Just days ago, the life of Warren resident and local small business proprietor Kristi (Dukoff) Little changed dramatically in a single conversation.

The owner of "Kristi's Kraftails" beverages learned that she has an extremely large mass, about the size of an NBA basketball, pressing on and spreading across several of her organs.

At her first meeting with a surgeon in recent days, she learned how serious her case is. Doctors described the mass as highly invasive and complex. They must perform a biopsy before moving forward with urgent surgery.

"Life throws us curveballs when we least expect it," Little said. "But then something happens. Your community and people show up, and you are blown away by all the love and support."

Little won't be able to work for at least three months. For a solo small business owner in the service industry, that means three months with no income. She does have health insurance, but it isn't enough.

"I will be out of work for the next three months, which, as a small solo business owner, is beyond scary," Little said. "Not to mention having health insurance and it not even touching or keeping up with the amount of bills this is creating."

Little's situation is far too common. Like many gig workers and self-employed Rhode Islanders, she has no paid medical leave and no employer-backed disability coverage. Nothing replaces her income while she heals.

One friend, who first met Little at the Tiverton Farmers Market more than four years ago, described her as "a ray of sunshine" who "embodies everything great about Rhode Island." That same friend put it plainly: her coverage "will barely make a dent."

Personal, but a potential portent
Little's story is deeply personal, but it's also a potential preview of what more working families may soon face.

HR1, the federal budget reconciliation law known as the "One Big Beautiful Bill Act" (Public Law 119-21), was signed on July 4, 2025. It rewrites key rules for Medicaid and the Affordable Care Act marketplaces. Some provisions took effect on October 1, 2026. Others begin on January 1, 2027.

Starting in January, new federal Medicaid work and community engagement requirements will begin to apply. Expansion adults ages 19 to 64 must log 80 hours per month of work, education, or community service to keep their coverage. The Congressional Budget Office projects that the law will leave 10 million more Americans uninsured by 2034.

The American Medical Association has warned that the law could make it harder for patients to access care and could lead to worse health outcomes. The AMA has also backed legal challenges to a federal rule that narrows the definition of "medical frailty," a key path to exemptions for people with serious health conditions.

People with work like Little carry the greatest risk. Gig workers, solo entrepreneurs and service industry employees often have hours that rise and fall with the seasons. Their income can be unpredictable, and their paperwork rarely fits neatly into government forms. When illness strikes, these workers may lose their income and their coverage at the very moment they need care most.

But the ripple effects of Medicaid cuts don't stop at the people who lose coverage. When millions of Americans lose Medicaid, hospitals and clinics absorb the cost of treating uninsured patients who have nowhere else to turn. That uncompensated care puts enormous financial strain on providers — strain that doesn't disappear. It gets passed along.

Hospitals raise prices. Insurers adjust premiums. And the people holding private or employer-paid plans end up paying more for the same care, or finding that their own coverage covers less than it used to. In communities that depend on safety-net hospitals and community health centers, the cuts can shrink access for everyone — insured or not. 

Learn more about HR1's health care provisions: American Medical Association: AMA offers resources as major provisions of H.R. 1 take effect; AJMC: 5 Things to Know About the One Big Beautiful Bill Act 

How you can help
Even in her hardest week, Little's focus has been on gratitude.

Johnson's Roadside Market sparked what she calls a "love train" of support, and friends from across the state have followed. Neighbors and customers have shared her story, along with vendors and fellow small business owners. Many first got to know her through the farmers market circuit and the local food and service scene.

"Luckily, for people like Johnson’s Farm stand who are my friends starting that GoFundMe, getting the word out has been really special and I’ll forever be grateful," Little said. "It's insane how the word has gotten out and how many people wanna support I feel overwhelmed with so much love and I’m very grateful."

Donate. Every dollar helps cover medical bills and lost income while Little focuses on healing.

GoFundMe: https://gofund.me/7dfb69af3; Venmo: @KristiLittle

Share. Pass Little's story along to friends, family, and local networks. Every share brings her closer to the support she needs.

Advocate. Contact your state and federal representatives. Ask them to protect health coverage and create real safety nets for gig workers, solo entrepreneurs, and service industry employees. That means paid medical leave, income protection, and insurance that truly covers the cost of care.

"I’m just forever grateful for the love and support," Little added.