There was a time when I was sleeping on subway cars and struggling to survive with HIV, diabetes, and high blood pressure, unsure if I would live to see the next year. I cycled in and out of treatment. I didn’t trust the healthcare system. I was battling depression and suicidal thoughts, and for a long time, I felt like I had nowhere to turn.
Access to consistent care changed everything. It is the reason I am alive today — and why I spoke out last year in these pages, warning about the devastating harm that proposed federal Medicaid cuts would cause for Black New Yorkers like me. I warned that these cuts would strip coverage, destabilize care, and deepen racial health disparities.
Unfortunately, too many members of Congress, including seven from New York’s delegation, did not heed those warnings. Now, we are beginning to see the consequences — and unless Congress acts, things are about to get much worse.
The federal budget law passed last year — a massive transfer of wealth from working people to the richest Americans, paid for by slashing healthcare and food assistance — is already undermining Medicaid in New York. The state stands to lose an estimated $8.4 billion in federal funding each year. That loss doesn’t just exist on paper — it means fewer people covered, fewer services provided, and more barriers to care.
We are already seeing the early warning signs.
More than 1 million New Yorkers are at risk of losing affordable coverage due to changes to the Essential Plan, long a critical pathway to care for low- and moderate-income residents. Many of those pushed off will be forced into private insurance they simply cannot afford, as premiums continue to rise, leaving people to choose between paying for coverage or going without care altogether. Others will lose coverage entirely, while new red tape makes it harder just to sign up or stay enrolled. Lawfully residing immigrants — people who are part of our communities and workforce — are now being shut out of coverage altogether.
These are not minor policy tweaks. They are structural changes that will push people out of the healthcare system.
When people lose access to preventive care, they do not stop getting sick. They end up in emergency rooms, sicker and in crisis, driving up costs and straining an already burdened system. Hospitals and clinics that serve Medicaid patients — especially in Black communities — will face impossible financial choices, leading to layoffs, service cuts, or closures.
We have seen this before. We know how this story goes.
Black Americans already face higher rates of chronic illness and shorter life expectancies due to systemic inequities in access to care. Medicaid has been one of the most effective tools we have to close those gaps. Cutting it now will reverse years of progress and widen disparities that should have been eliminated long ago.
It will also undermine New York’s leadership in the fight against HIV. Medicaid is the largest source of coverage for people living with HIV in this country. It funds the medications, preventive care, and support services that have helped reduce new infections and keep people like me healthy and alive. Rolling back that support will not just harm individuals — it will set back public health across the state.
None of this was inevitable. It was a choice. However, it is not too late to make a different one.
While President Trump may be doubling down on domestic cuts and increased military spending in his proposed 2027 budget, Congress must stand up. They should act now to reverse the enacted cuts to Medicaid, restore funding, and protect access to care before more people lose coverage and more lives are put at risk. New York’s leaders must also do everything in their power to mitigate the damage and ensure that no one falls through the cracks.
When I was finally able to access care through Medicaid, I began to rebuild my life. With consistent coverage and the right support, I stayed in treatment, managed my conditions, and regained stability and dignity.
My story is not unique. Across New York and the country, millions rely on Medicaid for lifesaving care — for HIV, chronic illness, mental health, and more. It allows people to get healthy, stay healthy, and live full lives.
Without it, many would fall through the cracks, ending up in crisis, in emergency rooms, or worse. For countless Americans, Medicaid is not just coverage. It is the difference between surviving and truly living.
That is what is at stake.
Last year, I asked: How much is my life worth? Today, we are seeing the answer reflected in policy decisions already costing people their care — and, soon, their lives.
We cannot afford more warnings ignored. The damage is here. The question now is whether our leaders will act before it is too late.
Anthony Randolph is a longtime health advocate and peer worker in business development for Harlem United.