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Dr. Byrce Pulliam spends his nights in a community emergency room in Southern Oregon, where the line between life and death can come down to seconds—and insurance coverage.
“I show up 24 hours a day, seven days a week, 365 days a year with one goal in mind: to provide excellent care for patients in crisis. Being a doctor is often challenging, but it has become harder because our nation’s healthcare system is on life support,” he said before a House hearing on Oct. 8.
Pulliam, a founding member and chair of the Southern Oregon Providers Association, which is part of the AFT’s Northwest Medicine United, Local 6552, testified at a U.S. House Steering and Policy hearing on the Republican healthcare crisis as the federal government entered its eighth day of the shutdown. House Democrats called the session to draw attention to what they describe as a looming catastrophe: millions of Americans facing skyrocketing insurance costs if Congress fails to renew Affordable Care Act tax credits that are set to expire.
Republicans have refused to act, insisting that healthcare negotiations should wait until after the shutdown ends. But for doctors like Pulliam, the consequences of political inaction are already visible in emergency rooms across the country. In his testimony, Pulliam described the chaos unfolding daily inside American hospitals.
“Our nation's emergency rooms are packed,” he said. “Patients receive care in ER hallways, and hospitals are so full that patients have to wait hours or days to be admitted. The television show The Pitt doesn't lie. This is real life.”
He explained that the expiration of ACA tax credits and deep cuts to Medicaid are not abstract policy issues. They are decisions that determine whether someone can afford medication or hospital care.
Pulliam noted that when Republicans worked with “the Trump White House to enact partisan law that slashed Medicaid and allowed healthcare tax credits to expire for working families, all while funding tax breaks for billionaires, they did this at a time when our healthcare system was already at a breaking point with a national nursing shortage and too few doctors to care for those who need us,” he said. “If we keep cutting from our healthcare system, we aren’t just trimming fat. We’re cutting to the bone.”
For Pulliam, the reality is grim: Many patients show up to the ER because they can’t afford to see a specialist or get preventive care.
While the hearing was about politics, the stories shared were deeply personal.
One came from Mariah Plante, a small business owner in rural West Virginia who cares full-time for her brother Matt, who is blind and nonverbal and has autism. Medicaid pays for his medications, eyeglasses and the care that allows him to live at home instead of in an institution.
“Medicaid is our lifeline in West Virginia,” she said. But Plante’s own coverage depends on the very tax credits the GOP is refusing to address. “If these enhanced tax credits expire, my monthly premiums will nearly double,” she said. “This isn’t about politics. It's about people like my brother, like my neighbors, like my mom and dad, like my sister, and people that we love back at home. We cannot trade their health and security for tax breaks for the wealthy.”
Pulliam echoed that sentiment, noting that when patients lose coverage, they “will have to forgo care, skip medication or delay going to the doctor. They’ll get sicker, and both red and blue communities will suffer,” he said. “What we ask for is simple: protect and expand coverage, invest in safe staffing and fund community hospitals so care is available where people live.”
Policy experts warned that those cuts could have far-reaching consequences, especially for rural communities.
“The budget law makes many changes to Medicaid that will have ripple effects that could push Medicaid enrollees like children with disabilities, adults who are juggling multiple jobs, older Americans who rely on home and community-based services, ... and our healthcare system and our state budgets to their breaking point,” said Chiquita Brooks-LaSure, former administrator for the Center for Medicare and Medicaid Services. “Over 300 rural hospitals are at risk of closing due to Medicaid cuts,” she said, adding that although many of the Medicaid provisions in the bill do not take effect until 2027, many are already having an effect on the healthcare system.
Pulliam sees that reality every day in Southern Oregon. “We have a large population of Medicaid patients, ... and clinics rely on those patients to keep their doors open and keep the lights on. If those patients can’t afford care, even when they need it, those clinics will not be able to sustain their operations and close, so even patients who did have private insurance or are millionaires aren’t going to get the care they need.”
He added that burnout among healthcare workers is at an all-time high, and it’s driving even more people out of the profession.
As the hearing drew to a close, Pulliam called on Republicans to end the government shutdown by working with Democrats to restore and rescue healthcare.
“I always strive to do what’s right for my patients,” said Pulliam. “The Republicans that control Congress and the White House should do what’s right as well. Instead of creating a healthcare crisis, they should work with Democrats to fix it. The health of our communities depends on it.”
[Adrienne Coles]