The recent reductions in Medicaid coverage and rising insurance costs across Minnesota are often described as targeted adjustments that will affect only low-income families. But the reality is far broader and far more urgent. These changes stand to reshape the financial and physical well-being of students, staff, faculty and the average Minnesotan, and they mirror the deeper structural failures that Jonathan Oberlander and Theodore Marmor describe in "The Road Not Taken: What Happened to Medicare for All?". Their analysis shows that at every major decision point in U.S. health policy, lawmakers chose fragmented, market-based programs over a unified public insurance model, choices that created the instability we are now experiencing. My commentary focuses on three areas that most clearly reveal the consequences of those choices: access, affordability and affordability beyond health care.

The Minnesota Department of Human Services has already warned that the upcoming Medicaid cuts will affect "every Minnesotan," not only those enrolled in the program. Nearly 90,000 people will see their monthly premiums rise by an average of $177 beginning in 2026, and middle-income individuals earning around $62,000 or couples earning $84,000 will lose eligibility for critical tax credits. Minnesota Compass research shows that when Medicaid coverage declines, emergency room visits rise as people delay preventive care and long-term costs for the entire system increase. Hospital uncompensated care grows in response, and those expenses do not disappear; they are shifted onto individuals with private insurance through higher premiums. This is the exact kind of structural instability that Oberlander and Marmor describe: when a system depends on patchwork programs rather than universal coverage, any political fluctuation, such as the current cuts, reverberates through the entire population.

At the same time, Minnesota's health network is likely to sustain a deeper strain. Planned Parenthood already anticipates major disruptions to reproductive care access as patients lose coverage for screenings and preventive visits. Rural hospitals, many of which count on Medicaid reimbursements to survive, face renewed threats of closure. When reimbursements decline, communities do not just lose insurance; they lose clinics, maternity units and emergency rooms. With rural hospital closures already accelerating, Medicaid cuts risk turning entire regions into medical deserts.

Affordability is the second and most visible consequence of this crisis. Oberlander and Marmor remind us that Medicare was originally imagined as the first step toward a universal national health insurance program, one that would prevent volatility like what Minnesota now faces. Instead, Medicare became limited to older adults and Medicaid became the country's means-tested safety net, vulnerable to political shifts that now push costs onto families and workers. We are witnessing the result: rising premiums, shrinking benefits and growing pressure on those least able to absorb it. At Macalester, employees will feel these pressures immediately.

For full-time faculty and staff, monthly premiums for the high-deductible "employee only" plan will rise from $146.17 to $160.77, while family coverage will jump from $641.68 to $705.79, an almost $770 increase per year. PPO plans, which many employees with dependents rely on for broader networks, will rise by over $100 per month, with family PPO coverage now exceeding $1,078 per month. Part-time employees face even sharper increases: a family PPO plan rises from $1,634.47 to $1,797.76, costing nearly $2,000 more each year. These increases do not simply affect household budgets; they alter whether employees can remain in the insurance plans they need.

The final and perhaps most overlooked concern is affordability beyond health care, especially for students. Since I arrived on campus in 2022, Macalester's total cost of attendance has climbed from $78,900 in 2022-23, to $82,991 in 2023-24, to $86,133 in 2024-25, an increase of nearly 10 percent in just three years. Macalester is not alone; institutions across the country have reported similar spikes, driven in part by rising employee health insurance costs. When institutions face higher premiums, often hundreds or thousands of dollars more per employee, the financial pressure eventually flows through to tuition increases for students. Medicaid cuts worsen this trend by increasing uncompensated care costs statewide, which in turn, raise premiums and strain colleges further. Even students who waive Macalester's health plan feel the ripple effects; rising operating costs translate into tuition hikes that shape who can afford to stay enrolled.

Minnesota's Medicaid changes are often framed as isolated policy decisions. They are not. They reflect a national failure to treat health care as a shared public good rather than a fragmented market. The consequences are here, and they touch every corner of our campus community. So I urge Macalester students, staff and faculty to pay attention, speak up and organize. Contact your representatives. Attend local hearings. Push this institution to publicly advocate for the stability and affordability its community depends on. We cannot afford to watch these changes unfold in silence.