or the cost of a village’s teacher dying before her students graduate. They simply count bodies.
When I began writing this piece, I thought the story might be about budgets. It’s not. It is about a philosophy. In federal rulemaking and memos and waivers that will never trend on social media, the U.S. signaled to the world—and to its own people—that healthcare is optional.
America once defined itself by what it built—the TVA, the interstate system, the moon landing. This year, it defined itself by what it chose not to build.
I look outside now, past the window where winter is arriving again. The wind has shifted off the Atlantic. The cold will get worse before it gets better. And somewhere near the wood stove, Sofia is asleep—curled into herself, breath slow, trusting the house to hold.
It is hard not to think of the millions of people this country once sheltered—who now live without that kind of warmth.
Bibliography (Chicago-Style)
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2. U.S. Department of Health and Human Services. Medicaid Optionality Rule, 2025. Federal rule change permitting state block-granting and eligibility removal.
3. The Denverite. Local reporting on pediatric ER testimony regarding Medicaid lapse and asthma medication gaps.
4. U.S. HHS. Notice of Termination of Cost-Sharing Reduction Payments, February 2025.
5. Federal Register. Rule Reinstating Short-Term Limited-Duration Health Plans, February 2025.
6. Kaiser Family Foundation. Patient Case Archive – Interview with Michele Ray Smith, Tampa, FL, regarding chemotherapy delay.
7. Tampa Bay Times. Coverage of ACA marketplace subsidy disruptions affecting Florida cancer patients.
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9. DHS Policy Memo on Epidemiological Data-Sharing Limitations, April 2025.
10. Reuters. “Trump Halts Foreign Aid, Including AIDS Relief and TB Funding.”
11. UNAIDS. Press statement on U.S. foreign aid freeze: “Treatment interruptions place millions of lives in jeopardy.”
12. Reuters. “Trump Administration Scraps Over 80% of USAID Programs.”
13. Wikipedia. “2025 United States Federal Mass Layoffs.” Summary of USAID employment collapse.
14. Reuters. “Watchdog Warns USAID Freeze Leaves $8.2B Unspent with No Oversight.”
15. AP News. “Federal Judge Orders Partial Lift of USAID Funding Freeze.”
16. HIV Prevention Program Clinical Reports, KwaZulu-Natal region, cited in Reuters.
17. Reuters. “Global Funding Cuts Devastating HIV Prevention Programmes, UNAIDS Says.”
18. WHO/UNAIDS joint statement: eight countries at risk of HIV medication depletion.