While the Trump White House and Republican leaders in Congress continue their lying claims that no one will be hurt by the massive cuts they are proposing in Medicaid, food stamps and other social programs, one Republican senator gave a glimpse of the chilling human cost.
Senator Joni Ernst of Iowa, speaking Friday at a town hall meeting in rural Butler County, claimed that Republicans would “protect” social services for the most vulnerable and that only immigrants and able-bodied adults would lose their Medicaid coverage.
One audience member shouted, “People will die.” Ernst then responded, “Well, we all are going to die.” Many in the audience groaned or jeered, and Ernst continued, “For heaven’s sake, folks,” and continued to defend the Trump administration’s plans to cut 7.6 million people from the Medicaid rolls, largely through stricter work requirements and increased bureaucratic paperwork that many recipients will be unable to cope with.
The negative response from the audience is politically significant. This was not a town hall in an urban center or one infiltrated by Democrats. Butler County is overwhelmingly rural and gave 72 percent of its votes to Trump in 2024. The county’s population has fallen to an estimated 14,172 in 2023, fewer people than were reported nearly a century and a half ago, in the 1880 census.
According to Wikipedia, “Butler County is the only county in Iowa that does not have any four-lane roads (US Highway or interstate), a hospital, or a movie theatre. There are also no national fast-food chains in Butler County. As well as one of the only counties in Iowa without a stoplight.”
Not content with telling her rural constituents to shut up and die, Ernst posted a video on Instagram Saturday in which she sarcastically declared her desire “to sincerely apologize for a statement that I made yesterday at my town hall.”
Citing the shout from the back of the hall that people are going to die, “I made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth. So I apologize, and I’m really, really glad that I did not have to bring up the subject of the tooth fairy as well.”
Those who objected to the prospect of death, the senator continued, should seek “eternal and everlasting life” and “embrace Jesus Christ.”

Ernst’s remarks were widely publicized in the media as a combination of callousness and cluelessness, but Trump administration officials and other Republicans vehemently defended the Iowa senator.
Interviewed Sunday on the CNN program “State of the Union,” Russell Vought, director of the Office of Management and Budget, dismissed the constituent anger at Ernst as “astroturf” (i.e., artificial and concocted) and reiterated the lie that Trump would be able to cut $700 billion from Medicaid without causing harm to anyone’s health.
He claimed that “one out of every five or six dollars in Medicaid is improper. We have illegal immigrants on the program … we have able-bodied working adults that don’t have a work requirement that they would have” in food stamps and other federal programs. “No one will lose coverage as a result of this bill.”
According to the Congressional Budget Office (CBO), Trump’s budget would reduce federal Medicaid spending by $723 billion, and 7.6 million people would lose Medicaid coverage by 2034, mainly due to the expansion of work requirements from age 54 to age 64.
The Center on Budget and Policy Priorities estimates an even higher toll, with up to 14.4 million people possibly losing coverage over the next 10 years. Its statement on the budget declares: “Research shows—and the CBO previously concluded—that work requirements do not increase employment. Instead, they lead enrollees who lose coverage to take on more medical debt, delay getting needed medical care, and delay taking medications.”
Despite the posturing by Ernst, Vought, House Speaker Mike Johnson and others, the Medicaid cuts will mean a significant increase in both sickness and death. A study by the National Bureau of Economic Research found that the expansion of Medicaid in recent years—which will be largely rolled back by Trump—reduced mortality among low-income adults by 2.5 percent. New Medicaid enrollees were 21 percent less likely to die than they were before receiving coverage.
The Medicaid cuts are the largest spending reduction in the giant “reconciliation” bill passed by the House of Representatives and now awaiting action in Senate, where it cannot be filibustered. The legislation has two major purposes: to make permanent the tax cuts for the wealthy which Trump pushed through in 2017, which are set to expire at the end of this year; and to offset some of the cost of this bonanza for the rich by slashing social programs for the poor.
The massive 1,220-page bill cuts other social spending besides Medicaid, including food stamps, Pell grants for low-income college students, housing aid for low-income families, and the WIC (Women, Infants and Children) program, which provides food aid for 6.7 million pregnant women and infants. Spending for the National Cancer Institute would be cut 40 percent, as part of an overall $18 billion cut in the budget for the National Institutes of Health (NIH).
There are a multitude of additional reactionary provisions which have nothing to do with taxation and spending, the nominal topics of a reconciliation bill, such as restrictions on federal judges issuing injunctions against executive orders, deregulation of gun silencers, further restrictions on transgender care, and stiff new fees for immigrants seeking to file claims for asylum or to obtain green cards and other residence permits.
Senate Democrats claimed that many of these provisions would be struck down by the Senate parliamentarian under the rules governing what can be included in a reconciliation bill. The parliamentarian eliminated Democrat-supported measures such as a rise in the national minimum wage in reconciliation bills passed under the Biden administration.
But in that case, the Democrats refused to overrule the parliamentarian, preferring to accommodate the Republicans and their own right wing. There is no reason to believe that Senate Republicans will follow that example in 2025. On the contrary, Senate Majority Leader John Thune has pledged to enact the full agenda of the Trump White House through the legislation that Trump has dubbed “One Big Beautiful Bill.”
Appearing on the same CNN program as Russell Vought, House Minority Leader Hakeem Jeffries declared that the Democrats would fight Trump’s “beautiful bill,” claiming “we can’t let our foot off the gas pedal” in terms of opposition. But when pressed by interviewer Dana Bash on what that actually meant, Jeffries offered only mush: “In terms of additional things that may take place with respect to our congressional oversight, authority and capacity, we will respond in a time, place, and manner of our choosing…”
The Socialist Equality Party is organizing the working class in the fight for socialism: the reorganization of all of economic life to serve social needs, not private profit.