ebonyicons

The body politic refers to the people of a nation considered as a political unit — the collective body whose health, representation, and survival a government is theoretically organized to protect. Violence, in its most honest definition, is not limited to what leaves a visible mark. It is any act — or deliberate absence of act — that causes harm to a person’s physical, psychological, or social wellbeing. When institutions withhold care, representation, or resources from specific populations through policy, that withholding is violence. It does not require a weapon. It requires only a budget, a map, and a decision about whose body counts.
These definitions matter here because what follows is a story about both.

I want to tell you about a room at a YWCA in Saint Louis and what happened in it, and why I have been thinking about it every day since the One Big Beautiful Bill Act passed in July 2025 and began its work of removing Medicaid coverage from the people who need it most.
I was a young social worker then. New enough that I still believed expertise lived where credentials lived. I was working for a program called Raising Saint Louis — sending social workers into the homes of new mothers in the zip codes with the highest infant mortality rates in the city, teaching child development curriculum, connecting families to resources. The work was meaningful in the way that work is meaningful when you have not yet learned to look at the distance between what you are offering and what is actually needed.
Our predominantly white administration had spent considerable time and organizational pride developing a partnership with the city diaper bank. The idea was sound on its face: our mothers reported struggling to afford diapers. Corner stores in disinvested neighborhoods had developed a predatory practice of opening bulk packs and selling individual diapers at significant markup, making it cheaper sometimes to buy two or three diapers and make them stretch past the point they should have been changed than to purchase a new full pack. This was not a metaphor. This was a daily material calculation that mothers in Saint Louis were performing for their infants, and it was a calculation I — with the privileges of my own upbringing — had never been required to consider or even imagine.
The administration’s solution was reusable diapers. They announced it at a monthly resource meeting with the energy of people who believed they had solved something. I remember the room. I remember the mothers. I remember the warmth they did not return and the administration’s inability to locate the source of its own disappointment.
I could not locate it either. Not yet.
The understanding came later, in a home visit. A mother — a client in the program — received me with the same quiet that had filled that YWCA room. I encouraged the reusable diaper program again. I could feel something in her that I was not yet skilled enough to read. And then she explained it to me with a patience I did not deserve.
She was not in stable housing. For much of the year her family moved between cars, shelters, friends’ homes — the specific geography of poverty that policy documents call housing instability and that the people living it call their life. She walked me through what the reusable diaper program required. Storage. A washing machine. A dryer. Access to each of these things consistently and reliably enough to maintain a clean supply. She did not say it unkindly. She said it the way you explain something to someone who genuinely does not know — with the generosity of a person who has learned that her survival sometimes depends on educating the people who are supposed to be helping her.
I felt shame. I felt embarrassment. I felt confusion at how a room full of professionals and veterans of this field could have built a solution so precisely wrong. I felt gratitude — the complicated kind, the kind that sits beside the shame because she owed me nothing and gave me everything.
And then I took what she had given me back to the people with the authority to change things.
Nothing changed.
The program eventually collapsed. The mothers were not remedied. The apparatus that had designed the intervention — well-resourced, well-intentioned, full of people who treated the experiences of poverty as a subject of professional interest rather than as an act of state-sanctioned violence — moved on. And I carried with me the lesson that would take me a decade of clinical work to fully understand: that the distance between the people designing care and the people receiving it is not incidental. It is structural. It is maintained deliberately. And the refusal to close it — even when the people most affected have taken the time and the labor to explain exactly what is needed — is not a failure of imagination.
It is a political choice.

Missouri has been making that choice for a long time.
When the Affordable Care Act passed in 2010 and offered states the option to expand Medicaid coverage to low-income adults, Missouri’s Republican-controlled legislature declined. Year after year they declined, while the hospitals in the rural parts of the state closed and the uninsured rates climbed and the maternal mortality numbers moved in a direction that everyone could see and no one with the authority to intervene chose to address. In 2020, Missouri voters passed Medicaid expansion by ballot initiative — the people went around the legislature because the legislature had made clear it would not move. The Republican supermajority then refused to fund the expansion for a year, forcing a lawsuit before the courts compelled implementation in 2021.
Let me be precise about what that sequence of events represents. The legislature knew what the body needed. The voters told them. The courts told them. They delayed anyway. They treated the health coverage of hundreds of thousands of Missourians as a political instrument — a thing to withhold, to leverage, to use as a demonstration of ideological commitment — and they did this while people went without care, while rural hospitals shuttered, while the specific populations most dependent on Medicaid coverage continued to produce the worst maternal mortality numbers in the developed world.
This is not a failure of the system. This is the system functioning exactly as it was designed to by the people who designed it.
The One Big Beautiful Bill Act, signed by President Trump in July 2025, made the largest cuts to Medicaid in the program’s history. Medicaid covers 40 percent of all births in the United States. It is the single largest payer of maternity care in this country. Black women are three times more likely to die from pregnancy-related causes than white women. That gap has been widening since Dobbs. The Medicaid cuts are closing hospitals, eliminating obstetric units, gutting the infrastructure in rural and underserved communities that have no other option for care. The Congressional Budget Office estimates that when all the provisions are implemented, 16 million people will lose health insurance coverage. Almost half of them — 7.8 million — will lose it because of changes to Medicaid specifically.
In Missouri, where expansion was fought for years and implemented only by legal compulsion, the apparatus is ready for this moment. The maps were already drawn. The ideology was already in place. What the federal legislation provided was permission. The apparatus does not hesitate. It has been prepared. I think about the mother in that home visit when I read these numbers. I think about what she understood that the administration did not — that care which does not speak to the actual conditions of a person’s life is not care. It is performance. It is the institutional equivalent of announcing a solution to a room full of people whose circumstances make the solution inaccessible, and then measuring your success in metrics that never had to account for a washing machine.
The Medicaid cuts are the reusable diaper program at scale. Designed by people who have made a political decision about whose body counts — whose health, whose pregnancy, whose infant, whose survival — and who have dressed that decision in the language of fiscal responsibility and community engagement and work requirements, the way my administration dressed their decision in the language of sustainability and environmental consciousness. The vocabulary changes. The mechanism does not. The people most affected are the ones who will take the time to explain, patiently and with a generosity they do not owe anyone, exactly why the solution does not reach them.
And the people with the authority to change it will nod and continue to measure their metrics.
I have been a healthcare advocate for more than a decade since that home visit. I have sat with patients in acute care settings about to be discharged into the same kind of instability that mother described — and watched the institution process their discharge as a logistical event rather than a human one. I have worked in a state that has consistently demonstrated, through its legislative choices, that the health of its most vulnerable residents is a bargaining chip and not a commitment.
What I learned from that mother — what it took me years of clinical work to fully metabolize — is that the distance we maintain between ourselves and the people we claim to serve is not neutral. The belief that we will never be one of those mothers, that the circumstances producing their need are too far from our own to require our urgent political response, is the same belief that allows a legislature to withhold Medicaid expansion for a decade, that allows a federal government to cut 16 million people from healthcare coverage, that allows a room full of administrators to congratulate themselves on a program that the people it was designed to help quietly knew would not reach them.
The apparatus does not require malice to function. It requires distance. It requires the sustained conviction that some bodies and their needs belong to a category of problem that is unfortunate but acceptable — that can be noted in a report, tracked in a metric, mourned in a statement, and left unremedied while the budget cycle moves on.
Missouri’s constituents are living in the landscape that its politics built. The mothers I worked with were living in the landscape that ours built. The 16 million people about to lose Medicaid coverage are living in the landscape that this one is building right now, in real time, with the same institutional self-congratulation that filled that YWCA room.
The body needs what it needs.
Not what the administration decided to offer. Not what is convenient to provide. Not what can be measured in a grant report.
What it actually needs.
And until the people designing the care are willing to sit in the home of the person receiving it — to be taught, as I was taught, with patience they do not deserve — the distance will remain.
And the distance, as Missouri has demonstrated across decades and as this federal budget is now demonstrating at scale, is not a gap.
It is a choice.
And choices about whose body the body politic decides to protect are, by every honest definition of the word, a question of violence.