We should call it what it is “social Darwinism”. In their minds if someone who does not have the wherewithal to obtain employment with a company that subsidizes the cost of health insurance, then they don’t deserve healthcare. They will make the right noises about the disabled and poor children, but essentially they have no compassion, empathy or understanding of a person who isn’t like them. They don’t recognize the privilege they were born with or if they came from a disadvantaged background acknowledge that what they achieved cannot be expected of everyone.
"We have to eliminate people on, for example, on Medicaid who are not actually eligible to be there—able-bodied workers"
The key word there is "workers", people who are working but wouldn't be able to get health insurance without Medicaid. So they are planning on removing health insurance from millions of people who are working but don't get health insurance from employers because either they don't offer it or it costs too much, or can only get insurance on their own which is often much too costly. Clearly Republicans think they should just avoid getting sick and if they do they should either die or go into medical bankruptcy which might mean they can't get a new job (they lost their old job because they were sick and got fired) because they can't pass a credit check (recent bankruptcy).
Just rip their health insurance out from under them. Great job. We all know that you don't have to worry Mr Johnson, your speaker of the house and don't have a care in the world about healthcare for the poor! You all are failing BADLY in the eyes of the Nation!
Mikey Johnson wants the beneficiaries of Medicaid to bear the burden of his effort to stamp out "waste, fraud and abuse" but not go after the fraudsters in the health care industry who actually commit the waste, fraud and abuse by committing more resources to watchdogs
40% of babies born in the US are covered by Medicaid. 50% in rural America. Missourians passed a referendum making their state legislature expand Medicaid coverage. MAGA politicians are playing with a fire they don't understand. Their own voters want and need Medicaid as it is currently structured. In my state large numbers of people who work full time have medical insurance through Medicaid
My bonus daughter is a mental health counselor. The agency she works for serves primarily Medicaid patients, they rely on this program for even transportation to get to and from their appointments. They face a wide variety of poverty induced barriers. A good proportion are houseless or at high risk for it. She is worried about losing her job. She works with a large cohort but especially young people make up about 65% of her clients.
Here’s something MAGAs don’t realize: Hospitals are legally required to treat all comers by something called EMTALA (the Emergency Medical Treatment and Labor Act). When the working poor and unemployed lose their Medicaid, they *won’t* stop getting sick. What they will do is show up at our Emergency Rooms—probably sicker than necessary because they haven’t seen a doctor—and rack up huge bills that will go unpaid. You wanna know why your hospital charges $37 for a band-aid or $412 for a bag of IV saline? To pay for all the unreimbursed care they provide—THAT’s why. And if you’re a small hospital in Appalachia or rural America, you may well go bankrupt because there aren’t enough paying customers to gouge. So, they close and the residents just…die, I guess. God, I hate these people so f*****g much…
That's what they always did before Obamacare. The people who want to roll back Obamacare to what we had pre 2010 don't care about that. What those uninsured won't do is get any preventative care or care for routine illnesses, which won't be provided without coverage or payment. That is where the roll-backers think the savings is.
Yup. They think we’re wasting money by letting “the poors” get checkups/meds/etc, but don’t realize that we’re going to pay *huge* bills when these folks wind up in our ERs and ICUs later.
Only one thing is certain in this particular debate - Congress WILL pass a tax cut extension. Whether that is offset by repealing Medicaid expansion, or simply added to the deficit will be decided in the next few months. Tax cuts are table stakes for all Republicans, or at least the ones who the politicians care even a little about. In the end, they know that those stakeholders couldn't care less whether we cut Medicaid expansion or increase the deficit. The Spice must flow.
>>"simply added to the deficit will be decided in the next few months."
That could pose a problem for the MAGA Republicans. Under reconciliation, a funding bill is specifically forbidden from adding to the debt. To increase the debt they have to pass the budget bill under regular order and get 60 votes if the Dems filibuster. So they'll have to find the money for the billionaire tax cut somewhere or do voodoo accounting like the last time in 2017 and lie saying the tax cuts pay for themselves.
They will do the fuzzy math accounting, and also make very rosy predictions about growth that will pay for the tax cuts. That is what I meant by "adding to the deficit". The problem is that guys like Massie are onto that scheme, and they are deficit hawks. They might not vote for the tax cut extension unless it is offset with spending cuts.
All that said, I'm sure they'll find a way to get this passed. Afterall, the Donors and the Establishment GOP don't really like Donald Trump, nor do they like all the chaos and crazy that comes with him. The ONLY two things they get out of his presidency are keeping the Democrats from taking things away from them and tax cuts. They are sure as hell going to get their tax cuts.
Combine massive cuts in Medicaid with massive cuts to federal food and public health programs (including all the rural hospitals that will soon be closing) and the recession being forecast by most economists and we'll have a home grown Poor People's Perfect Storm - including numerous elderly thrown out of nursing homes and adults and children with disabilities. Throw in a hurricane or floods with no help from a decimated FEMA (if it even still exists) and we can only imagine the death and illness toll - I said imagine because the government will not have the staff to accurately (nor want to) count the victims (just as they can't already count the number of children with measles).
The true, core Republican motivator is unabashedly in the open - it's all about the grift - taking more than you need or deserve from those who have less and need it more. If Mike Johnson is able to pull it off, he and his unprincipled buds will take health benefits from those who need them the most and will attempt to hide it behind the lame fig leaf of reducing the cost of government. It's all about the grift!
I'm disappointed at Cohn glibly buys into the "welfare queen" GOP narrative about safety net programs:
For the past few months, Republicans have been signaling they would limit themselves to imposing “work requirements” and going after what they call “waste, fraud, and abuse” in the program. EITHER COULD HAVE A SIGNIFICANT IMPACT ON BOTH THE BUDGET (i.e., federal spending would come down by more than $100 billion over ten years) and access to health care (i.e., several million people would lose insurance).
Of course there is some degree of "waste, fraud and abuse" in Medicaid, as there would be in any large program. But I've never seen any credible evidence of systematic WF&A - it's all anecdotes about individuals or criminal convictions of insurers and providers. There's probably just as much WF&A in the Defense Department as in Medicaid.
And all the studies on "work requirements" I've read about just say all work requirements do is create administrative barriers to enrolling and staying in the programs. I've never heard of anything documenting a positive impact on employment of Medicaid recipients.
If Medicaid is defunded, the number of homeless elderly and severely disabled people will skyrocket due to the financial collapse of the assisted care sector.
I'm not so sure I agree. Republicans are not stupid. They know that everybody uses Medicaid to keep Grandma in the nursing home. They also know that not only poor people have to care for the sick and truly disabled. What they want is to roll back the Medicaid spending to pre-Obamacare levels, meaning Grandma and the kid with a disability still gets covered, but able-bodied poor people are back on their own. While the elderly and disabled are still sympathetic figures in America, there is, and pretty much always has been, zero real sympathy or compassion for the poor.
Everything Republicans are doing and have done to destroy health care for everyday Americans further cements my view that Medicare for All is the only thing that makes sense. Insure every American through the same Medicare system that serves 68-year-old me so well, fold all the separate agencies like Medicaid, military Tricare and VA, Iand ndian Health Services into the system, let any American see any licensed private medical provider anywhere in the United States for service, pay the bills through the tax system . . .
. . . then go solve the next problem created for us by Republicans.
I retired a couple of years ago from a corporate job that provided health insurance for which we paid some portion (about $350 a month). At 62, Medicare is not available, so I am insured with a marketplace BCBS plan that closely matches coverage from what I had before I retired --except for the annual deductible. That plan is subsidized --advanced premium tax credits (APTC) is the term. Those tax credits reduce the cost of health insurance, and depending on income some can be clawed back when you file your tax return. Last year I had to give back about half of the tax credits. These tax credits were extended to the end of 2025 by the American Rescue Plan Act of 2020.
Here are some numbers. BCBS is about $1200/month (retail) for just me. The APTC is $700/month. So I have to pay $500 a month to have insurance coverage. In my own budget, $500 is reasonable. $1200? If the APTC were eliminated, the state might pick up some portion of it, but I doubt it with the current state budget deficits. The loss of premium payers creates financial issues for insurers and healthcare providers. My other concern is that major changes to the APTC would cause marketplace instability and insurers might pull out completely.
It appears that this current budget bill has little to say about APTC but the Medicaid changes make it easier to say "no" to extensions at the end of the year. And with a single vote, millions of people (not just "like me" but others in similar situations), would potentially lose (or choose to lose) health insurance.
I dare say that any individual below the age of 65, the Republicans will deem them as "able workers" outside any documented disability (which takes 2 years to get approved as an "official disability" for SSDI) and cancel any subsidy.
I was going to say the same. The GOP will say you should have kept working until 65, if you couldn't afford healthcare "without someone else paying for it"
That is a possibility. Without adding any more detail I would suggest that my retirement was not voluntary, and covid adjacent. As the current administration continues their RIF, there will be many more workers in the same position.
The US healthcare supply chain, from insurance to pharmacy benefit managers (PBM) and prescription costs to labor (nurses, specialists, etc), and most notably opaque pricing structures for common issues, is a complete mess. The ACA was a compromise to prop up a system that needs total reform -- it was a step in the right direction, but reform must include single payer with empowered management to negotiate transparency and pricing.
We should call it what it is “social Darwinism”. In their minds if someone who does not have the wherewithal to obtain employment with a company that subsidizes the cost of health insurance, then they don’t deserve healthcare. They will make the right noises about the disabled and poor children, but essentially they have no compassion, empathy or understanding of a person who isn’t like them. They don’t recognize the privilege they were born with or if they came from a disadvantaged background acknowledge that what they achieved cannot be expected of everyone.
"We have to eliminate people on, for example, on Medicaid who are not actually eligible to be there—able-bodied workers"
The key word there is "workers", people who are working but wouldn't be able to get health insurance without Medicaid. So they are planning on removing health insurance from millions of people who are working but don't get health insurance from employers because either they don't offer it or it costs too much, or can only get insurance on their own which is often much too costly. Clearly Republicans think they should just avoid getting sick and if they do they should either die or go into medical bankruptcy which might mean they can't get a new job (they lost their old job because they were sick and got fired) because they can't pass a credit check (recent bankruptcy).
Just rip their health insurance out from under them. Great job. We all know that you don't have to worry Mr Johnson, your speaker of the house and don't have a care in the world about healthcare for the poor! You all are failing BADLY in the eyes of the Nation!
Mikey Johnson wants the beneficiaries of Medicaid to bear the burden of his effort to stamp out "waste, fraud and abuse" but not go after the fraudsters in the health care industry who actually commit the waste, fraud and abuse by committing more resources to watchdogs
These sewer clowns will turn America into Chernobyl by summer.
40% of babies born in the US are covered by Medicaid. 50% in rural America. Missourians passed a referendum making their state legislature expand Medicaid coverage. MAGA politicians are playing with a fire they don't understand. Their own voters want and need Medicaid as it is currently structured. In my state large numbers of people who work full time have medical insurance through Medicaid
I continue to pray for the day when we cease to be the only major nation that doesn’t have a universal healthcare system that covers everyone.
My bonus daughter is a mental health counselor. The agency she works for serves primarily Medicaid patients, they rely on this program for even transportation to get to and from their appointments. They face a wide variety of poverty induced barriers. A good proportion are houseless or at high risk for it. She is worried about losing her job. She works with a large cohort but especially young people make up about 65% of her clients.
Here’s something MAGAs don’t realize: Hospitals are legally required to treat all comers by something called EMTALA (the Emergency Medical Treatment and Labor Act). When the working poor and unemployed lose their Medicaid, they *won’t* stop getting sick. What they will do is show up at our Emergency Rooms—probably sicker than necessary because they haven’t seen a doctor—and rack up huge bills that will go unpaid. You wanna know why your hospital charges $37 for a band-aid or $412 for a bag of IV saline? To pay for all the unreimbursed care they provide—THAT’s why. And if you’re a small hospital in Appalachia or rural America, you may well go bankrupt because there aren’t enough paying customers to gouge. So, they close and the residents just…die, I guess. God, I hate these people so f*****g much…
That's what they always did before Obamacare. The people who want to roll back Obamacare to what we had pre 2010 don't care about that. What those uninsured won't do is get any preventative care or care for routine illnesses, which won't be provided without coverage or payment. That is where the roll-backers think the savings is.
Yup. They think we’re wasting money by letting “the poors” get checkups/meds/etc, but don’t realize that we’re going to pay *huge* bills when these folks wind up in our ERs and ICUs later.
Only one thing is certain in this particular debate - Congress WILL pass a tax cut extension. Whether that is offset by repealing Medicaid expansion, or simply added to the deficit will be decided in the next few months. Tax cuts are table stakes for all Republicans, or at least the ones who the politicians care even a little about. In the end, they know that those stakeholders couldn't care less whether we cut Medicaid expansion or increase the deficit. The Spice must flow.
>>"simply added to the deficit will be decided in the next few months."
That could pose a problem for the MAGA Republicans. Under reconciliation, a funding bill is specifically forbidden from adding to the debt. To increase the debt they have to pass the budget bill under regular order and get 60 votes if the Dems filibuster. So they'll have to find the money for the billionaire tax cut somewhere or do voodoo accounting like the last time in 2017 and lie saying the tax cuts pay for themselves.
They will do the fuzzy math accounting, and also make very rosy predictions about growth that will pay for the tax cuts. That is what I meant by "adding to the deficit". The problem is that guys like Massie are onto that scheme, and they are deficit hawks. They might not vote for the tax cut extension unless it is offset with spending cuts.
All that said, I'm sure they'll find a way to get this passed. Afterall, the Donors and the Establishment GOP don't really like Donald Trump, nor do they like all the chaos and crazy that comes with him. The ONLY two things they get out of his presidency are keeping the Democrats from taking things away from them and tax cuts. They are sure as hell going to get their tax cuts.
Combine massive cuts in Medicaid with massive cuts to federal food and public health programs (including all the rural hospitals that will soon be closing) and the recession being forecast by most economists and we'll have a home grown Poor People's Perfect Storm - including numerous elderly thrown out of nursing homes and adults and children with disabilities. Throw in a hurricane or floods with no help from a decimated FEMA (if it even still exists) and we can only imagine the death and illness toll - I said imagine because the government will not have the staff to accurately (nor want to) count the victims (just as they can't already count the number of children with measles).
The true, core Republican motivator is unabashedly in the open - it's all about the grift - taking more than you need or deserve from those who have less and need it more. If Mike Johnson is able to pull it off, he and his unprincipled buds will take health benefits from those who need them the most and will attempt to hide it behind the lame fig leaf of reducing the cost of government. It's all about the grift!
I'm disappointed at Cohn glibly buys into the "welfare queen" GOP narrative about safety net programs:
For the past few months, Republicans have been signaling they would limit themselves to imposing “work requirements” and going after what they call “waste, fraud, and abuse” in the program. EITHER COULD HAVE A SIGNIFICANT IMPACT ON BOTH THE BUDGET (i.e., federal spending would come down by more than $100 billion over ten years) and access to health care (i.e., several million people would lose insurance).
Of course there is some degree of "waste, fraud and abuse" in Medicaid, as there would be in any large program. But I've never seen any credible evidence of systematic WF&A - it's all anecdotes about individuals or criminal convictions of insurers and providers. There's probably just as much WF&A in the Defense Department as in Medicaid.
And all the studies on "work requirements" I've read about just say all work requirements do is create administrative barriers to enrolling and staying in the programs. I've never heard of anything documenting a positive impact on employment of Medicaid recipients.
If Medicaid is defunded, the number of homeless elderly and severely disabled people will skyrocket due to the financial collapse of the assisted care sector.
I'm not so sure I agree. Republicans are not stupid. They know that everybody uses Medicaid to keep Grandma in the nursing home. They also know that not only poor people have to care for the sick and truly disabled. What they want is to roll back the Medicaid spending to pre-Obamacare levels, meaning Grandma and the kid with a disability still gets covered, but able-bodied poor people are back on their own. While the elderly and disabled are still sympathetic figures in America, there is, and pretty much always has been, zero real sympathy or compassion for the poor.
I hope nothing from Medicaid is cut. This administration doesn’t seem to care who is hurt.
Everything Republicans are doing and have done to destroy health care for everyday Americans further cements my view that Medicare for All is the only thing that makes sense. Insure every American through the same Medicare system that serves 68-year-old me so well, fold all the separate agencies like Medicaid, military Tricare and VA, Iand ndian Health Services into the system, let any American see any licensed private medical provider anywhere in the United States for service, pay the bills through the tax system . . .
. . . then go solve the next problem created for us by Republicans.
I retired a couple of years ago from a corporate job that provided health insurance for which we paid some portion (about $350 a month). At 62, Medicare is not available, so I am insured with a marketplace BCBS plan that closely matches coverage from what I had before I retired --except for the annual deductible. That plan is subsidized --advanced premium tax credits (APTC) is the term. Those tax credits reduce the cost of health insurance, and depending on income some can be clawed back when you file your tax return. Last year I had to give back about half of the tax credits. These tax credits were extended to the end of 2025 by the American Rescue Plan Act of 2020.
Here are some numbers. BCBS is about $1200/month (retail) for just me. The APTC is $700/month. So I have to pay $500 a month to have insurance coverage. In my own budget, $500 is reasonable. $1200? If the APTC were eliminated, the state might pick up some portion of it, but I doubt it with the current state budget deficits. The loss of premium payers creates financial issues for insurers and healthcare providers. My other concern is that major changes to the APTC would cause marketplace instability and insurers might pull out completely.
It appears that this current budget bill has little to say about APTC but the Medicaid changes make it easier to say "no" to extensions at the end of the year. And with a single vote, millions of people (not just "like me" but others in similar situations), would potentially lose (or choose to lose) health insurance.
I dare say that any individual below the age of 65, the Republicans will deem them as "able workers" outside any documented disability (which takes 2 years to get approved as an "official disability" for SSDI) and cancel any subsidy.
I was going to say the same. The GOP will say you should have kept working until 65, if you couldn't afford healthcare "without someone else paying for it"
That is a possibility. Without adding any more detail I would suggest that my retirement was not voluntary, and covid adjacent. As the current administration continues their RIF, there will be many more workers in the same position.
The US healthcare supply chain, from insurance to pharmacy benefit managers (PBM) and prescription costs to labor (nurses, specialists, etc), and most notably opaque pricing structures for common issues, is a complete mess. The ACA was a compromise to prop up a system that needs total reform -- it was a step in the right direction, but reform must include single payer with empowered management to negotiate transparency and pricing.