Reading Lindsay Ryan’s “The Reality My Medicaid Patients Face” felt like being led into a parallel world; one that sits beside mine every day, unnoticed but unbearably real. As a physician in a public California hospital, Ryan reveals not only medical crises but the structural violence that shapes them. Her essay forced me to recognize how poverty, bureaucracy, and illness collide, and I often felt anger, grief, and awe as she illuminated the lives hidden behind clinical charts.
Ryan opens with a scene so vivid it jolted me: “The bus smashed into him last month when he was crossing the street with his wheelchair. By the time he made it to the public hospital…two quarts of blood had hemorrhaged into one of his thighs” (Ryan). I could almost hear the metallic screech of the brakes and imagine the harsh fluorescent lights over the trauma bay. Ryan uses this detail to dissolve any distance between readers and the realities of Medicaid patients; she forces us to see the human consequences behind abstract policy debates.
A later moment stayed with me even more: a patient who “lives in shelters and lacks a fixed address” and “does not have a cellphone” (Ryan). I pictured him crouched under a thin government-issued blanket, his medical discharge papers already wrinkled, his next steps unclear. Ryan shows how what seems like a small detail;a phone, an address;is actually a life-or-death requirement in a digital healthcare system. It made me wonder how policymakers imagine someone completing a web-based job requirement or printing out a verification form while trying simply to survive the night.
Her discussion of the “time tax”; “a levy of paperwork, aggravation, and mental effort imposed on citizens in exchange for benefits that putatively exist to help them” (Ryan) deepened my understanding of how bureaucracy harms. I’ve felt annoyed filling out financial aid forms or waiting on hold with insurance, but imagining doing that while sick, homeless, or Non-English-speaking made the term “tax” feel literal.
To ground her claims, I added research of my own. According to data from the Kaiser Family Foundation, 83% of adult Medicaid enrollees live in working families, and nearly half work themselves, contradicting stereotypes that Medicaid recipients “don’t want to work” (KFF). I didn’t know this before reading Ryan. Learning it broadened my understanding of how political narratives erase the reality of laboring families who simply cannot afford private insurance. Research from the U.S. Government Accountability Office also shows that work requirement programs in states like Arkansas caused more than 18,000 people to lose Medicaid coverage, often because they failed to navigate confusing online reporting systems, not because they were unemployed (GAO). These facts helped me see Ryan’s anecdotes not as isolated tragedies, but as symptoms of structural design.
Ryan’s blunt assertion, “That’s the predictable consequence of legislation that saves money by letting Americans get sick” (Ryan) cuts through political euphemism. Her purpose is moral, not just informational. She insists that policy choices reflect societal values: whom we protect, and whom we allow to slip through bureaucratic cracks.
Work Cited
Ryan, Lindsay. “The Reality My Medicaid Patients Face.” The Atlantic, 5 July 2025, https://www.theatlantic.com/health/archive/2025/07/medicaid-cuts-work-requirements-patients/683437/
Kaiser Family Foundation. Medicaid in the United States. May 2025, https://files.kff.org/attachment/fact-sheet-medicaid-state-US
U.S. Government Accountability Office. Medicaid Demonstrations: Actions Needed to AddressWeaknesses in Oversight of Costs to Administer Work Requirements. GAO-20-149, 1 Oct. 2019 https://www.gao.gov/products/gao-20-149
Reading her essay made me reflect on my own stability. A sudden accident, medical bill, or job loss could push anyone into the same situations her patients face. Growing up, I watched relatives struggle to afford medication or delay care because they feared the bill more than the illness. Those memories shaped my sensitivity to inequities, but Ryan’s narrative connected them to a larger historical context from segregated hospitals to modern Medicaid barriers, making me see these issues not as personal misfortunes but as systemic patterns.
Her writing also challenged cultural narratives surrounding Medicaid. Ryan notes that “more than two-thirds of adult Medicaid beneficiaries under age 65 without a disability” already work (Ryan). Hearing this shattered the stereotype that people receiving assistance are unwilling to contribute. It reminded me how often policies are built on myths rather than on lived realities.
Literarily, Ryan’s craft guided my own revision. She writes with vivid imagery, precise diction, and moral clarity. In revising this essay, I tried to emulate her approach: grounding ideas in physical scenes, connecting personal reflection with researched context, and balancing emotion with analysis. Strengthening my details, like imagining the shelter blanket or the hospital’s antiseptic smell helped me draw the reader more fully into the essay’s world.
Ultimately, Ryan’s work reminded me that healthcare is not only about treating illness; it is about recognizing dignity. Her presence at her patients’ bedsides models a form of witness one that pushes readers toward empathy rather than judgment. The essay taught me that writing can expose hidden realities and make injustice harder to ignore.
Answering the questions her essay raises, I believe healthcare can reach people without phones, IDs, or transportation through mobile clinics, community partnerships, simplified eligibility processes, and caseworkers trained to locate and assist unhoused patients. Ordinary people can help by voting, volunteering at clinics, donating to shelters, and educating themselves about the realities behind Medicaid. And empathy can grow as Ryan suggests by reading, listening, and refusing to look away.
In the end, her essay made me realize that the deepest illness in America may be moral rather than medical. The only cure, as Ryan suggests through her example, is presence: noticing, listening, and acting with care. Writing hers and ours can bridge divided worlds and remind us of the humanity we often overlook.
Sury Olivas is a student at Houston Community College majoring in Health Sciences.