THE SET-UP: How long can Americans expect to live?
Researchers at the University of Washington took a deep-dive into that question and came up with a surprising number: 20.4 years. That’s how much longer people at the top tier of America’s healthcare hierarchy can expect to live beyond those at the bottom. That disparity also contributes to the nation’s “middling average life expectancy.” The US ranks 48th out of 200 countries.”
Published last November in The Lancet, the report also found that life expectancy “varies dramatically depending on where one lives, the economic conditions in that location, and one’s racial and ethnic identity.” The authors lamented the “extent and magnitude of health disparities in American society” despite its “wealth and resources.” The “unequal and unjust distribution of resources and opportunities,” they continue, “have profound consequences on well-being and longevity.”
To wit, the authors identified a “hierarchy of health outcomes” with disparities so sharp that they cut the nation into “ten different Americas.” That translates into ten different levels of life expectancy ranging from 84 years at the top … to 64 years at the bottom. “Asian and Native Hawaiian or Pacific Islander” and “Latino populations living outside the Southwest” are in the first two spots respectively. “White Americans” occupy the 3 and 4 slots, “Latinos living in the Southwest” occupy the 5 slot and geographically-delineated “Black Americans” are found in slots 6-9. “American Indian or Alaska Native” occupy the bottom rung of the ladder.
Is the role of race and geography a bug … or a feature of American healthcare? Is it coincidental that the bottom of the hierarchy is where researchers found “Black Americans” (slavery) and Indigenous Americans (ethnic cleansing). Is it possible that generational trauma and intergenerational poverty are called “intergenerational” for a very good reason?
Or, as the Republican Party has long professed, is poverty a reflection of one’s character? Does persistent poverty indicate a breakdown of an individual’s resolve or the breakdown of institutions like the family? Does a society that provides food, shelter and medicine to its poor only invite more people to embrace poverty as a lifestyle? For example, did Obamacare inadvertently create a generation of “Medicaid Kings”? They are the young, able-bodied males who, according to the GOP’s oft-repeated talking points, unfairly take advantage of Medicaid expansion from the comfort of a couch in their mother’s basement. Supposedly, these videogame addicts refuse to work … and why should they? The government is lavishing them with all perks of Medicaid!
Tyler Wilde, Editor-in-Chief of PC Gamer, pointed out back in April:
The picture Johnson paints of Medicaid enrollees stealing from mothers and disabled people so they can sit around playing Call of Duty may be an effective emotional appeal—the call to return "dignity" to American men is a nice touch—but it makes little sense on its face.
In February, healthcare researcher KFF reported that the majority of people who use Medicaid do work. 64% of Medicaid recipients under the age of 65 work full or part-time, according to the organization's analysis, and most of those who are not working have an illness or disability, are caregivers, or are in school.
And if being able to see a doctor while unemployed makes people lazy, I'm not sure why US politicians spend so much time fretting over China's growing economy, because its universal healthcare program covers over 95% of its population.
Add to that the fact young, single men are the least likely to seek out and utilize healthcare … which might be an important flaw in the GOP’s argument. Perhaps that’s why they didn’t produce data or a shred of evidence to back up their claims. But that didn’t stop them … because it works. The rightness of a proposition is doesn’t factor into it. In fact, the Medicaid King fable has far less evidence for it than Ronald Reagan’s infamous “Welfare Queens.” At least he based his specious stereotype on the story of one professional grifter who’d played the welfare system in Chicago.
Then again, Reagan mutated the tale of one unique fraudster into a mythological army of professional layabouts who, he claimed, demonstrated the rot that sets into the human condition when the government steps in to help. That’s why Reagan preached that poverty shouldn’t be rewarded with free “handouts.” The “Welfare Queens]” shtick was central to his presidential campaign in 1976 and it resurfaced when he ran on the slogan “Make America Great Again” in the 1980.
The assertion is that handouts create social ills … broken homes, children born out of wedlock and it saps the competitive drive and the will to succeed. Milton Friedman and his Neoliberal Supply Siders didn’t explicitly say it, but they were (and still are) Social Darwinists (they should be called “Spencerists,” but that’s another post). They believe(d) in a natural order of competition. Government interference in this natural order of things is an abomination. In the “natural order” of “free markets,” “the good” is rewarded and “the bad” is punished. Good products and good service are good for business. Bad products and bad service are not … and they will be punished by the market. The same goes for economic behavior … unless the government incentivizes bad behavior … like incentivizing poverty by lavishing the poor with “handouts.” It turns their world on its head … because it rewards bad behavior. Laziness should not come with free Medicaid.
That’s why so many Republicans—particularly loudly-professing Christians—have been so committed to derailing the Affordable Care Act. They particularly despised the ACA’s expansion of Medicaid, which gave the working poor, and specifically, poor, unmarried men, access to healthcare for the first time. These are the real targets behind the phony Medicaid Kings. They, like millions of Americans, could not depend on employer-based coverage. Enter the ACA, which gave those near or under the federally-determined poverty line Medicaid coverage or, for those just above the limit, heavily subsidized insurance. No longer would they have to rely on costly visits to the emergency room or simply let their untreated ailments progress to catastrophic conclusions.
When the ACA expansion was buttressed by the COVID expansion, the uninsured rate fell to a historic low of 9.5% in 2023. Still, that “historic low” meant, according to the Kaiser Family Foundation (KFF), a staggering “25.3 million people ages 0 to 64 were uninsured.” As KFF found, that low was reached by a three-year decline “driven primarily by gains in Medicaid and Marketplace coverage because of pandemic-era coverage protections.”
Now that’s coming to an end … and not just for videogaming bros. The Kaiser Family Foundation dug into Trump’s Big Beautiful Bill and found that individuals and families who purchase through the ACA’s exchanges are in for some serious sticker shock later this year.
Although Donald Trump was ridiculed during last year’s campaign for his amorphous “concepts of a plan” to replace Obamacare, the fact is that this was the plan all along … kneecap the ACA, make the marketplaces more expensive and not only arrest the ACA’s “Medicaid Expansion,” but eject millions of Americans who tread the poverty line. Lest we forget, Speaker Johnson let it slip during the campaign that Obamacare was targeted for deconstruction. He quickly walked-back his moment of truth so Trump could go on telling lies about protecting Medicaid and Medicare. But Speaker Johnson had the “One Big Beautiful Bill’s” draconian cuts in mind all along.
Like so many Christian Conservatives, he’s been fixated on reversing socialized medicine and free food and anything else that interferes with their “Darwinian” worldview. In fact, as a “Young Earth Creationist” who helped Ken Ham navigate his infamous Ark Encounter park through some legal issues, Johnson exemplifies one of American Christianity’s oddities: loudly-professing Christians who loudly reject biological evolution also tend to be loudest endorsers of Social Darwinism (just noting again that it should be called “Spencerism” because Herbert Spencer is the father of Social Darwinism). They absolutely believe in survival of the fittest when it comes to society and government.
Mostly, though, they want poverty to be punished. And that’s why they love work requirements for Medicaid. It will erect barriers that people find hard to navigate. That, along with straight-up cuts, will shrink the rolls. As the rolls shrink, Speaker Johnson & Co. will assure themselves that they’ve lit a moral fire under the arses of America’s Medicaid Kings … inspiring them to find real “meaning” and “dignity“ in newfound work.
Of course, what will really happen is people who can’t afford healthcare will simply stop getting healthcare. Many of them will be working people who will have to hold-out until the Emergency Room can no longer be avoided. Hospitals will have to absorb those unpaid bills. And that, along with the disruption of the ACA’s marketplace and subsidies, will send healthcare costs skyward.
So, too, will the uninsured rate.
When the denials come in the mail, I guess we should embrace them as patriotic signs of America’s impending return to greatness.
After all, isn't under-treated cancer or persistent, unresolved pain from a chronically denied procedure just the price we must pay to remain free of government bureaucracy?
How will we keep the cutting edge for the chosen few if we provide equity-based healthcare for all?
And what's the point of getting rich if people who are not rich get access to comparable healthcare? Where the reward for winning?
Do we really want to live cooperatively instead of competitively?
If so, how will we divine the Dollar Signs Of Election if everyone’s equally able to access precious and pricey healthcare? How will we know if God is rewarding us with prosperity if the government is muddying the picture with “equity”?
It’s true that free enterprise does deliver … for those who can afford the $1 million tab for the latest immunotherapy for cancer. Healthcare is a product, like anything else. And if you can’t afford the latest treatment, the latest treatment should be an aspiration and a reason to work harder so you can afford “the good stuff.” - jp
TITLE: What Medicaid Recipients Should Know About The 'One Big Beautiful Bill'
https://www.investopedia.com/what-medicaid-recipients-should-know-about-the-one-big-beautiful-bill-11773484
EXCERPTS: Medicaid is the biggest source of funding for long-term care for disabled and elderly people. It covers more than half of the $415 billion spent on these services every year, according to KFF.
Without federal funding for Medicaid, many nursing homes would have to rely on more state funding to stay open. But many states don’t have room in the budget to help, which could force some facilities to close.
Those that don’t, however, will likely be overwhelmed, forcing more seniors to visit hospitals or emergency rooms for care. Many of these hospitals are also heavily funded by Medicaid, which means that care for everyone–not just those covered under Medicaid–could be impacted.
A new program, the Rural Health Transformation Program, was created to help rural areas of America that will be hit hard by the Medicaid cuts. The program will allocate $10 billion across all 50 states for five years, according to the Bipartisan Policy Center, and will be implemented starting in 2026.
The program, however, won’t be enough to offset the Medicaid cuts hitting rural America, some hospital executives say.
Millions of sick and disabled people also rely on family members to take care of them. If these caretakers don’t have enough time to take another job, per the new eligibility requirements, they might lose their own Medicaid coverage.
The Big Beautiful Bill also strips Planned Parenthood of any Medicaid funding for women’s health care. While Medicaid generally cannot be used to cover abortions (except in certain cases), it can be used for contraception, cancer screenings, wellness exams, and other preventative care that Planned Parenthood offers.
States will be required to impose co-pays of up to $35 for medical services on people with incomes more than 100% of the federal poverty level. In 2025, that’s $15,650 for individuals and $32,150 for a family of four.
The law does include exceptions for certain types of health care providers. It also allows providers to turn away patients who cannot afford the co-pay for medical services.
Under the Big Beautiful Bill, states will be responsible for more of the costs of operating the Medicaid program–costs that currently come from federal funding.
“Very few of these states are going to have the resources to replace the federal money that they lose, so they're going to be forced, in many cases, to redefine who is eligible for the program,” Maria Freese, senior legislative representative at the National Committee to Preserve Social Security and Medicare, previously told Investopedia.
The bill also curtails provider taxes, which every state except for Alaska currently uses to help fund their Medicaid programs.
A provider tax is a health care-related fee, assessment or other mandatory payment where at least 85% of the burden of the tax revenue falls on health care providers. States can levy taxes and assessments on a variety of provider types, like hospitals and nursing facilities in order to help fund Medicaid.
Under the bill, Medicaid applicants will not qualify if their home equity is valued at more than $1 million. That figure is not eligible to be adjusted for inflation.
There are currently state-determined maximum limits on home equity, which fall between $730,000 and $1,097,000, and are indexed to inflation.
This means that if an individual resides in a home valued above $1 million, even if they don’t make enough money to sustain themselves, they will be considered ineligible for Medicaid.
“This change will be particularly harmful in states with higher property values like California, New York, Massachusetts, New Jersey, and Washington,” said Dan Adcock, director of government relations and policy at the National Committee to Preserve Social Security and Medicare.
TITLE: Georgia Shows Rough Road Ahead for States as Medicaid Work Requirements Loom
https://kffhealthnews.org/news/article/georgia-pathways-to-coverage-medicaid-work-requirements-gop-bill-implementation/
EXCERPTS: Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.
Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so.
What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.
Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.
The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports.
“That was truly a pretty shocking waste of taxpayer dollars,” Alker said.
The Government Accountability Office is investigating the costs of the program after a group of Democratic senators — including both members of the Georgia delegation — asked the government watchdog to look into the program. Findings are expected this fall.
A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.
The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.
In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.
New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.
TITLE: Medicaid: Do Work Requirements Make Sense
https://www.golocalprov.com/news/medicaid-do-work-requirements-make-sense
EXCERPTS: The first Trump administration promoted Medicaid work requirements through demonstration waivers (i.e., Section 1115 Projects). In June 2018, Arkansas became the first state to implement a Medicaid work requirement for adults aged 30-49 years old [REF]. The program required people to file monthly online reports on their employment to maintain coverage. The program ended in April 2019 when a federal judge halted the effort. During that time, 18,000 adults lost insurance. Furthermore, work requirements did not increase employment based on scientific evaluations of the program. People who lost Medicaid coverage due to the work requirements reported significant medical debt, delayed care, and delayed treatments.
In July 2023, Georgia launched the Pathways to Coverage program, which requires lower-income adults to work, attend school, or volunteer for at least 80 hours a month to obtain Medicaid [REF]. During the 18 months of implementation, 6,500 people were covered which is a fraction of the 240,000 uninsured people that were estimated to be eligible. Reports of application backlogs, excessive paperwork, and complex rules have hampered the program. The program has cost more than $86.9 million, three-quarters of which has gone to “consultants”. Initially, the program required verifying that people were working every month. However, that has been changed to at the time of enrollment and during an annual renewal. Georgia is the only state with a current Medicaid work requirement program.
Based on the evidence to date, Medicaid work programs appear to create significant administrative work and inefficiency, lead to loss of health insurance coverage, and lead to delays in medical care and treatment, which likely further increase healthcare costs in the long run. Furthermore, the majority of Medicaid spending is by people with complex medical conditions, not “able-bodied” people who can easily work.
Addressing healthcare in America means ensuring that people have access to care, not creating administrative hurdles and other challenges that limit care. Preventive care and screening for diseases lead to cost savings and a healthier population that can work and contribute to society. Instead of investing in additional government bureaucracy to implement Medicaid work requirements, we should be using funding to increase access to healthcare and fund our hospitals and primary care clinics which are already overwhelmed. Promoting, not hindering, healthcare access will lead to a more prosperous and productive society.
SEE ALSO:
Trump's 'big, beautiful bill' is projected to add $3.4 trillion to the debt, budget office says
https://www.nbcnews.com/politics/donald-trump/trumps-big-beautiful-bill-add-3-trillion-debt-cbo-says-rcna220004