Curious: For those of you that work with Medicaid populations, what would be helpful to help inform (1 pager?) or help navigate in these next few years?
The 1 pager should include the state name for their version of Medicaid and a visual timeline for when changes kick in. (After midterm elections.) in very simple language. Is this possible?
Just want to emphasize a critical point you made: “Most of the provisions are delayed, with the bulk of changes not set to take effect until 2026 or 2027 (after the midterm elections)…”
Also, some of the key tax benefits start their availability in the current tax year: (1) Increased SALT deduction to $40,000; and $12,000 senior deduction (for a couple over 65 years old).
Thus, it will be challenging for the Dems to win in the midterms. The MAGAts will emphasize the benefits, and say see there has been no damage done with the OBBB bill from the Medicaid/SNAP cuts.
Most of your readers know this, but one factor in most of the electorate not understanding this is that it’s not called Medicaid in most states. Each state has its own name for it: Medi-Cal, Georgia Care, Denali Care, Hawk-I, etc.
I would love to see you publish that, or a link to where you published it previously. Living in California, I was very much aware of Medi-Cal, but not about any others.
This is a big issue! Too many people don't realize their state Medicaid program may not be called KS Medicaid or IN Medicaid...it's KanCare or Healthy Indiana Program.
Thanks, Katelyn, you hit all the right points. We're working to create an app for people to comply with the new requirements. All the required paperwork and work verfication could easily be done because, while people don't have computers, iPads or the time to submit paperwork, they do have cell phones. We'll get this one, despite this major attack on poor children and families, disabled and elderly Americans.
One key reason why requirements for frequent re-submission of qualifying data and work information leads to loss of insurance is that even when recipients do submit everything they're asked for, the systems make errors, lose paperwork, fail to notify them of what's needed, etc. This has always been a problem, and with all the added administrative burdens this bill creates, it will be a huge problem.
And haven't they cut the staffing in Medicaid offices? That would slow things down when our disabled middle-aged daughter must keep proving her schizophrenia is real and also for newly disabled people applying for the first time.
I'm just pointing out your hypocrisy and bias. You are pretty much just a political hack at this point.
You go on a rant about Medicaid cuts and talk about preventable deaths, yet you supported policies that caused damage to public health that dwarfs anything this bill will cause
I helped open up Texas in August 2020 so not sure why you’re directing this all to me. And i did talk about all of the negative impacts during the pandemic, like an increase in child abuse cases. I know you’re frustrated with the pandemic, but please get your facts straight before throwing stones.
I am very surprised to see this kind of comment in an otherwise enlightened group.
I worked in an acute care hospital all through the pandemic-the lockdowns, masks and fast work toward a vaccine saved millions. Sadly many wonderful people lost their lives before we could get a handle on the disease. Perhaps you could have volunteered to take over a shift in the emergency room for an exhausted stressed health care provider-since it was just hysteria...
Please stop with this. You are just parroting a narrative. There's zero evidence that even 1 life was saved, let alone millions. Nobody on the planet can control this virus. All the stuff that was done failed.
Covid hysteria, Paul? Do you mean that the death rate was not high enough “to get hysterical about” and try to mitigate? Covid only killed a million or so Americans and there are at least 330 million of us left, so no biggie?
The virus was never controllable. All the restrictions and mandates not only failed to control the spread, they caused significant collateral damage. Our covid response will go down in history as an epic policy failure and trampling of freedoms and liberties
How do you explain New Zealand or Australia or Japans response? Huge lockdowns, way more than in the U.S., until vaccines were avalaible, resulting in very little life lost
"This bill also assumes that all fraud is committed by Medicaid recipients. That’s wrong. Most fraud comes from providers. The 2023 federal health care fraud enforcement report listed no cases of beneficiary fraud."
I wish I could understand why the republicans want to punish people for being poor or disabled, even though a lot of the poverty is due to republican policies. I was reading this morning about what the Big Ugly Bill will do to our economy. On top of how the loss of Medicaid coverage will impact it. Republicans have been very short sighted for a very long time now (most of my life). It is sickening (and you can take that statement any way you want).
Firstly, I will say that healthcare, especially the funding, in the US is royally messed up (keeping the language family friendly here if you catch my meaning). It is abysmal. We get the wait times to receive care of the worst of the socialized nations, we get providers that are like bad mechanics performing flip chart troubleshooting constrained to protocols from insurance carriers and govt., the atrocity called "pharmacy benefit managers" whose function is just to deny, and then we get to pay through the nose for it with a solid 30% of the costs going to administrative overhead. Pricing, sure our state auditor tried to get it from the former administrator of our State employee plan and got hundreds of pages of, "the price for procedure X is ... redacted". Look up the definition of racketeering, because it sure fits. As the Europeans say, I wouldn't wish the American healthcare system on anybody.
That being said, as someone who is paying through the nose, I have little sympathy for the whining about folks losing their healthcare handouts. I have to pay $8K per year out of pocket for coverage for my wife through my employer. Consequently it stands to reason that my care, though hidden, costs about the same. On top of that we have copays for everything, including the $300 I had to pay when my wife needed emergency surgery a few months ago and then get the $4,000 bill before any stupid "insurance" kicks in.
Of course when Obamacare passed, folks like me got boned in the backside. Our costs went up, our coverage declined. Excuse me, but I did not go to college for several years, obtain a degree to work in a field that is paid decently to be taxed to pay for someone else's care. Yes, there are some that are in true need, but what should be a safety net has become a lifestyle for some others. If you can't afford care, it doesn't mean that someone else should have to subsidize your care, it means that there is either something wrong in the medical industry or the market that determines how much your job pays.
Second, insurance is the wrong financial vehicle for regular healthcare. It may make some sense in terms of catastrophic care, where out of a pool of people someone is going to need it, but its hard to determine who or when. (Edit to add: routine healthcare is an expense. Think of it this way, if we used insurance to pay for car oil changes, you'd pay $50 per month for a policy that covers your oil change. The mechanic would bill the insurance company $200 and settle for $100, where absent the system you could get an oil change for $25 a few times a year). The fact that for many, healthcare has become an employment issue is just plain wrong, and is another example of how socialism fails. The reason we have employer sponsored insurance for coverage is largely due to FDR's wage freezes back around WW2. Employers couldn't attract help with wages so they started offering this as a "benefit". Just another factor driving the costs up, as well.
Third, this should never have been made a federal system to begin with. Once again, folks, lets go back to constitutional principles. Powers not expressly granted to the federal govt belong to the States. I see nothing in the documents that should define the federal govt. concerning healthcare. Sending back to the states is the right move. With any luck, this may start to shine some light on how messed up the system is and if it causes enough pain there just might be a motivation to finally fix it.
The fundamental problem in the US is that you attach health care to work. That's not how it's done in Europe. I was a NP in the US for 40 years & I have a MBA in health care. I live in Europe now. Here we see health care like education. It benefits everyone, therefore everyone gets it. We pay a small monthly amount & yes, I pay more taxes, but it's worth it. We don't have homelessness & I don't fear bankruptcy due to health care costs.
Medicaid is not necessarily a hand out. Some states charge premiums and have co-pays. And if a person is disabled, it makes sense (to me, at least) that such person receives the care they need. It would be nice if you could learn to have empathy for those who are not as fortunate as you.
What is your solution for people like my sister-in-law, born with cerebral palsy, and now in a wheelchair and physically unable to work because of the many health issues she has? She lives in a group home. Medicaid is her healthcare. She did not ask to be born this way.
"No healthcare coverage means delayed care, higher health care costs, and death. A study found it could lead to 52,000 preventable deaths per year"
How many preventable deaths were there as a result of the covid lockdowns championed by Dr. Jetelina and others in public health? How many missed/delayed cancer diagnoses, missed appointments/screenings, delayed or forgone preventative care, etc. How many deaths of despair resulting from isolation? How many lost life years due to job losses, increased poverty levels, and cost-of-living hardships?
How about I just look at the pandemic planning guidance that existed in March 2020, which specifically didn't recommend any of the extreme measures and restrictions that we put in place?
Then compare the outcomes in USA with countries that locked down harder, closed borders more completely AND for longer, limited internal travel as well as overseas travel - chalk and cheese! (The latter did MUCH better!)
It’s so easy to pick holes in the responses used with the benefit of hindsight - and on the matter of how well vaccines contributed to improved outcomes, you only need to compare those from low-vaccinated States and Counties with their higher death and morbidity rates, to those with the opposite scenario - high vax, lower deaths and hospitalisations!
It's not hindsight. There were people expressing concern about our response in March 2020. They were shouted down, censored, etc. We totally ignored our pandemic planning guidance (based on decades of study/research) and jumped right into draconian lockdowns/closures. No debate, no discussion...just panic-based hysteria.
Do you think maybe there are other factors at play besides the intensity of lockdowns that influenced mortality rates? Comparing the United States and Europe to island nations thousands of miles away (without controlling for many other variables) is ridiculous.
“We totally ignored” - don’t you mean Trump had already destroyed what had been built as pandemic preparedness by the previous administrations?
Comparisons with other nations, including Europe, are still valid, and the ones conducted between States and Counties with differing vaccine uptakes are relevant too! You do realise that quarantine is still a reliable defence against the spread of contagion, as are masks, hand-washing, good ventilation and clean air? And that America is STILL losing around 200 people to COVID EVERY WEEK?
pandemic guidelines that were built from years of study specifically recommended against lockdowns and lengthy closures (even for Spanish flu level pandemics). There's simply no evidence that they work, and the negatives are quite obvious. We ignored all of that guidance, and enacted restrictive policies and mandates without any debate/discussion.
I'd sure that's a good idea, but I would say that pandemics are not real predictable, and in some areas extreme measures might have been required to keep some level of control on the spread of the disease. I know that my area never went into lockdown.
Paul, I don’t know estimates for any of these Covid lockdown effects you mention. I do know that my brother-in-law died of a cancer that might have been found earlier if COVID had not put pressure on the already underfunded UK National Heath Service. But none of his survivors think waiting for herd immunity to end the Covid pandemic, would have saved him or anyone else.
I've heard some argue that these cuts will only impact udocumented immigrants who don't "deserve" to benefit from Medicaid. Where can I find information to address this? My understanding is undocumented immigrants can't directly apply for Medicaid but would benefit indirectly when visiting an emergency room for example. Surely this is a small percentage of costs comparatively though right? Just curious if you have information to share on the stance that these cuts will only take from those that are here "illegally".
Curious: For those of you that work with Medicaid populations, what would be helpful to help inform (1 pager?) or help navigate in these next few years?
The 1 pager should include the state name for their version of Medicaid and a visual timeline for when changes kick in. (After midterm elections.) in very simple language. Is this possible?
Yes!!!
Just want to emphasize a critical point you made: “Most of the provisions are delayed, with the bulk of changes not set to take effect until 2026 or 2027 (after the midterm elections)…”
Agree, this point is critical for everyone to know.
Agree.
Also, some of the key tax benefits start their availability in the current tax year: (1) Increased SALT deduction to $40,000; and $12,000 senior deduction (for a couple over 65 years old).
Thus, it will be challenging for the Dems to win in the midterms. The MAGAts will emphasize the benefits, and say see there has been no damage done with the OBBB bill from the Medicaid/SNAP cuts.
You are so effing right! The trumplicans stacked this beautifully to avoid electoral blame. The masses will be blindsided.
Most of your readers know this, but one factor in most of the electorate not understanding this is that it’s not called Medicaid in most states. Each state has its own name for it: Medi-Cal, Georgia Care, Denali Care, Hawk-I, etc.
Agree this is a huge issue! I have a map in the archives that outline the name for each.
I would love to see you publish that, or a link to where you published it previously. Living in California, I was very much aware of Medi-Cal, but not about any others.
This is a big issue! Too many people don't realize their state Medicaid program may not be called KS Medicaid or IN Medicaid...it's KanCare or Healthy Indiana Program.
Thanks, Katelyn, you hit all the right points. We're working to create an app for people to comply with the new requirements. All the required paperwork and work verfication could easily be done because, while people don't have computers, iPads or the time to submit paperwork, they do have cell phones. We'll get this one, despite this major attack on poor children and families, disabled and elderly Americans.
One key reason why requirements for frequent re-submission of qualifying data and work information leads to loss of insurance is that even when recipients do submit everything they're asked for, the systems make errors, lose paperwork, fail to notify them of what's needed, etc. This has always been a problem, and with all the added administrative burdens this bill creates, it will be a huge problem.
And haven't they cut the staffing in Medicaid offices? That would slow things down when our disabled middle-aged daughter must keep proving her schizophrenia is real and also for newly disabled people applying for the first time.
Katelyn, this is a crime against the American people.
No, the crime against the American people was committed by those who pushed covid hysteria and lockdowns
Hi Paul- What does this have to do about Medicaid?
I'm just pointing out your hypocrisy and bias. You are pretty much just a political hack at this point.
You go on a rant about Medicaid cuts and talk about preventable deaths, yet you supported policies that caused damage to public health that dwarfs anything this bill will cause
What policies did I support that killed 52000 people a year?
did you speak out against covid lockdowns and hysteria? If you did, I don't remember it.
How many cancer diagnoses were missed or delayed in 2020/2021 do you think? How many preventative screenings were missed?
How many lives were lost or shortened due to the mental health effects of covid policies? (isolation, business closures, school closures, etc.)
If you care so much about public health, write about this.
I helped open up Texas in August 2020 so not sure why you’re directing this all to me. And i did talk about all of the negative impacts during the pandemic, like an increase in child abuse cases. I know you’re frustrated with the pandemic, but please get your facts straight before throwing stones.
I am very surprised to see this kind of comment in an otherwise enlightened group.
I worked in an acute care hospital all through the pandemic-the lockdowns, masks and fast work toward a vaccine saved millions. Sadly many wonderful people lost their lives before we could get a handle on the disease. Perhaps you could have volunteered to take over a shift in the emergency room for an exhausted stressed health care provider-since it was just hysteria...
Please stop with this. You are just parroting a narrative. There's zero evidence that even 1 life was saved, let alone millions. Nobody on the planet can control this virus. All the stuff that was done failed.
Covid hysteria, Paul? Do you mean that the death rate was not high enough “to get hysterical about” and try to mitigate? Covid only killed a million or so Americans and there are at least 330 million of us left, so no biggie?
The virus was never controllable. All the restrictions and mandates not only failed to control the spread, they caused significant collateral damage. Our covid response will go down in history as an epic policy failure and trampling of freedoms and liberties
How do you explain New Zealand or Australia or Japans response? Huge lockdowns, way more than in the U.S., until vaccines were avalaible, resulting in very little life lost
Yeah, let's compare island nations half a world away to the United States (without controlling for any other variables)? Great idea! lol
There are so many other things at play here. New Zealand and Australia all had significant excess mortality in 2021-2024, btw.
This was really an excellent summary. Many Trump supporters are trying to downplay the impact of this bill.
Key message of this post:
"This bill also assumes that all fraud is committed by Medicaid recipients. That’s wrong. Most fraud comes from providers. The 2023 federal health care fraud enforcement report listed no cases of beneficiary fraud."
I wish I could understand why the republicans want to punish people for being poor or disabled, even though a lot of the poverty is due to republican policies. I was reading this morning about what the Big Ugly Bill will do to our economy. On top of how the loss of Medicaid coverage will impact it. Republicans have been very short sighted for a very long time now (most of my life). It is sickening (and you can take that statement any way you want).
This is one of the best summaries I've read about the Medicaid cuts. Thank you.
Firstly, I will say that healthcare, especially the funding, in the US is royally messed up (keeping the language family friendly here if you catch my meaning). It is abysmal. We get the wait times to receive care of the worst of the socialized nations, we get providers that are like bad mechanics performing flip chart troubleshooting constrained to protocols from insurance carriers and govt., the atrocity called "pharmacy benefit managers" whose function is just to deny, and then we get to pay through the nose for it with a solid 30% of the costs going to administrative overhead. Pricing, sure our state auditor tried to get it from the former administrator of our State employee plan and got hundreds of pages of, "the price for procedure X is ... redacted". Look up the definition of racketeering, because it sure fits. As the Europeans say, I wouldn't wish the American healthcare system on anybody.
That being said, as someone who is paying through the nose, I have little sympathy for the whining about folks losing their healthcare handouts. I have to pay $8K per year out of pocket for coverage for my wife through my employer. Consequently it stands to reason that my care, though hidden, costs about the same. On top of that we have copays for everything, including the $300 I had to pay when my wife needed emergency surgery a few months ago and then get the $4,000 bill before any stupid "insurance" kicks in.
Of course when Obamacare passed, folks like me got boned in the backside. Our costs went up, our coverage declined. Excuse me, but I did not go to college for several years, obtain a degree to work in a field that is paid decently to be taxed to pay for someone else's care. Yes, there are some that are in true need, but what should be a safety net has become a lifestyle for some others. If you can't afford care, it doesn't mean that someone else should have to subsidize your care, it means that there is either something wrong in the medical industry or the market that determines how much your job pays.
Second, insurance is the wrong financial vehicle for regular healthcare. It may make some sense in terms of catastrophic care, where out of a pool of people someone is going to need it, but its hard to determine who or when. (Edit to add: routine healthcare is an expense. Think of it this way, if we used insurance to pay for car oil changes, you'd pay $50 per month for a policy that covers your oil change. The mechanic would bill the insurance company $200 and settle for $100, where absent the system you could get an oil change for $25 a few times a year). The fact that for many, healthcare has become an employment issue is just plain wrong, and is another example of how socialism fails. The reason we have employer sponsored insurance for coverage is largely due to FDR's wage freezes back around WW2. Employers couldn't attract help with wages so they started offering this as a "benefit". Just another factor driving the costs up, as well.
Third, this should never have been made a federal system to begin with. Once again, folks, lets go back to constitutional principles. Powers not expressly granted to the federal govt belong to the States. I see nothing in the documents that should define the federal govt. concerning healthcare. Sending back to the states is the right move. With any luck, this may start to shine some light on how messed up the system is and if it causes enough pain there just might be a motivation to finally fix it.
The fundamental problem in the US is that you attach health care to work. That's not how it's done in Europe. I was a NP in the US for 40 years & I have a MBA in health care. I live in Europe now. Here we see health care like education. It benefits everyone, therefore everyone gets it. We pay a small monthly amount & yes, I pay more taxes, but it's worth it. We don't have homelessness & I don't fear bankruptcy due to health care costs.
Medicaid is not necessarily a hand out. Some states charge premiums and have co-pays. And if a person is disabled, it makes sense (to me, at least) that such person receives the care they need. It would be nice if you could learn to have empathy for those who are not as fortunate as you.
What is your solution for people like my sister-in-law, born with cerebral palsy, and now in a wheelchair and physically unable to work because of the many health issues she has? She lives in a group home. Medicaid is her healthcare. She did not ask to be born this way.
"No healthcare coverage means delayed care, higher health care costs, and death. A study found it could lead to 52,000 preventable deaths per year"
How many preventable deaths were there as a result of the covid lockdowns championed by Dr. Jetelina and others in public health? How many missed/delayed cancer diagnoses, missed appointments/screenings, delayed or forgone preventative care, etc. How many deaths of despair resulting from isolation? How many lost life years due to job losses, increased poverty levels, and cost-of-living hardships?
I would like to suggest that you try learning about pandemics. That might help you understand why COVID-19 was handled as it was.
How about I just look at the pandemic planning guidance that existed in March 2020, which specifically didn't recommend any of the extreme measures and restrictions that we put in place?
Then compare the outcomes in USA with countries that locked down harder, closed borders more completely AND for longer, limited internal travel as well as overseas travel - chalk and cheese! (The latter did MUCH better!)
It’s so easy to pick holes in the responses used with the benefit of hindsight - and on the matter of how well vaccines contributed to improved outcomes, you only need to compare those from low-vaccinated States and Counties with their higher death and morbidity rates, to those with the opposite scenario - high vax, lower deaths and hospitalisations!
It's not hindsight. There were people expressing concern about our response in March 2020. They were shouted down, censored, etc. We totally ignored our pandemic planning guidance (based on decades of study/research) and jumped right into draconian lockdowns/closures. No debate, no discussion...just panic-based hysteria.
Do you think maybe there are other factors at play besides the intensity of lockdowns that influenced mortality rates? Comparing the United States and Europe to island nations thousands of miles away (without controlling for many other variables) is ridiculous.
“We totally ignored” - don’t you mean Trump had already destroyed what had been built as pandemic preparedness by the previous administrations?
Comparisons with other nations, including Europe, are still valid, and the ones conducted between States and Counties with differing vaccine uptakes are relevant too! You do realise that quarantine is still a reliable defence against the spread of contagion, as are masks, hand-washing, good ventilation and clean air? And that America is STILL losing around 200 people to COVID EVERY WEEK?
pandemic guidelines that were built from years of study specifically recommended against lockdowns and lengthy closures (even for Spanish flu level pandemics). There's simply no evidence that they work, and the negatives are quite obvious. We ignored all of that guidance, and enacted restrictive policies and mandates without any debate/discussion.
How many deaths were avoided because of those lockdowns? I guess we'll never know for sure, but you have to consider both aspects.
I'd sure that's a good idea, but I would say that pandemics are not real predictable, and in some areas extreme measures might have been required to keep some level of control on the spread of the disease. I know that my area never went into lockdown.
Paul, I don’t know estimates for any of these Covid lockdown effects you mention. I do know that my brother-in-law died of a cancer that might have been found earlier if COVID had not put pressure on the already underfunded UK National Heath Service. But none of his survivors think waiting for herd immunity to end the Covid pandemic, would have saved him or anyone else.
Thank you for this excellent detailed review of the painful cuts to the Medicaid program.
Perhaps the most startling information included in the piece is that only 8% of the population is aware of this!
Even with a political change in 2 and 4 years, this effect on coverage may not be able to be undone.
A devastating attack on our patients welfare.
Half of the cuts in the bill will take place before the 2026 election; some by January 1st 2026. Check this site with info based on KFF:
https://acasignups.net/25/07/08/heads-over-half-maga-murder-bills-healthcare-carnage-will-kick-midterms?utm_source=substack&utm_medium=email
I've heard some argue that these cuts will only impact udocumented immigrants who don't "deserve" to benefit from Medicaid. Where can I find information to address this? My understanding is undocumented immigrants can't directly apply for Medicaid but would benefit indirectly when visiting an emergency room for example. Surely this is a small percentage of costs comparatively though right? Just curious if you have information to share on the stance that these cuts will only take from those that are here "illegally".