Well, it’s official. The most sweeping tax-and-slash bill in recent memory is now the law of the land.

Depending on your vantage point, that’s either a victory for fiscal sanity or a front-row seat to a slow-motion train wreck. Spoiler alert: If you operate a nursing home, you’re likely sitting in the latter camp — whether you realize it yet or not.

Let’s start with the piece that matters most for this field: more than $1 trillion in healthcare cuts over 10 years. That’s not a typo. That’s what lawmakers just carved out of the system, with Medicaid taking the biggest hit. You know, that minor federal program that just so happens to be the sector’s largest funding source.

Now, if you’re thinking, “Surely someone stood up for us,” well, you’d be half right. There were warnings, statements, impassioned floor speeches. There was even talk of “preserving access” and “supporting our seniors.” But at the end of the day, the votes were counted, and the money walked out the back door.

Here’s what providers are left with: states forced to patch together funding with fewer federal dollars, all while trying to balance budgets that were already wheezing under the weight of inflation and increased care demand. For facilities already operating on razor-thin margins, this isn’t just pressure. It’s a pressure cooker.

Expect Medicaid reimbursement cuts. Expect even more scrutiny of optional services — like those nice extras that help residents stay out of the hospital. And if your facility relies on supplemental payments or waiver programs to help make ends meet? You might want to start making more friends in the statehouse, because things are about to get even more political. Fast.

Of course, the architects of this bill say the trade-off is worth it. Trillions in tax cuts! Prosperity around the corner! That might sound great — if you’re a hedge fund manager. But for the average nursing home trying to keep nurses, aides, food and lights paid for, it’s a little like getting socks for Christmas: not what you asked for, and not remotely helpful right now.

The Congressional Budget Office, not exactly known for hyperbole, estimates this new law will rack up another $3.3 trillion in debt by 2034. And it may also speed up the insolvency of Medicare and Social Security — because clearly, what providers needed was more uncertainty about future survival.

Advocacy groups sounded the alarm. They warned this would hurt older adults, reduce staffing and shutter facilities. And yet here we are.

So what now? Providers will have to stretch thinner, triage harder, and prepare for tougher budget battles ahead. Some facilities — especially in rural areas — may not survive the squeeze. And when they go, access goes with them.

That’s not politics. That’s math.

Lawmakers may sleep well tonight, convinced they did something brave. But for providers in the trenches — fighting for staff, residents, and solvency — this isn’t brave. It’s bewildering.

And unfortunately, the worst is yet to come.

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.