July 30 marks the 60th anniversary of Medicaid and Medicare. As a country and a state, we should be celebrating these landmark institutions. But earlier this month President Trump signed the “big, beautiful bill,” which will have devastating consequences for Medicaid, Medicare, the Affordable Care Act marketplace, our health care system and our most vulnerable populations.

What the Trump administration and its Republican allies call “trimming waste, fraud, and abuse” will, in reality, pull away the safety net from those who need it the most to fund an aggressive, inhumane deportation policy and tax cuts for the wealthiest Americans. Fortunately, our state lawmakers, governor, and our new incoming governor can act to mitigate this damage and protect New Jerseyans from some of the worst effects of this legislation.

The task before us is daunting. Thanks to Trump’s legislation, budget cuts will reduce New Jersey’s state Medicaid funding by $360 million annually and gut hospital and public health funding by $3.3 billion each year. We will face a dramatic rise in the uninsured and skyrocketing health care costs. Up to 350,000 residents are expected to lose NJ FamilyCare/Medicaid, and more than 450,000 more will see ACA premium hikes of 110% , according to Get Covered NJ; that’s an average increase of more than $4,000 in insurance premiums for a family of four.

Insurance premiums for those not on ACA or Medicaid plans — whether you get your coverage individually, through your employer, or New Jersey’s state plan — are expected to spike, regardless. New Jersey’s hospitals warn of service cuts, community health center closures and rising refusals of care for immigrant populations. Medical debt is already a growing burden; the Trump budget cuts will simply pour oil on a fire.

What NJ lawmakers can do

Our state budget, passed just weeks ago, may need to be reworked to account for this brutal wave of federal reductions. The State Health Benefits Program is already buckling under pressure, with projected rate hikes of up to 36% . The federal cuts could put significant strain on our budget this year and in years to come. Here’s how our elected officials can help protect New Jersey consumers from these inhumane cuts:

First, we must reassess how we raise and spend public funds. New Jersey’s Stay NJ property-tax relief program is projected to cost $1.2 billion annually starting in 2026. Modest adjustments — lowering income eligibility from $500,000 to $150,000 and reducing the maximum benefit from $6,500 to $5,000 — would cut the program’s cost nearly in half, saving $520 million. That revenue could instead help shore up health care coverage for the hundreds of thousands who may lose coverage or face daunting new premiums.

Second, we need impactful action to control the cost of health care. Gov. Murphy took a crucial first step by establishing the Office of Health Care Affordability and Transparency. The Legislature should codify and strengthen that office, enabling it to enforce a cap on the growth of health care costs below 3% annually. We must also empower the state’s Prescription Drug Affordability Council to set enforceable upper payment limits for high-cost medications.

New Jersey should also explore an NJ FamilyCare/Medicaid Buy-In Program — an affordable, public insurance option for residents ineligible for Medicaid but priced out of private coverage. This would give those losing federal subsidies a lifeline to stay insured.

Third, we must rethink how we use our existing health care funds. The NJ Health Insurance Affordability Fund — financed partly through shared-responsibility penalties — is designed to both stabilize insurers and help people afford coverage. But right now, half of certain high-cost claims between $35,000 and $270,000 are reimbursed to insurers. That’s helpful, but it’s time to ask: What if we raised the minimum claim threshold and redirected more of those funds toward direct subsidies for low- and moderate-income enrollees?

At the same time, we must revise the shared-responsibility exemption criteria. No one who loses coverage due to federal cuts should be penalized for being uninsured.

Finally, the state has made admirable strides in medical debt relief . We should now go further by launching a statewide medical debt mediation program, offering residents a chance to settle debt disputes before they escalate into lawsuits. No one should lose their home or their peace of mind over an emergency room visit they can’t afford.

We can’t change how the Trump administration’s GOP allies voted to shut tens of millions of Americans out of health care, to say nothing of food, shelter, and other critical assistance programs. But we don’t have to play a game of lifeboats with our fellow New Jerseyans. We can use meaningful state policy levers to help mitigate the fallout of this legislation and continue to explore other solutions to the coming crisis.

We urge our elected officials to put the needs of our residents first, rather than tax breaks for the wealthy or the war on immigrants and people of color. We call on our governor, our future governor and our Legislature to do their utmost to protect New Jerseyans from this unprecedented attack on Medicaid and our health care system.