BALTIMORE — Many Marylanders are reeling as the U.S. Senate prepares to debate President Donald Trump’s “big, beautiful bill,” the signature legislation that cements the agenda in his second term.

The bill proposes more than $720 billion in cuts to Medicaid spending nationwide. If approved by Congress and signed into law by Trump, it could severely impact over 1.5 million Marylanders who rely on the program, including more than 400,000 living in rural communities.

Among those at risk is Rev. Deacon Christine Sabas, a Medicaid recipient on the Eastern Shore. After moving from Canada to Salisbury in 2014, Sabas began experiencing chronic neurological symptoms. Though initially covered through a former job, her modest stipend from St. Andrew’s Episcopal Church in Princess Anne allowed her to qualify for Medicaid.

“Stories abound of people on that boat, where people can’t get the care that they need, and they end up dying,” she said. “I’m not in that boat, but it’s at the back of my mind.”

If Medicaid is gutted, Sabas said she may have to turn to her church’s limited coverage. But because it’s small, “I don’t know how those options would play out,” she said.

This isn’t her first brush with fear of losing coverage.

In an interview with The Baltimore Sun, Sabas recalled staying up late in 2017 to watch U.S. Sen. John McCain, an Arizona Republican, and his “famous John McCain thumbs down” vote that preserved the Affordable Care Act.

Navigating a chronic disease that she said numbs her left side and sometimes gives her “electrical shocks” in her brain and body, Sabas didn’t have any other options to secure health insurance coverage at the time.

“Thank goodness McCain did what he did at the time,” she said.

Rural communities could suffer most

About a third of Maryland’s Medicaid recipients live in one of the 18 state jurisdictions designated as “rural,” where health care access is already strained.

“Already, there are lower life expectancies in rural areas and higher rates of chronic diseases and, obviously, cuts to Medicaid would just exacerbate these disparities leading to even worse health outcomes, even greater financial strain on families that need the coverage,” said Jonathan Dayton, the executive director of the Maryland Rural Health Association.

Some small hospitals have merged with larger systems to stay afloat. Atlantic General Hospital in Berlin, Worcester County’s only hospital, recently merged with TidalHealth, which encompasses the former Peninsula Regional Health System. TidalHealth also has hospitals in Wicomico and Queen Anne’s counties, as well as medical facilities in Salisbury and Delaware.

Mergers won’t fully shield rural residents from disruptions. Without Medicaid, Dayton says tens of thousands of Marylanders could lose coverage, face rising medical debt or struggle to find providers at all.

Sabas has already seen signs of strain. She and her elderly mother have both had to delay care after four of their doctors retired without replacement. It took her a year to get a colonoscopy due to backlogs.

That problem isn’t unique to the Eastern Shore.

Shortage of providers, long waits for care

In Western Maryland, where Congresswoman April McClain Delaney, a Democrat, represents a largely rural district, three counties are designated as health professional shortage areas: Washington, Garrett and Allegany. That designation means those counties have 3,500 or more patients per provider. One in seven adults in her district relies on Medicaid, and one in three children relies on the Children’s Health Insurance Program (CHIP).

If Medicaid cuts pass the Senate, fewer of McClain Delaney’s constituents could qualify for care, and health care centers could become ineligible for grants to help them run in shortage areas.

“For me, this is neither a partisan issue nor an issue about government efficiency, which I am all for improving,” she said in a February statement. “The House Republicans’ proposed Medicaid cuts are an attack on the moral obligation we have to support the basic, and often lifesaving, healthcare needs of families and their children.”

Maryland’s budget struggles limit options

According to Dayton, it’s difficult to prepare for looming federal cuts to Medicaid — especially when the state’s financial situation is bleak.

During the 2025 legislative session, lawmakers wrestled with a $3 billion structural budget deficit exacerbated by the Trump administration’s federal cuts.

According to the Maryland Department of Health, the state receives approximately $8.5 billion in federal funding for Medicaid annually.

Maryland legislators have their eyes turned toward Capitol Hill to determine if they will need to convene a special session to try to reconcile cuts under the federal budget and Trump’s “big, beautiful bill,” which Trump and fellow members of the GOP are pushing forward in the name of ousting waste, fraud and abuse.

In early May, state Senate President Bill Ferguson, a Baltimore Democrat, said Maryland stands to lose $430 million in federal funding under Trump — something the state can “weather” until the General Assembly reconvenes for its regular legislative session in January.

But that figure doesn’t account for cuts to Medicaid, which is his main concern.

Ferguson said that if Maryland’s Medicaid program were to move to a full 50-50 split with the federal government, the state would either have to take on approximately $1 billion in costs or remove 300,000 people from their secured health insurance.

Under the state’s budget for fiscal year 2026, Gov. Wes Moore’s administration is required to create a report if federal cuts collectively reach at least $1 billion.

But these bigger health care cuts could lead to a special session “because it will have such a disruptive impact on our entire health care system,” Ferguson said in May.

‘This bill hurts Maryland’

Though members of the U.S. House of Representatives have already voted on the bill, members of the Maryland congressional delegation have been fielding calls from constituents who are nervous about losing their coverage.

In a statement provided to The Sun in late May, U.S. Sen. Angela Alsobrooks confirmed that she would be voting “no” on the bill that would enact the cuts.

“Over 1.5 million Marylanders rely on Medicaid and Republicans’ tax scam bill threatens to kick them off their health insurance. It is so callous, and we are sick of it,” said Alsobrooks. “This bill hurts Maryland. I am voting no.”

Speaking at a May vigil in Washington, D.C., U.S. Sen. Chris Van Hollen read a testimonial from a Carroll County constituent about what the cuts to Medicaid could mean for her son, who is suffering from colon cancer and receives chemotherapy treatment through Medicaid.

“The chemo is enabling him to have one good week out of two,” Van Hollen read. “If they take his Medicaid away, it will be a death sentence.”

Van Hollen said that this “death sentence” that could be imposed on millions of Americans is only on the table so that billionaires can receive tax cuts.

“We are here to say: That is a corrupt bargain, and we’re not going to let it happen,” he said.

Sabas, who lives in the district represented by Congressman Andy Harris, Maryland’s lone Republican on Capitol Hill, said she has not reached out to his office with her concerns about Medicaid.

Harris, Maryland’s lone Republican representative on Capitol Hill, voted in favor of Trump’s bill.

“I voted to move the bill along in the process for the President,” Harris wrote on X regarding Trump’s legislation. “There is still a lot of work to be done in deficit reduction and ending waste, fraud, and abuse in the Medicaid program.”

Sabas said she doesn’t expect Harris would have a “sympathetic ear” regarding Medicaid preservation.

“I guess I could email him, but I don’t have any hope that he would care,” she said.

Dayton said that he and other advocates understand the push from certain lawmakers for cuts in the name of government efficiency, but want to make sure that the coverage remains for the families who need it the most.

“We don’t want to see any higher rates of chronic diseases or lower life expectancies for any family, regardless of whether they live in rural or urban areas,” said Dayton.

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