The Measure of a Community Is How It Cares

In Western Pennsylvania, we tend to look out for each other. Whether it's an ambulance showing up in minutes, a neighbor checking in when someone’s porch light hasn’t turned on, or a nurse pulling a double shift at a long-term care facility, our communities are built on quiet, often invisible acts of care.

But the scaffolding that makes that possible — the financial and policy backbone — is under threat. And nowhere is that more apparent than in the proposed cuts to Medicaid.

Medicaid isn’t just a line item. It’s the infrastructure that supports health care for nearly one in four Pennsylvanians. It pays for emergency services, mental health care, long-term care, substance use treatment, and support for people with disabilities. It funds home health aides who help our elders remain at home. It keeps hospitals open. And it's one of the few programs that ties funding directly to need not to profit margins.

Here’s what’s on the table. The federal government is considering sweeping changes: mandatory work and reporting requirements for adults covered under the ACA expansion, new limits on provider taxes that states use to fund Medicaid, and reductions to the federal matching rate that helps states cover expansion costs. These aren’t tweaks. These are structural changes that would force states including Pennsylvania to raise taxes, reduce eligibility, or cut services. Likely all three.

And the effects will not be felt in just one part of the region. They will spread across our urban neighborhoods, our suburbs, and our rural counties.

In the urban core, Medicaid funds behavioral health programs, community clinics, and emergency services that are already operating at capacity. These are lifelines for children with trauma, veterans with PTSD, and individuals battling addiction. Proposed work requirements, even when they don’t result in actual disqualification, can lead to coverage losses simply because people miss a deadline or can’t navigate the paperwork. This disproportionately affects those without internet access, stable housing, or childcare.

In the suburbs, Medicaid is quieter but no less essential. It pays for home and community-based services for aging parents. It covers mental health services for teenagers. It allows children with disabilities to access speech therapy, physical therapy, and specialized care. The proposed limits on provider taxes would hit Pennsylvania hard — because we rely on those funds to meet our Medicaid obligations without large-scale general tax increases. If that revenue is stripped away, states like ours are forced into impossible tradeoffs between taxes and services.

And in our rural communities, the impact could be catastrophic. Rural hospitals operate on razor-thin margins and depend heavily on Medicaid reimbursement. If the federal matching rate for Medicaid expansion is reduced, Pennsylvania will be on the hook for a larger share but without the revenue to cover it. The result? More hospital closures, longer ambulance rides, and reduced access to maternity care, mental health, and emergency services. When the nearest ER is 45 minutes away, losing one more facility isn’t a budget story. It’s a survival story.

And this isn’t just a hypothetical. In Allegheny County alone, more than 250,000 residents  rely on Medicaid. The County’s Department of Human Services receives more than $500 million annually in Medicaid funding. That funding supports behavioral health programs, elder care, substance use treatment, child protective services, home-delivered meals, caregiver support, and transportation for people with disabilities. About $96 million of that goes specifically toward expanded mental health and addiction treatment.

Cutting this lifeline would immediately jeopardize services across the region. And it doesn’t stop there.

Local emergency medical services relies on Medicaid reimbursements to stay afloat. When Medicaid is cut or when more residents lose coverage, EMS agencies are left with unpaid calls and fewer resources. Suburban and rural departments often already operate on narrow financial margins. A sudden gap in Medicaid revenue means municipalities may face an ugly decision: cut services or raise taxes. And often, there is nowhere left to cut.

As a volunteer EMT, I’ve seen firsthand how fragile this system already is. Departments are already running short-staffed. Our region is responding to more behavioral health calls, more overdoses, and more late-stage emergencies all because preventive systems are underfunded. Strip away Medicaid, and we’re not making the system leaner. We are leaving it to collapse in on itself.

The broader workforce impact cannot be overstated. Health care and social assistance is the largest employment sector in Pennsylvania. Direct care workers are already working long hours for low wages. Medicaid is what keeps those jobs viable. When you reduce provider payments, you’re not just squeezing margins. You’re driving away the very people we need to do the work.

Let me say this as someone who works in public finance and does my part on the front lines of emergency response. When systems fail, the burden doesn’t disappear. It shifts. When we underfund preventive care, emergency services get flooded. When we underinvest in mental health, police and paramedics are called to handle crises they were never meant to manage. When long-term care dries up, families are forced to quit jobs, spend down savings, and shoulder impossible responsibilities alone.

These are not just budget decisions. They are moral ones.

Budgets are statements of values. When we reduce federal support for Medicaid, we are choosing to balance books on the backs of those least able to absorb the blow, children, older adults, people with disabilities, working families. We are choosing instability in our hospitals, our ambulances, and our neighborhoods.

So what do we do?

We speak up. We reject the idea that Medicaid is broken or bloated. We defend it as the health and economic foundation of our communities. We support reform, yes. But we do not support policies that would destabilize the systems our neighbors rely on to live, work, and age with dignity.

In Pittsburgh, we know how to rebuild after hard times. But we cannot rebuild if we tear out the foundation. Medicaid is part of that foundation. Let’s not let it crumble.