THE SET-UP: Given the wave of anger unleashed by the assassination of UnitedHealthcare CEO Brian Thompson, it seems kinda odd that healthcare wasn’t a factor in the 2024 Election.
Kamala Harris tried, particularly after Trump said he had “concepts of a plan” to replace the Affordable Care Act (ACA). House Democrats tried, too, when Speaker Mike Johnson’s disdain for the law slipped-out in a moment of candor. He said “health care reform is going to be a big part of the agenda” if Trump is elected … and he promised a “massive reform” that would lead to “no Obamacare.” The Trump Campaign immediately disavowed his comments and he quickly denied saying what we all heard him say.
It was a far cry from Trump’s first run for the White House, when his personal grudge against Obama seemed to fuel an obsession with “repeal and replace.” Although he tried and failed in 2017, he now claims he “saved it,” despite the fact it was and still is, according to him, “terrible.”
Most Americans don’t agree.
The once much-maligned law garnered a 62% favorability rating in a recent sampling of the Kaiser Family Foundation’s fourteen year-long tracking poll. That popularity explains Johnson’s hasty retreat. It may also explain voters’ indifference to Trump’s “concepts of a plan” … perhaps because it sounded like he wasn’t planning to end it.
They probably figured it was safe.
But that was then and this is now. And now they control both ends of Pennsylvania Avenue. They also have the “Trump Tax Cuts” to “pay for.” And that, in turn, is a made-to-order opportunity for many Republicans, including many vocal Christians (like Speaker Mike Johnson), still hell-bent on fighting the specter of “socialized medicine” and evil of socialism.
The problem is that the ACA isn’t really socialism. The anger triggered by Luigi Mangione highlighted the fact that the ACA did not turn healthcare over to government bureaucrats … quite to the contrary … it seems to have supercharged profit-motivated bean-counters in the insurance industry.
But that’s not all the ACA did.
It also committed the unforgivable sin of providing free healthcare to all poor people with “incomes up to 138% of the federal poverty level.” That meant single adults and two-parent families got access to the same government-funded healthcare previously reserved for poor single mothers and their kids. Called “Medicaid Expansion,” it’s been an unsung cornerstone of the law’s success. It’s a big reason why the uninsured rate fell “to a record low of 7.7%.” in 2023. Also, anyone just above the 138% level (“about $20,780 annually for an individual or $35,630 for a family of three”) gets access to plans subsidized on a sliding scale.
And that’s exactly the kind of socialism Ronald Reagan railed against when he preached that poverty shouldn’t be rewarded with free “handouts.” It was central to his demonization of so-called “Welfare Queens” when he ran in 1976 and again in 1980. And it was the impetus for dismantling the “welfare state” after he won the White House. It took time, but his “revolution” was completed fifteen years later when Bill Clinton declared “the era of big government is over” and his administration “reformed” the welfare system by, among other things, adding work requirements to public assistance.
Surprise! Guess what House Republicans have planned for the ACA?
That’s right, they want to impose work requirements on all able-bodied Medicaid Queens and Medicaid Kings. They hope it will simply push people off Medicaid when they fail to meet the requirement. If it works, they can use the money “saved” to “pay” for tax cuts. Then again, Republicans can also just reverse recent budgetary increases that expanded the “expansion.” If they do, Kaiser Health News found that over 3 million adults in nine states would lose health coverage … no work requirement required.
If so, they’d join Americans in ten states never touched by the ACA’s Medicaid program because their Governors and legislatures simply refuse to take the ACA’s money. It’s an unsurprising list: Texas, Kansas, Wyoming, Wisconsin, Alabama, Georgia, Tennessee, South Carolina, Florida and the nation’s poorest state—Mississippi.
While they all have varying degrees of need, Mississippi’s recalcitrance is particularly cruel and unusual. In addition to its leading rates of poverty across all age groups, the Commonwealth Fund ranks its healthcare system “last overall” and “47th for access and affordability, 47th for prevention and treatment, 37th for avoidable hospital use and costs, [and] 35th for income disparity.” And “14% of Mississippians…said they were unable to see a doctor at some point in the prior twelve months because of cost.”
With Medicaid Expansion, the state government could quickly cover many if not most Mississippians in need. And it’s a relative bargain. The state picks up 10% of the cost and Uncle Sam covers the remaining 90%. Then again, Mississippi kicked off 2024 by declining Federal food aid for children living in poverty. At the same time, state officials infamously expanded welfare benefits to include former NFL Quarterback Bret Favre. Meanwhile, his buddy, GOP Governor Tate Reeves, still defies advocates of Medicaid Expansion in the legislature. Reeves, channeling his inner Reagan, derides “Medicaid as ‘welfare' and has frequently said he does not want more people to enroll” in the program.
Georgia took a different tack. Instead of taking the ACA’s Medicaid Expansion, they launched a state-level “expansion” alternative with prohibitive hurdles built into it, including a work requirement. That, among other obstacles, forced poor Georgians to jump through new hoops after the pandemic’s temporary expansion lapsed. It was, according to Kaiser Health News, a disaster. The reboot tripled the time it took to process applications. Within months Georgia was the second slowest in the nation. It also impacted applications for financial and food assistance.
Most problematic was the fact that it didn’t provide much healthcare. The Atlanta Journal-Constitution noted in October that Georgia Pathways to Coverage “doesn’t cover all poor adults,” it costs the state’s taxpayers more than it would with full Medicaid expansion and, because there are “fewer than 5,000 enrollees at last count,” the program’s “administrative costs per enrollee are heavier.”
It also sounds like a model for denying coverage … which, as you will see below, brings us back to today’s TRIFECTA. Republicans probably assume their plan to fund tax cuts with Medicaid money will, unlike pre-existing conditions, fly under most Americans’ radar. But I wouldn’t be so sure. I’d bet there are a lot of working people hovering around the poverty line and a lot more who know somebody who depends upon Medicaid. And then there’s something that stood out from a new, wide-ranging Wall Street Journal poll on the “MAGA” agenda::
Voters place a high priority on protecting funding for education, healthcare and social safety-net programs—a caution for Trump and his advisers, Musk and Vivek Ramaswamy, who are leading an effort to identify large spending cuts. By about 60% to 34%, voters say protecting those programs is more important than cutting taxes or reducing the federal debt.
Maybe voters should’ve of thought about that before went into the booth. And maybe Congressional Republicans should think about it before they do something they’ll regret in the midterms. - jp
TITLE: Trump’s early moves signal rollbacks on drug costs, ACA coverage
https://www.modernhealthcare.com/politics-policy/donald-trump-executive-orders-healthcare-medicare-drug-prices-medicaid-aca
EXCERPTS: President Donald Trump’s early actions on healthcare signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.
A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.
Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘Hey, agency, could you do something?’” said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s down the line.”
That’s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months. Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated to lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as acting secretary for the department.
The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to test ways to lower drug costs, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.
Trump’s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children, and the disabled — and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.
“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”
The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals, and housing.
Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.
Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”
TITLE: Trump may use Medicaid cuts to fund tax reform. These states would be hit hardest.
https://www.marketwatch.com/story/trump-may-use-medicaid-cuts-to-fund-tax-reform-these-states-would-be-hit-hardest-569c0e62
EXCERPTS: President Donald Trump and congressional Republicans entered office on promises to enact trillions of dollars in new tax cuts at a time of record federal budget deficits, rising interest rates and stubbornly high inflation.
For decades, the GOP has been willing to forgo budget discipline in order to enact tax cuts, arguing that the economic benefits of lower taxes outweigh the negative effects of higher deficits, but in the current environment that strategy has run out of steam.
That has led Republican leaders in Congress to circulate a document outlining plans for more than $5 trillion in spending cuts to Medicaid, Medicare and the Affordable Care Act, which if implemented would have far-reaching effects on the U.S. healthcare system and on Americans’ access to healthcare services.
Hayden Dublois, who studies healthcare policy for the conservative Foundation for Government Policy, believes there will be a lot of support for reducing the amount of money the federal government must spend to cover new enrollees in the program who joined under the Affordable Care Act.
In order to entice states to expand Medicaid to cover nondisabled adults who have income up to 138% of the poverty line, the law has the federal government cover 90% of the cost, compared with the 50% to 78% covered by traditional Medicaid.
“It isn’t morally right for the federal government to be subsidizing able-bodied adults at a higher rate than they do disabled individuals,” Dublois said.
Another idea conservative wonks think will gain traction will be to lower the rate the federal government pays for Medicaid enrollees in wealthier states by eliminating a floor in the percentage the government pays to states based on a formula comparing a state’s per capita income with the federal per capita income.
States with lower per capita income pay a smaller share of Medicaid costs than do states with higher per capita income, on the logic that states with wealthier residents can afford to raise taxes to pay for those benefits themselves.
Spencer Perlman, a healthcare policy analyst with investment adviser Veda Partners. estimates that this proposal could save nearly $400 billion over 10 years and would largely affect states that send Democrats to Congress, including California, Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Washington and Wyoming, as well as the unrepresented Washington, D.C.
Paying for tax cuts by cutting healthcare subsidies for Americans in so-called blue states may seem appealing to many Republican lawmakers and voters, but there are 27 House Republicans representing such states, and the political backlash to supporting such a change could be severe.
That said, the allure of tax cuts could lead many Republicans to vote to cut funding for healthcare programs nonetheless.
“The threat of millions of people losing their coverage will be sure to spark a pushback,” Beacon Policy Advisors analyst Maxwell Shulman wrote in a recent client note, adding that this pushback could come even from red-state officials who are reliant on federal money to fund healthcare programs.
TITLE: Trump vs. Medicaid — What can he do to cut it? Experts are clear
https://www.eldiario24.com/en/trump-vs-medicaid-what-can-he-do-to-cut/7873/
EXCERPTS: The $900-billion Medicaid program supports health coverage for 79 million people who meet income or disability requirements. Trump’s team knows exactly how to reduce Medicaid spending yet these moves will severely harm healthcare access for Americans across large numbers.
The GOP led by Trump expects to shrink Medicaid resources through block grant administration. Under this plan states would receive a predetermined yearly federal budget rather than money following state spending with unlimited amounts.
Block grant funding reforms would let states get less federal Medicaid money than before. States would control their Medicaid budget spending, yet they could run out of funds when economic or health crises occur. States would likely have to scale back their programs or implement more stringent entry requirements when the money runs short.
Since Ronald Reagan’s administration, Republicans have pushed to replace Medicaid funding with block grants. The proposed fixed funding approach meets resistance since opponents say it does not provide enough support for needy groups. The Republican Party pushes forward with block grants because they see this approach as keeping federal spending under control despite known difficulties.
The GOP can try reducing federal money for health coverage expansion through ACA Medicaid programs. The ACA lets states extend Medicaid service to people earning no more than 138% of poverty by having federal authorities pay 90% of the financial costs.
The GOP might ask Washington to lower the proportion of federal funds used for Medicaid expansion to the standard Medicaid level which stands at 60%. More state funding responsibility could force limited access to healthcare services for low-income people. Health care access would decrease especially for low-income adults that rely on ACA expansion benefits.
The cutback in ACA Medicaid support affects both political influences and public life. States where Republicans govern have picked up Medicaid expansion benefits; they may protect their current programs from budget reductions. Reversing these healthcare improvements would put more people without health insurance while making access worse for those who need care most.