OUR DAILY THREAD: The Cost Of Cutting Medicaid
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Here’s an unusual story.
Ultraconservative Republican legislators in Idaho quickly released it was a mistake to cut a cost-effective Medicaid program that helped severely mentally ill citizens from ending up in an emergency room, a jail cell or a coffin.
“They realized, well, that was a mistake,” said Sheriff Sam Hulse of Bonneville County, a Republican. “You started seeing deaths occurring in the community. We started seeing the numbers in the crisis system rise. The very thing we told them would happen was beginning to happen.”
The defunded program Sheriff Hulse lamented was, according to new reporting by The New York Times, Assertive Community Treatment (ACT). The program was created in the 1970s after “half a million patients dispersed from state psychiatric hospitals into private homes in American neighborhoods.” Sometimes known as a “hospital without walls,” the $4 million per year program interrupted a cycle that invariably led those suffering from psychotic episodes into hospitalization and/or incarceration … where they’d be stabilized and released back into communities … until their illnesses started the cycle again:
[ACT] provided each client with a team of clinicians who were paid to make home visits and build relationships, sometimes delivering medications on a daily basis. Researchers have found this approach can reduce emergency hospitalizations by anywhere from 40 to 80 percent.
So, for the cost of roughly one or two Tomahawk missiles, ACT forestalled the far more costly prospect of using jails and emergency rooms to temporarily hold and treat patients who often spiraled after missing or refusing to take medication. That, in turn, meant police officers and ER staff were not spending valuable time, and police departments and hospitals were not spending valuable funds, mitigating the fallout of untreated illness.
Sherriff Hulse started dealing with the fallout almost immediately after the state defunded ACT in response to a combination of Trump’s Federal-level tax cuts, impending cuts to Medicaid and a series of state level tax cuts that left the state with a $1.3 billion shortfall. Because Idaho’s state Constitution “prohibits deficit spending,” the governor directed the state’s agencies to reduce spending by 3% to help “‘make way’ for the president’s tax cuts."
Sheriff Hulce said that after the services ended in December, his patrol teams were carrying out 14 involuntary psychiatric commitments per month, more than double the rate from a year ago, and crisis centers had seen a 28 percent increase in demand.
Ironically, the state’s Republican legislators not only reversed the elimination of ACT by the private contractor that administers Idaho’s behavioral health Medicaid program, but they more than doubled the annual budget by allocating $10.4 million from the state’s tobacco and opioid settlements.
It’s an unusual turn for a state that gave Trump 66.9% of its votes in 2024. But, as the Times pointed out, it “may serve as a harbinger for other states poised to make deep cuts in Medicaid” as provisions in his “Big Beautiful Bill” begin to kick-in after the Midterms.
That delay was both a cynical ploy and a tacit admission that they knew voters might not like trading away programs like ACT or, in many cases, their own access to Medicaid in exchange for tax cuts that, according to the Institute on Taxation and Economic Policy (ITEP), mostly reward the wealthy:
[ITEP] analysis found that the richest 1% of Americans, or those with incomes of more than $916,900, will receive the largest tax cuts in 2026, an average of $8,850. By contrast, those with an income of between $92,100 and $153,600 will pay an additional $980.1
It’s a disparity made more maddening by the Trump regime’s profligate spending on a war of choice in Iran that his supporters both in Idaho and around the country were promised would not happen if they returned him to the White House.
Approximately fifteen months later, the impact of the looming cuts to Medicaid, which covers nearly 76 million low-income Americans, portends a hyperscaled version of Idaho’s experience with ACT. As those cuts and new hurdles kick-in, the Robert Wood Johnson Foundation estimates somewhere between five and ten million people will be kicked off Medicaid over the next two years. That will force them to use costly emergency room visits hospitals to treat often-advanced illnesses … costs hospitals around the country will be forced to absorb.
Additionally, the loss of Medicaid reimbursements for those former patients will drain valuable funding. That double-whammy of increased costs and declining reimbursements will put an estimated 446 hospitals at risk of closing or reducing care.
Meanwhile, the war on Iran is, according to an analysis by the American Enterprise Institute, costing taxpayers a cool $500 million per day to maintain. - jp
What Medicaid Cuts Mean For American Hospitals
https://www.npr.org/2026/04/07/nx-s1-5776610/what-medicaid-cuts-mean-for-american-hospitals
As Medicaid Cuts Push 446 Hospitals To The Brink, Mark Cuban Says Their Spending And Overpaying Is The Real Problem. ‘Prove Me Wrong’
https://www.benzinga.com/news/topics/26/04/51682264/as-medicaid-cuts-push-446-hospitals-to-the-brink-mark-cuban-says-their-spending-and-overpaying-is-the-real-problem-prove-me-wrong
Rural hospital system asks NC lawmakers for help in the face of federal cuts
https://ncnewsline.com/2026/04/07/rural-hospital-system-asks-nc-lawmakers-for-help-in-the-face-of-federal-cuts/
CT’s potential fallout from federal Medicaid changes outlined in new report
https://www.ctpublic.org/news/2026-04-07/cts-potential-fallout-from-federal-medicaid-changes-outlined-in-new-report
Rural Alabama hospitals named in national report, but state association disputes closure risk
https://www.fox10tv.com/2026/04/07/rural-alabama-hospitals-named-national-report-state-association-disputes-closure-risk/
Bracing for federal cuts, some states are already paring back Medicaid services
https://www.gpb.org/news/2026/04/07/bracing-for-federal-cuts-some-states-are-already-paring-back-medicaid-services
Montana halts doula funding amid budget shortfall, Medicaid cut fears
https://tippahnews.com/national-news/montana-halts-doula-funding-amid-budget-shortfall-medicaid-cut-fears/
Kentucky’s Medicaid budget grows, but concerns remain over care
https://spectrumnews1.com/ky/louisville/news/2026/04/06/kentucky-budget-medicaid
Indiana’s Medicaid program could be ditching a popular discount drug program
https://indianacapitalchronicle.com/2026/04/06/fssa-wants-changes-to-federal-drug-discount-program-for-hospitals/
Reform bills advance as Medicaid expansion threatens Oklahoma budget
https://ocpathink.org/post/independent-journalism/reform-bills-advance-as-medicaid-expansion-threatens-oklahoma-budget
Oklahoma Republicans move to reverse Medicaid expansion
https://www.kosu.org/oklahoma-medicaid-expansion-reversal-threatened
Recent Medicaid expansions sharply increased access to treatment for opioid use disorder, researchers find
https://medicalxpress.com/news/2026-04-medicaid-expansions-sharply-access-treatment.html
Postpartum Medicaid extensions reduce uninsured status
https://medicalxpress.com/news/2026-03-postpartum-medicaid-extensions-uninsured-status.html