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German Chancellor Merz says welfare entitlements are becoming a strain on the economy. The welfare entitlements growing in size puts huge strain on the budgets of US, Germany, UK, and France. Small changes in the Medicaid program in work requirements became politicized in the US spending bill passed in Congress. The size of the Medicaid program in 2025 is an example. Started in the LBJ administration it was $1 billion in 1965 covering 4 million people increasing to $10 billion covering 20 million people in 1976. 50 years later it covers 3.5 times the number of people at 71 million at a cost that is staggering of $900 billion. US population in the 50 years increased from 218 million to 342 million by 57% when the Medicaid population grew at 355% of 6 times the actual population growth showing that the country in some ways was growing much poorer and unhealthier and that other factors were also at work. As a percentage of the size of the economy  Medicaid growth was $10 billion when GDP was $1700 billion in 1975 or .00059% vs $900 billion when Medicaid is $900 billion  when economy GDP in 2025 is 30,000 billion or .03000 which is 50 times the percentage in 2025 vs 1975. At work in this is the ballooning cost of the way medicine is practiced in the US, and other factors.   ...

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This NYT editorial points out that the cuts to Medicaid amount to taking out a fourth of its budget and are sure to hurt low income Americans. The cuts are about $880 billion over 10 years for Medicaid. The $300 billion less in subsidies over ten years is likely to hurt the elderly. It also points out that removing the individual mandate will make it harder to reduce premiums as fewer healthy adults offset the costs of sick patients.

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The Big Beautiful Tax and Spending Bill in the US Congress faces close votes in the US Senate with Senators Rand Paul of Kentucky, and Thom Tillis of North Carolina, both Republicans against it.  The Senate version has additional cuts to Medicaid funding. Tillis expressed concern about these cuts. Senator Rand Paul is opposed to increasing the deficit for enlarged spending and tax cuts. Republicans and DJT have close votes in the Senate and in the Congress. Republicans Murkowski of Alaska and Curtis of Utah want to change the early phaseouts of tax credits to the renewable energy industry in the Senate bill, and the excise tax after 2027 to avoid buying from China and develop American manufacturing in renewables. Senator Collins of Maine has an amendment to add $25 billion for rural healthcare and rural hospitals to offset the effects of large Medicaid cuts. Collins plan also lets taxes revert to 39.6% from 37% for married couples incomes over $50 million.  The bill then heads back to the House for changes by Wednesday, July 2, for a goal to have it on the president's desk by July 4th, Friday. ...

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Krugman in the NYT cites president Trump's reference in an interview with the Economist magazine to the expression "priming the pump." Trump in that interview in May 2017 said he had come with the expression and feels good about it. "Priming the pump" is an expression used by president Franklin Roosevelt during the Depression period. During the depression and in 2009 the economic crisis needed a stimulus response and priming the pump. The economy today with lower unemployment is not the time to increase deficits with tax cuts for the wealthy, says Krugman. Only infrastructure spending with a long term return justifies increasing the deficit. He is critical of Speaker Ryan for supporting deep cuts into Medicaid for poor people, and yet supporting the tax cuts weighted more towards helping higher income people.

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Democratic states face a sobering reality- can California, Minnesota, Illinois afford it? It turns out that they cannot and are diverting important funds away from the Nation's priorities in transportation, housing, education, rural healthcare. Here is what happened-- When California Gov. Newsom used state's Medicaid budget for poor citizens and disabled for illegal migrants to give free coverage, Medi-Cal went $6.2 billion over budget in 2025. In Illinois the program for Medicaid coverge to illegal migrants estimated at $112 million annually now costs $800 million and parts of it are now suspended. California had not thought this thing through, with free medical coverage not available to even citizens of the US, why would unrestricted borders not overwhelm a border state's Medicaid system signed into law by a Texan president Lyndon Johnson for the people of this Nation. Democratic States are running into a logical fallacy that the European Union and Germany are already experiencing, stretching straining public services, which has nothing to do with one's sentiments. Gov. Newsom now wants to give this benefit for $100 monthly premiums in 2027. ...

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Losers in US Tax Mega Bill 2025- Medicaid users, food aid recipients, college borrowers, and EV drivers.

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Krugman on tax breaks for large corporations that do not create jobs and large cuts to Medicare and Medicaid.

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Flat payment rates for Medicare Advantage to Insurers by the DJT administration which is questioning how health care needs of the country remain unmet and US healthcare comparing very unfavorably with other advanced countries in Europe and Japan and also in India. Some of this is because of the behaviour and practices of the health and pharmaceutical industries in the US. The 2027 payment by government for Medicare Advantage is 0.09 percent. In 2026 it was about 5%. In 2025 it was -0.16 percent and in 2024 it was -1.12% under the Biden administration showing a great deal of dissatisfaction with funding Medicare Advantage. Medicare Advantage was set up by the Bush Republicans in 2003 who set it up with the nice sounding name Medicare Modernization Act. It was an effort to help the insurance companies with government money. Today in the second term of DJT in 2026 affordability is what American people care about most and the DJT administration is unhappy with the insurance companies. Dr. Mehmet Oz is in charge of Medicare and Medicaid Services Agency of the federal government and he says about Medicare Advantage and new policy to save “taxpayers from unnecessary spending (on Medicare Advantage) that is not oriented towards addressing real health needs.” The DJT Kennedy-Oz approach is for comprehensive digital information linking all medical providers, making America healthy again, cutting through the dense fog created over the last 2 decades, making pharmaceutical costs as affordable as the best in European nations, and refusing to subisidize if delivery is poor and health results are poor.   ...

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The coverage of the Republican healthcare bill and how it affects the elderly, and people on Medicaid, people in rural areas, is likely to have changed public opinion in the U.S. about the necessity of ensuring all Americans have health coverage. The Pew survey cited here in this NYT report by Zernike and Goodnough was done in Jan 2017, and shows a shift. The shift would be much higher today after people look hard at the consequences of what were simply hypothetical positions or ideological positions taken without looking at consequences in daily living. On Medicaid that opinion by July 2017 compared to Jan 2017 has shifted 10 percentage points for Republicans to 53% who think Medicaid is important to them and their families, according to Kaiser research. There is stronger sentiment about people having benefits taken away.  [article-55059] The opinion has shifted to where people see that coverage is important and people should not have coverage denied or benefits taken away from them. Opinion remains strong in favor of changes to reduce the high premiums, but not to replace the existing health benefits and law with no law at all to replace it. That leaves 20 million more uninsured according to the Congressional Budget Office. Changes have to be constructive is the popular view today,  and this requires dialogue between Republicans and Democrats- which has not taken place. ...

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With government spending currently at 24% of GDP, the budget proposed by Paul Ryan, chairman of the House Budget Commttee, proposes to bring this down to 22.5% in 2012, and to 20% by 2018. The Ryan proposal would cut spending by $5.8 trillion for 2011-2021, with spending $6.2 trillion less than proposed by the Obama administration. It is a bold effort by House Republicans to bring the deficits down from the $1 trillion plus levels of the last 3 years. Major changes are made under this proposal to Medicare, and Medicaid. People who retire after 2021, would choose from an array of private insurance programs, and the federal government would help pay the premium. Medicare under this arrangement would be a "premium support" system. Medicaid would become a block grant for the states. This proposal estimates a saving of $771 billion on Medicaid over 10 years. The Food Stamp program would also become a block grant system. In addition to this the top individual and corporate tax rates would be 25% instead of 25%, with the changes being revenue neutral as a series of tax breaks would be eliminated....

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Senate Finance Committee chairman says Senate Democrats have found ways to reduce the cost of the health care plan from $1.6 trillion to $1 trillion. A tax on some employer provided health benefits, cuts in Medicare and Medicaid spending, employers helping to pay the cost of health insurance for low-income workers, and limiting the eligibility for subsidies to households with incomes at 3 times the poverty level or $66,150, instead of 4 times the poverty level. Also a reduction in the plan to give tax credits to small businesses to help them buy insurance. And expansion of Medicad would be delayed to 2013.

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The Congressional Budget Office analysis of the Republican House health Care bill shows 24 million Americans would lose health insurance over 10 years. In terms of budget savings the bill saves $337 billion over 10 years. The increase in uninsured comes from the roll back of expansion of Medicaid under the House plan, the reduction of tax credits, plus the removing of income based credits replacing it with tax credits based on age. President Trump is promoting the bill saying it will reduce the premiums that have gone up since Affordable Care Act was passed and increase competition. House Speaker Ryan in promoting his plan says he is not in "some coverage beauty contest." The House Plan says Ryan, does not mandate that all be covered, but simply says coverage is in a free market giving people the option to buy insurance that they want, so that the numbers of insured would not be as many as under a mandate.

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Republican governors hold governorships in 30 states in the U.S. They have a different perspective on the expansion of Medicaid envisaged in the healthcare law, as long term funding for the expansion is uncertain. With the deficit reduction planned in negotiations between president Obama and the Republican controlled House the outlook for money going to state funding is precarious.

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The Fiscal Survey of States, a report put out by the National Governor's Association, says that Medicaid will become an increasing burden on state budgets as help from the federal government declines. The report points out that state general fund revenue remains $21 billion below 2008 levels, just as the states prepare for less federal help.

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Paul Ryan, chairman of the House Budget Committee, explains his U.S. budget proposal to bring down the deficit. Ryan's Republican budget proposal is a bold effort to make a break from a status quo which is leading to higher levels of U.S. debt as a percentage of GDP. It envisions changes to Medicare, Medicaid, and the tax code. It is built on the idea that sustainable finances will lead to a better economic future for America, compared to small changes to the staus quo envisioned in Democratic proposals and the 2012 budge proposal of the Obama administration. It is also bold in its effort to tackle Medicare with a "premium-support" system, and Medicaid by turning it into a block grant system. It also incorporates the Bowles -Simpson President's Deficit Commission's ideas for simplifying the tax code.

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....

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House Democrats in the U.S. see the Republican health care plan making the same mistakes in 2017 that the Democrats made in 2008. With the passage of the bill in the House of Representatives with a vote margin on May 4, 2017, rushed through in the way the Obama bill was also rushed through, the nation remains as divided as ever on the issue of health care. The Republicans favoring limiting subsidies and cutting Medicaid, and using some of the savings for a tax cut. The Democrats favoring mandated coverage for all and large subsidies to reduce the number of uninsured Americans, with expansion of Medicaid for very low incomes. Democrats in the House say the Republican House bill will result in Republicans losing seats in the House in midterm elections.