You took the medicine from 280,000 people, Donald. Some of them cannot walk. One of them arrived broken out of Iraq in 2011, and this country put him back together, and last year you signed the paper that takes the putting-together away. Your name is on it. Your hand moved the pen. On the first of October it took effect. You did not call it what it is.
The bill is H.R. 1, carried through the House by Speaker Mike Johnson, advanced through the Senate under Majority Leader John Thune on a party-line reconciliation vote, and signed into law by Donald Trump under the name he gave it, the “One Big Beautiful Bill Act.” Its section titled “Alien Medicaid Eligibility” narrows federally funded Medicaid coverage for refugees admitted on humanitarian grounds. Per KFF Health News, roughly 280,000 people lose coverage under the provision, effective October 1, 2026. The man at the center of the reporting is Mustafa Rfat, a U.S. citizen, a PhD, a husband and father, and a professor of social work at the University of Nebraska at Omaha. He came to the United States in 2011 as a refugee from Iraq with ankylosing spondylitis, no English, and no money. “I was in a very bad situation. I couldn’t walk. I was in so much pain. I missed my medications for a long time. I didn’t see a doctor. So it was a very, very difficult and vulnerable situation,” he recalls. “I was determined and in this determination, Medicaid was the big factor that made my dreams come true.” His field, and his own research, puts the disability rate among refugees at more than a third. “By the time I arrived in the U.S., a lot of doctors told me, ‘You are one of the worst cases that we are seeing,’” he says. “And that is the case for a lot of refugees that come here.” He calls the policy “a nightmare for the community.”
Donald, hear what you did to him. Ankylosing spondylitis is a disease that fuses the spine. He came off the plane unable to stand straight. The doctors here opened his body to the treatment that the doctors there could not give him. He learned the language. He took the examinations. He defended the dissertation. He teaches now, in a classroom, to students who will go out and treat other people’s spines. That is what the program you cut did for one man. He is going to Washington University in St. Louis this weekend to sit with a few dozen refugees with disabilities and teach them how to find their representatives and write to them. “These are new Americans,” he says. “These people are going nowhere. By making their health and well-being worse, it’s not going to benefit anyone.” He is teaching them civics while your decree removes their doctors.
You, Donald. There is a taste at the back of your mouth this morning, copper, sitting under the tongue where the coffee cannot reach it. It has been there since the pen moved across the page in your own hand. No amount of water takes it out. Something has settled behind your sternum, a flat hand pressing steadily inward, and it does not lift for the press conference, and it does not lift for the photograph, and it presses on the same slow rhythm at every hour of your day, the rhythm of a man who signed away other people’s breath and cannot un-sign it. You wake at three in the morning and the ceiling is above you and the room is dark and a man you have never met is sitting in a chair in 2011, unable to stand up, waiting for a country that has not decided yet whether he is worth a doctor. Your bones know what they did. Sleep does not come back, and you lie there listening to your own breath the way those doctors in Iraq listened to his, and there is no one in the room to fix you, because you are not broken, you are the thing that breaks.
Mike, the same paper is in your hands. You counted the votes. You called it relief for the taxpayer while a man with a fused spine lost the treatment that stood him up. Your hand was steady when the count came in. It should not have been.
You are small in this, Donald. Not dangerous. Small. A man in a chair with a pen, playing at kingdom, while a professor in Omaha carries your decree into a room full of people who cannot walk. What would you do, Donald, if your own child could not walk, and the country with full waiting rooms and clean hallways closed its door on the first of October and called the closing an exit? You would tear the building down. You know you would. You have never once been asked to tear anything down that could not be rebuilt by someone else’s body.
I see what you did. I will not look away from it, and neither will the record. At the hour your morning begins in a room where everything is already paid for, a man who could walk is learning which appointments he can no longer keep. A woman whose sight the pills were holding is learning what the dark looks like from the inside. They are not statistics to you, and they are not going anywhere, and the taste in your mouth is the taste of knowing that. You are not complicated in this matter. You took the medicine from the man who could not walk, and then you went to bed, and the taste did not leave, and that is the whole of you.
“Luke records a man in fine linen who feasted every day, and a beggar named Lazarus laid at his gate, covered with sores, longing to eat what fell from the rich man’s table. Even the dogs came and licked his sores.” Between you and Mustafa a great chasm has been set in place. You set it. On the first day of October, in your own name, with your own hand. The dogs still lick the sores at the gate. That is what the record will say of you. That, and the date.