The image shows Representative Bresnahan gripping an oversized axe marked Big Beautiful Bill and raising it above a gurney covered with a sheet labeled Medicaid Recipients. A small sign marks the space as an operating room while a speech bubble from Bresnahan states that it helps to not think of the action as a cut.

The visual ties directly to votes taken in mid July 2025 on a large Republican backed bill that combined tax reductions with changes to Medicaid payments. Hospitals and patient advocates had warned that the payment adjustments would reduce services for low income residents across Pennsylvania.

Bresnahan is shown mid swing with the axe blade already in motion toward the covered figure. The composition places the speech bubble to the left and the axe to the right creating a clear line of action from the representative to the gurney.