The closure of medical facilities can lead to thousands being without work, and the changes to Medicaid could lead to smaller offices closing alongside the large hospitals. “You’re going to see physicians who are going to say ‘I can’t accept people on Medicaid’ or ‘I have to close my office.’ It’s not that they don’t care. It’s just that these cutbacks impact their livelihood, their staff’s livelihood. Everything. These cuts just bleed into every activity of daily living,” explains Rosen.

The economy will be impacted, too. “It’s going to be an obvious and immediate impact for those [for whom SNAP] is a critical resource, but also what it’s going to do to the economy … . For every dollar that SNAP generates, $1.50 is generated in economic activity. The cuts to SNAP are going to put farmers out of business,” Beros says. “We’ve already hit them with the cuts at the federal level. They’re already concerned if they’re going to be able to continue. At the same time, grocery stores have huge reliance, especially in rural communities, on SNAP. Are we going to be closing down more grocery stores? And then we’re creating more food deserts.”

For social workers, the impact will be felt on many levels. “Social workers will be on the front lines of this fallout. We’ll see caseloads increase as more individuals lose coverage and benefits. We’ll face the moral distress of working in systems where we can no longer connect clients to adequate care, and we’ll burn out faster,” says Gomez. “Rural practitioners will be especially vulnerable, and we risk losing skilled professionals from the field entirely.”

Social Worker Response

Knowing that these cuts are coming and the wide-ranging impact they will have, social workers must prepare to best support their clients (and themselves) through direct service and advocacy.

“Social workers are on the front lines, but we’re also behind the scenes coordinating care, writing policies, and leading human service programs,” says McLaughlin. “Now more than ever, we need to prepare by building coalitions, assessing our services for gaps, and communicating transparently with our clients about what may change for them. Social workers can help their clients prepare for what might be ahead by developing safety plans and natural support systems to help meet whatever unmet needs our clients experience.”

Social workers should also continue to advocate. It may seem daunting after the passage of the One Big Beautiful Bill Act—a law that was widely protested but passed regardless—however, advocacy and education can still effect change. Equally as important, social workers should vote. “Your vote is your voice,” says Rosen. “You need to walk into that voting booth to help make a difference.”

Finally, self-care will remain important for social workers, as they are faced with even more challenges. Never forget, says Arp, that there will always be more to do within the community. Self-care does not mean stepping back to the point of no longer working. It means supporting oneself so that one can continue to fight.

Sue Coyle, MSW, is a social worker and freelance writer in the Philadelphia suburbs.

Resources

NASW Stronger Together Resource and Action Center: socialworkers.org/advocacy/social-justice/stronger-together-resource-and-action-center

NASW Issue Brief: “Now the Reconciliation Bill Passed, What is Next?”: socialworkers.org/advocacy/policy-issues/now-the-reconciliation-bill-passed-what-is-next