Yesterday, the Senate narrowly passed their version of the budget reconciliation bill, H.R.1. The bill, which now moves to the House, slashes nearly a trillion dollars from Medicaid, chips away at the Affordable Care Act, and decimates SNAP in order to finance tax breaks for the wealthy. All in all, an estimated 17 million Americans will lose access to healthcare, millions will lose food assistance, and working families across the nation will pay more for basic needs due to this bill. If the House votes to pass the bill and it becomes law, it will enact the largest transfer of wealth from the poorest households to the richest in decades.

These cuts will ripple through local economies, shutter rural hospitals, and force millions of working families to pay more for healthcare, food, and other basic needs. If the bill becomes law, healthcare will become less affordable, unmet social needs will surge, local governments will face shortfalls, and community health infrastructure will struggle to fill the breach. By all accounts, this bill represents a major act of structural violence that will put millions of people—including seniors, children, Veterans, and people with disabilities—in harm’s way. According to researchers at the University of Pennsylvania, at least 51,000 Americans are projected to die each year as a result of these cuts.

However you might feel now—frustrated, dejected, fearful, motivated, or upset—it’s time to channel feelings into quick action. It’s time to uphold a professional commitment not just to do no harm, but to help prevent it.

Take action now. Please call or email your representative and ask them to vote down this harmful bill:

1) Call your representative:

• Use this website to enter your zipcode and get connected to your representatives
• This site also shows you how many calls your representative has received
• The Hands Off Medicaid line is still functional for you to call, enter your zip code, and be connected directly to your House rep: 866‑426‑2631.

2) Write an email to your representative:

• Use this link to send an email to your House representative. The text is pre-populated, but you can add additional comments.

If you’ve already taken action to oppose these cuts in recent weeks—like signing petitions, joining protest fasts, or pausing clinical work—thank you for raising your voice. Please do so again today by calling or emailing your representative. If you have already called your representative, or your representative’s vote against this bill is secure, you can also:

• Join phone banking efforts to call voters in districts where the vote is not assured.

• The Op‑Ed Project (tools for submitting op-eds)

As we shared yesterday with colleagues in a National Academies of Sciences, Engineering, and Medicine (NASEM) meeting, the purpose of “moving upstream” is not to define and address the social and structural drivers of health equity in some abstract, passive, or technocratic manner. The purpose of moving upstream is to identify and counteract unjust social arrangements and structures that put people in harm’s way. Today, I ask you, as a fellow Upstreamist, to help advance that purpose. Please call your Representative now and tell them to reject cuts to Medicaid, SNAP, and other basic needs that force millions to lose healthcare and go hungry.

With Solidarity,

Rishi & Sadena