A good deal of anticipation surrounded the budget reconciliation bill that was pushed through Congress and signed by President Trump on July 4 . HR 1, also known as the One Big Beautiful Bill Act by its supporters, underwent numerous last-minute, middle-of-the-night changes before it was signed into law.

Some members of Congress, the very elected officials we rely on to have our best interests at heart, have since shown surprise by some of the actions they voted for. Sen. Josh Hawley, R-Mo., for example, recently introduced legislation to halt future cuts to Medicaid hospital funding after he voted for the OBB, which forced those cuts.

What is undeniably true, however, and well known to lawmakers, is that this budget bill will vastly increase inequality in our country, something we can ill afford to do when the gap between the rich and poor is already so wide.

Favoring excessive tax reductions for the very rich, while dramatically cutting programs in our nation’s social safety net, ensures that the impact of this law will be felt differently across income groups. The nonpartisan Congressional Budget Office estimates that as a result of the OBB, American households in the lowest income quintile (below $32,000) will suffer a loss of $1,559 each year, while households in the highest income quintile (over $155,500) will see an income increase of $12,044 each year. This doesn’t sound the least bit beautiful to me.

As many have said before me, cutting the safety net to provide the wealthy with tax breaks is downright cruel and shows a lack of compassion for those facing economic hardship. In Maine, the impacts will be widespread, painful and especially harsh for low-income, older adults.

Currently, 345,000 low-income Mainers of all ages are MaineCare recipients (MaineCare is Maine’s Medicaid program). Nearly 25% of Mainers benefiting from this program are now targeted for enormous cuts from this newly passed law.

One of the more significant changes will be a mandated work requirement for Medicaid beneficiaries, including for those between 50 and 64 years old. The advocacy group Justice in Aging estimates that nearly 1 in 5 Americans in this age group receives Medicaid; almost half have a disability. Nearly 2 in 5 older adults receiving Medicaid are employed, but among those who are not, 86% have a health condition that prevents them from working.

Compounding health challenges, which may restrict their abilities to work, is widespread discrimination against older adults seeking employment in general. Frustration, confusion, shame, exhaustion and, ultimately, loss of health insurance will, for many Mainers, be the likely outcome.

Further intensifying this is the Trump administration’s recent plan to terminate the Department of Labor’s only job training program for low-income seniors: the Senior Community Service Employment Program (SCSEP).

Work requirements will also affect family caregivers who are enrolled in Medicaid. They are crucial for keeping older adults with disabilities at home, where they prefer to remain rather than in costly nursing facilities. One-quarter of family caregivers receiving Medicaid fall into the 50-64 age range, some dealing with their own declining health. They often reduce their work hours or take a leave of absence from work to provide care.

Work requirements will add additional challenges to already complicated lives and result in their loss of health insurance. Individuals with disabilities who do not have a family member to provide assistance rely on paid direct care workers. The majority of these workers are older women: 57% of direct care workers are over age 45 and 85% are women.

In Maine, as is true across the country, there is a dearth of direct care workers, with serious shortages in both home and community-based care and nursing facilities. Among these workers, one-third receive Medicaid, earn very low wages and work irregular hours. Their variable schedules (based on the needs of their clients) will make it difficult to meet minimum work requirements, and burdensome to track and report their hours.

To meet current shortages in this workforce, we need to make this job more appealing, not less so. There is little doubt this Medicaid/MaineCare work requirement will exacerbate current workforce shortages among direct care workers. In Maine, as many as 67,000 individuals may lose MaineCare eligibility because of work requirements — requirements that decades of research shows are not only ineffective and dangerous but costly.

And while the impact on individuals will be extensive, rural areas will be hit extremely hard. The mostly rural and small-town health care facilities that depend on MaineCare funding risk hospital closures. It is already happening in other states, severely jeopardizing the health of all residents.

In Maine, 40.2% of the population live in rural areas, as do 24.1% of MaineCare beneficiaries. The consequences for these residents will be severe, eventually trickling down to affect us all. Ultimately, the associated risks of all these changes will be devastating.

Does any of this sound beautiful to you? It surely does not to me.