Disclaimer: The following is a letter to the editor. It represents their personal views on this issue. RVA Magazine is committed to providing a platform for community voices on important local matters. The opinions expressed do not necessarily reflect those of RVA Magazine, its staff, or affiliates.
By E. Thorne
The dismantling of Medicaid is not the byproduct of legislative oversight or the unintended consequence of a complex budget. It is a deliberate act, executed with precision and grounded in an ideology that has grown less apologetic with each passing year. The goal is not to fix what is broken, but to narrow the perimeter of who is deemed worth saving.
For decades, Medicaid has stood as one of the last unambiguous expressions of the belief that health care should not be reserved for the fortunate. It extended the possibility of stability to those long perched at the edge of crisis, not through charity, but as a matter of public duty. To unravel it now, framed in the language of fiscal restraint or government streamlining, is to abandon that responsibility. In its place, we are left with something far less functional than a reimagined system. What remains is absence, a quiet withdrawal that leaves millions to face illness, disability, and aging with nothing beneath them.
The language used to justify these cuts (calls for efficiency, sustainability, modernization) is antiseptic by design. But what has emerged in practice is not a more agile or responsive model of care. It is a hollowing out. In the vacuum left behind, families are forced to make impossible calculations. Long-term treatments are cut short. Medications are skipped. Home health aides disappear. This is not innovation. It is attrition.
The consequences are already visible, following a pattern we’ve seen before: clinics shutter in towns that have too few patients with private insurance, emergency rooms overflow with those who delayed care until it became urgent, and more people quietly recede from the system altogether, living shorter, harder lives as a result. None of this is surprising. Policymakers know it well. That they move forward regardless is not evidence of blindness but proof of intent.
Economic necessity does not drive these decisions. They reflect something more fundamental—a worldview in which health is treated as a transactional good, not a social commitment. In this framework, those who cannot pay are not just overlooked but are reclassified as undeserving. A society organized around such assumptions will always find justification for withdrawing care. It will call it reform, but its logic is exclusion.
This moral framework is not novel. It has been repackaged many times over, but the premise remains the same. Hardship stems from personal failure, and aid corrupts both individual initiative and collective virtue. What has changed is the transparency with which these beliefs are now embedded in policy. There is little interest in hiding the motivations or softening the blow. The veil has dropped, and what lies behind it is not unfamiliar, but it is increasingly unashamed.
The individuals most likely to be affected by these cuts do not make headlines. They are not the subjects of campaign speeches or the faces of urgent appeals. Elderly people with no family. Children with developmental delays. Adults whose injuries or illnesses prevent them from working. Their lives are politically quiet, and in that silence, their erasure becomes easier to rationalize, not through a single moment of rupture, but through sustained neglect, delivered with clinical detachment.
The collapse, if we can even call it that, will be slow. Appointments will vanish. Options will shrink. People will do what they can until they can’t. And then they will fall, often unnoticed, into gaps that used to be filled by something we once agreed to call care. No alarms will sound. The policy will remain in place. The harm will become background.
Beyond the loss of a program, this moment represents the severing of something older and quieter. An unwritten understanding that the state bears some responsibility for those who cannot carry themselves is disappearing. There won’t be a headline when that understanding disappears. There will be no public reckoning. Only the small, persistent weight of absence, measured in lives diminished, possibilities closed off, and losses absorbed by those least equipped to bear them.
What has failed is not just a system of care, but the belief that we still owe something to one another. The numbers may remain abstract. The rationale may be airtight. But the truth will persist in every room where help once arrived and no longer does.
Photo from a backyard in Eden NC 2021, by R. Anthony Harris
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