Here is an interesting dynamic: Among the things MedicAid does, to the tune of 10s or 100s of Billion dollars per year are MedicAid Waivers which fund programs. I am most familiar with the 1915 Health and Community Based Services Waivers which fund community-based long-term alternatives to institutional care. I work in California's Developmental Disability services which receives about more than $5B from two main 1915 (c) Waivers.
I have been nervous that the waivers would be a natural target for cuts, because that rhymes with the inaugural freeze in social security grants which then turned into a freeze in grants to non-profits. I have seen no coverage that the MedicAid waivers have been targeted.
In my world (people with developmental disabilities,) however, there is a lot of information from advocacy groups warning beneficiaries that Congress/Trump/Anyone plans to cut MedicAid and that essential waiver services are in danger. I receive and delete what I suspect is misinformation about that.
But I find the dynamic pretty interesting as there are rallies in front of congressional offices and congressional visits. Right now there seems to be a lot of people who don't know what is to be cut warning against the assumed cuts to representatives who also don't know what they are cutting.
Wow. So - an additional 7.6 million Americans become uninsured through Medicaid barriers and rule changes (i.e., cuts), and then another 2 million become uninsured through the Medicaid-Medicare interaction. That's 9.6 million more Americans losing health insurance, thanks to the Republicans. That will bring down a whole lot of rural hospitals.
All to fund extending and expanding tax cuts for billionaires. It's just so disgusting.
Cutting Medicaid is eugenics, plain and simple. The same people proposing tax cuts to the rich, simply want the poor, disabled, and elderly to die like some kind of government generated Darwinism.
When people lose coverage, they still will be treated with an increase in ER visits as well as significant increase in costs. The ability of republicans to not understand that more uninsured people significantly increases healthcare costs
These elected Republicans receive gold-plated medical coverage in office and full medical coverage for life after they are out of office. Yet they yank medical care from their own constituents who pay their salaries and life-long medical care! It boggles the mind how brazenly cruel they can be. How dare they refer to themselves as "public servants."
This tax cut is going to pass, and it has to be offset somehow by cuts to get past reconciliation rules. They can cheat and use fuzzy math to a great extent, but not entirely. They WILL pass this tax cut for two reasons:
1) Tax cuts are basically table stakes for GOP administrations. "The Money" could care less about the MAGA culture wars or Trump's personal vendettas and retribution tour. Hell, they actually like illegal immigration - it's good for business. They want their f*cking money, damn it! - otherwise why would they put up with the embarrassment of being associated with the MAGA rubes?
2) What is left of the Establishment GOP has little influence over who gets nominated these days, but they still have all the money, and money still talks in DC. Look at how fast Trump backtracked on tariffs after the Market crashed. This tax cut bill is literally all that an establishment-type gets from this asshat administration. Otherwise, it's pretty much just watching with disgusted shame as MAGA shouts all the formerly quiet parts out loud.
So, let's see how much they cut, and what they trade off from Trump's wish list, if they can't cut it all. I'd love to see no tax on SS benefits (which I think is patently unfair to tax anyway), but that and no taxes on tips are probably lower on their priority list than making the 2017 marginal rate cuts permanent and funding Trump's deportation scheme. And, BTW, pretty much all Republicans in the top 20% income brackets seem fine with 10 million people dropping off Medicaid, so long as it isn't their parents or their disabled child.
The irony of republicans cutting Medicaid is that they will be affecting large portions of their MAGA constituents. One more rallying cry for democrats in 2026 elections: Take from those in need and give more to the rich. Now that’s something to be proud of.
This looks like the countless failed votes to repeal "Obamacare" finally converted to a win of sorts. Won a little more circuitously and by more creative means, but it's finally being incrementally achieved. The blows to the ACA will happen under the radar, but will amount to partial, victory. The insidious damage to Medicare will also be less apparent, but very real as well, as the Medicaid component shrinks. The grim fallout of all of this may add up to what I would call a national health crisis. But what will 2026 have to say about it, when that vote arrives? A revisit to Midterm 2018 perhaps?
Visible homelessness is going to increase dramatically if this goes through. Imagine all of the people in Medicaid supported nursing homes - elderly and severely disabled folks - turned out on the street, homeless. The number of elderly people in homeless shelters is already alarming, and there aren't enough shelter beds to accommodate the current, homeless population.
reading about the complexities - and cruelties - of the American health insurance system makes me realize (for the thousandth time) that if people are sick they should just go visit a doctor, if really sick be hospitalized, need drugs go to a drugstore - and getting rid of all the bureaucracy and preying on the poor and ill would free up money to cover it. Civilized countries operate like that. Your neighbour, and never-to-be 51st state operates like that.
Thank you for this very informative piece. I hope everyone will forward it to others.
I am so f’ing tired of the hollow MAGA refrain of “waste, fraud and abuse”. Yes, there is fraud, but it is not coming from Medicaid patients. It is coming from providers who fraudulently bill Medicaid because they know they can get away with it. Bill for a non existent higher paying condition- check! Bill for services not rendered- check!
The MAGAites are the most deplorable group of people. They always go after the weakest groups. Yea- let’s go after those nursing home grannies who are out to defraud the government!
The truth is that they will largely get away with it too. The 2026 midterms won't be any worse for them if they pass this legislation than they otherwise would have been because of baked-in Trump/MAGA hatred - and they know it. If Trump has taught us anything, it's that you can accomplish a whole hell of a lot of policy change if you ignore norms and have no f*cks to give.
These people overturned Roe v Wade, then won the House in the ensuing midterms, and won the next presidential election. They watched Democrats avoid a red wave and fight the GOP to a draw just a few months after inflation hit 9% under a 39% Democrat president. They think this is the end of history, and hardened regional partisanship will protect them from direct consequences of political actions, so why not just throw caution to the wind and go for the brass ring?
And, even if they do get shellacked in the midterms, they'll have the consolation of having passed this thing anyway, and they'll spend the next two years spending the money.
Yes this is a huge deal. Life destroying deal. My father relied on Medicaid the last 5 years of his life due to debilitating disease. My disabled adult son will need it his entire life and will likely never work. This is what we talk about when we talk about Republicans being “Pro-birth” but not pro family. Yes, have that baby, but WE WILL VOTE AGAINST EVERYTHING that will provide support. It is so disheartening!! The average person also does not understand what Medicaid does, so THANK YOU for writing about it. Medicaid is not just healthcare, but it supports home and community-based services, caregiving, employment services and transportation for disabled people. What does community-based mean? For families like mine who have adult children with multiple disabilities, communities based services exist so that we do not have to put our loved ones into an institution. Do we really want to go back to that era?
“Pick a little, talk a little, pick a little, talk a little. Cheep cheep cheep, talk a lot, pick a little more”
At first the podcasts and articles were informative, but I think the American public have been educated. Some never will be.
When I am on Substack these days, the song “Pick a little, talk a little…” by Meredith Willson from the musical The Music Man comes to mind.
What are all the Substack writers willing to do? Hold up in their cozy home offices and “Pick a little, talk a little, pick a little, talk a little”?
How about standing outside GOP legislator’s office and protest. Ask them the hard questions in person. Go to their offices in their hometown and protest/ask the hard questions on camera about how their families are going to be affected. Challenge the Democratic legislators to do the same.
I’m going to say this as simply as possible and in as few words so it possibly sticks: a tax cut is government spending. Think about it!
Here is an interesting dynamic: Among the things MedicAid does, to the tune of 10s or 100s of Billion dollars per year are MedicAid Waivers which fund programs. I am most familiar with the 1915 Health and Community Based Services Waivers which fund community-based long-term alternatives to institutional care. I work in California's Developmental Disability services which receives about more than $5B from two main 1915 (c) Waivers.
I have been nervous that the waivers would be a natural target for cuts, because that rhymes with the inaugural freeze in social security grants which then turned into a freeze in grants to non-profits. I have seen no coverage that the MedicAid waivers have been targeted.
In my world (people with developmental disabilities,) however, there is a lot of information from advocacy groups warning beneficiaries that Congress/Trump/Anyone plans to cut MedicAid and that essential waiver services are in danger. I receive and delete what I suspect is misinformation about that.
But I find the dynamic pretty interesting as there are rallies in front of congressional offices and congressional visits. Right now there seems to be a lot of people who don't know what is to be cut warning against the assumed cuts to representatives who also don't know what they are cutting.
Cut Medicaid and the ads just write themselves.
Wow. So - an additional 7.6 million Americans become uninsured through Medicaid barriers and rule changes (i.e., cuts), and then another 2 million become uninsured through the Medicaid-Medicare interaction. That's 9.6 million more Americans losing health insurance, thanks to the Republicans. That will bring down a whole lot of rural hospitals.
All to fund extending and expanding tax cuts for billionaires. It's just so disgusting.
Cutting Medicaid is eugenics, plain and simple. The same people proposing tax cuts to the rich, simply want the poor, disabled, and elderly to die like some kind of government generated Darwinism.
When people lose coverage, they still will be treated with an increase in ER visits as well as significant increase in costs. The ability of republicans to not understand that more uninsured people significantly increases healthcare costs
These elected Republicans receive gold-plated medical coverage in office and full medical coverage for life after they are out of office. Yet they yank medical care from their own constituents who pay their salaries and life-long medical care! It boggles the mind how brazenly cruel they can be. How dare they refer to themselves as "public servants."
This tax cut is going to pass, and it has to be offset somehow by cuts to get past reconciliation rules. They can cheat and use fuzzy math to a great extent, but not entirely. They WILL pass this tax cut for two reasons:
1) Tax cuts are basically table stakes for GOP administrations. "The Money" could care less about the MAGA culture wars or Trump's personal vendettas and retribution tour. Hell, they actually like illegal immigration - it's good for business. They want their f*cking money, damn it! - otherwise why would they put up with the embarrassment of being associated with the MAGA rubes?
2) What is left of the Establishment GOP has little influence over who gets nominated these days, but they still have all the money, and money still talks in DC. Look at how fast Trump backtracked on tariffs after the Market crashed. This tax cut bill is literally all that an establishment-type gets from this asshat administration. Otherwise, it's pretty much just watching with disgusted shame as MAGA shouts all the formerly quiet parts out loud.
So, let's see how much they cut, and what they trade off from Trump's wish list, if they can't cut it all. I'd love to see no tax on SS benefits (which I think is patently unfair to tax anyway), but that and no taxes on tips are probably lower on their priority list than making the 2017 marginal rate cuts permanent and funding Trump's deportation scheme. And, BTW, pretty much all Republicans in the top 20% income brackets seem fine with 10 million people dropping off Medicaid, so long as it isn't their parents or their disabled child.
The irony of republicans cutting Medicaid is that they will be affecting large portions of their MAGA constituents. One more rallying cry for democrats in 2026 elections: Take from those in need and give more to the rich. Now that’s something to be proud of.
This looks like the countless failed votes to repeal "Obamacare" finally converted to a win of sorts. Won a little more circuitously and by more creative means, but it's finally being incrementally achieved. The blows to the ACA will happen under the radar, but will amount to partial, victory. The insidious damage to Medicare will also be less apparent, but very real as well, as the Medicaid component shrinks. The grim fallout of all of this may add up to what I would call a national health crisis. But what will 2026 have to say about it, when that vote arrives? A revisit to Midterm 2018 perhaps?
Visible homelessness is going to increase dramatically if this goes through. Imagine all of the people in Medicaid supported nursing homes - elderly and severely disabled folks - turned out on the street, homeless. The number of elderly people in homeless shelters is already alarming, and there aren't enough shelter beds to accommodate the current, homeless population.
Let's have the Republican members of Congress give up their health benefits - that should cut some of the fat.
It's all about the cruelty - just appalling.
Jonathan, hopefully we will have access to the replay of tomorrow night's emergency video.
reading about the complexities - and cruelties - of the American health insurance system makes me realize (for the thousandth time) that if people are sick they should just go visit a doctor, if really sick be hospitalized, need drugs go to a drugstore - and getting rid of all the bureaucracy and preying on the poor and ill would free up money to cover it. Civilized countries operate like that. Your neighbour, and never-to-be 51st state operates like that.
Thank you for this very informative piece. I hope everyone will forward it to others.
I am so f’ing tired of the hollow MAGA refrain of “waste, fraud and abuse”. Yes, there is fraud, but it is not coming from Medicaid patients. It is coming from providers who fraudulently bill Medicaid because they know they can get away with it. Bill for a non existent higher paying condition- check! Bill for services not rendered- check!
The MAGAites are the most deplorable group of people. They always go after the weakest groups. Yea- let’s go after those nursing home grannies who are out to defraud the government!
The truth is that they will largely get away with it too. The 2026 midterms won't be any worse for them if they pass this legislation than they otherwise would have been because of baked-in Trump/MAGA hatred - and they know it. If Trump has taught us anything, it's that you can accomplish a whole hell of a lot of policy change if you ignore norms and have no f*cks to give.
These people overturned Roe v Wade, then won the House in the ensuing midterms, and won the next presidential election. They watched Democrats avoid a red wave and fight the GOP to a draw just a few months after inflation hit 9% under a 39% Democrat president. They think this is the end of history, and hardened regional partisanship will protect them from direct consequences of political actions, so why not just throw caution to the wind and go for the brass ring?
And, even if they do get shellacked in the midterms, they'll have the consolation of having passed this thing anyway, and they'll spend the next two years spending the money.
Yes this is a huge deal. Life destroying deal. My father relied on Medicaid the last 5 years of his life due to debilitating disease. My disabled adult son will need it his entire life and will likely never work. This is what we talk about when we talk about Republicans being “Pro-birth” but not pro family. Yes, have that baby, but WE WILL VOTE AGAINST EVERYTHING that will provide support. It is so disheartening!! The average person also does not understand what Medicaid does, so THANK YOU for writing about it. Medicaid is not just healthcare, but it supports home and community-based services, caregiving, employment services and transportation for disabled people. What does community-based mean? For families like mine who have adult children with multiple disabilities, communities based services exist so that we do not have to put our loved ones into an institution. Do we really want to go back to that era?
“Pick a little, talk a little, pick a little, talk a little. Cheep cheep cheep, talk a lot, pick a little more”
At first the podcasts and articles were informative, but I think the American public have been educated. Some never will be.
When I am on Substack these days, the song “Pick a little, talk a little…” by Meredith Willson from the musical The Music Man comes to mind.
What are all the Substack writers willing to do? Hold up in their cozy home offices and “Pick a little, talk a little, pick a little, talk a little”?
How about standing outside GOP legislator’s office and protest. Ask them the hard questions in person. Go to their offices in their hometown and protest/ask the hard questions on camera about how their families are going to be affected. Challenge the Democratic legislators to do the same.