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The US abortions increased by about 9% from 2017 to 2020 says this report in WSJ, going from 862,000 to 930,000 according to the Guttmacher Institute. Some states expanded Medicaid access to abortions and increased funding, leading to more services being added. Illinois for example had 25% increase which may have included women from Missouri going to Illinois. If the Supreme Court reverses Roe vs. Wade, the 1973 precedent that established the constitutional right to abortion, 25 states would restrict or prevent the access to abortion.

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Former Louisiana fovernor Bobby Jindal comes under severe criticism from the Washington Post for policies it says hurt the poor by turning down federal Medicaid funds under Obamacare, for using rainy day funds, and cutting spending on education and other needed programs in the state. It says Jindal pursued Grover Norquist's no tax pledge leading to spending cuts in the state and budget gaps, merely to appeal to voters in the GOP presidential primaries. Jindal's appeal to Republican voters actually fell sharply because of unpopular policies and he did not qualify for participation in the presidential televised Republican debates. Republican voters turned to outside candidates such as Trump, Carson and others.

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A wealth tax passed by voters in 2022 in Massachusetts of 4% on incomes exceeding $1 million, yields 3 billion dollars in 2024. Other states are looking at doing this on income over $500,000 for married couples. This includes Minnesota, Maryland, Washington and other states that are seeing a shortfall in taxes and need to offset the loss of federal funding by the DJT administration for Medicaid and other services. The results in Massachusetts shows the revenue forecasted is exceeded proving that millionaires do not always move because they do not want to uproot homes and education of children. There is also an offsetting factor as federal rules under DJT have favored the wealthy in the tax code.

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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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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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Total public and private spending on health care in the U.S. will increase by 6.1% in 2014 compared to 2014 in a revised Commerce Department forecast. The total spending will reach $4.1 trillion in 2014 from $3.9 trillion in 2013. Some of the lower rise in spending than the earlier 7.4% forecast will come from 28 states opting out of Medicaid expansion under the health care overhaul because of a June 2012 Supreme Court ruling. Employers are trying to reduce costs and the public is reducing spending because of the recession. Less generous health plans mean users are paying more out of their own pocket, paying more attention to prices and even postponing care. Growth in health care costs is a about 3.9% a year since 2009 following the recession. The costs increase in 2015 by 5.8%, in 2018 by 5.9% and 2022 by 6.5%, according to U.S. government forecasts, because of enrollment in Medicare for baby boomers. This is still higher than the inflation rate of below 2%.

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Questions remain about how well Mehmet Oz, who had a popular television health show Dr Oz, can deliver on reducing obesity levels, handle the cuts in Medicaid, and tackle the overspending on Medicare Advantage, as head of the Center for Medicare and Medicaid Services, With it's $1.5 trillion budget it is the largest agency in the US government other than Defense. It is also not delivering health results as American health for the dollars spent is failing to deliver, many nations in Asia and Europe have better health with a small fraction of the US cost.

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Margot Sanger-Katz of the NYT provides an excellent summary of winners and losers under the new Republican House healthcare bill that passed the House in a 217-213 vote on May 4, 2017. On the whole middle income people and higher income people stand to benefit, with sharp cuts in Medicaid, and higher premiums as well as smaller subsidies based on age affecting older people. Pre-existing conditions and minimum benefits are included as in ACA, with the provision that states can in some ways limit that coverage. Employers are no longer required to provide mandatory health coverage, helping large and small business owners.

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Presley says the Governor's election is not about right vs. left, not Democrat vs Republican, just those of us on the outside vs those in the inside. NYT covers Brandon Presley's effort to win the Governor's race in a Deep Southern state Mississippi. He plans expansion of Medicaid in a state with alarming health conditions. He hopes to revive rural hospitals. He approved raises for public school teachers of $5100 a year. He is conservative on social and cultural issues. In 2001 at age 24 he was elected mayor of a small town Nettleton with 1900 people in northeastern Mississippi. He was elected four times to represent northern Mississippi on the Public Services Commission.

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Differing views of Republicans in the Senate on cuts to Medicaid and shifting of Medicaid to the states, cuts in food aid and distribution of the aid, green tax credits, business deductions are likely to lead to a revised bill being passed in the US Senate. It will then have to be passed in the US House of Representatives. DJT calls it the biggest tax cuts in history and one that aids small business.

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A Wall Street editorial on the problems identified in the budgets and finances of U.S. states identified by the State Budget Crisis Task Force co-chaired by Volcker and Ravitch. This includes Medicaid costs, underfunded pensions, and budget gimmicks that understate the true extent of problems.

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Krugman questions the Paul Ryan U.S. budget proposal on several grounds. He says the Ryan proposal depends on projections by the Heritage Foundation for its assumption that the tax cuts would generate higher revenues by creating a booming economy. The Heritage Foundation projection is for revenue increasing by $600 billon over the next 10 years as a result of tax cuts. Krugman cites a different view from the Congressional Budget Office estimate for the Ryan proposal, which shows assumed savings from spending cuts will go not to reduce the deficit but to pay for tax cuts, with bigger deficits in the next decade. He says the spending cuts excluding Social Security, Medicare and Medicaid- but including defense- go down from 12% of GDP in 2011 to 6% of GDP in 2022- meaning that cuts in public services will need to cut to the bone. The Medicare part of Ryan's proposal does not say how spending on medical care will be reduced. The voucher or premium support Ryan envisages is estimated by the Congressional Budget Office to cover only one third of the cost of insurance premiums for Medicare equivalent care by 2030. Krugman cites the Center on Budget and Policy Priorities, which says the Ryan proposal achieves two thirds of its $4 trillion in spending cuts over the next decade by cutting programs that primarily serve low-income Americans. ...

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Republicans are divided in Texas in 2023 which could turn it over to Democrats. One forgets that Texas is the state that a Democrat LBJ Lyndon Baines Johnson was from and his base of support, first vice president under John Kennedy and then elected president. LBJ signed legislation for amending Social Security to create Medicare and Medicaid. He also passed Civil Rights Act of 1964 banning segregation and in 1965 enfranchised black voters. The WSJ in this editorial sees the divisions between Republicans in the House and the Senate over the impeachment of Attorney General Paxton as signs that Texas has one party dominance for too long. It says this could turn the state to a Democrat majority in 2024 as it was under LBJ in 1960, who helped create programs revered by all Americans.

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The State Budget Crisis Task Force is co-chaired by former Fed chairman Paul Volcker and Richard Ravitch, a former lieutenant governor of New York. The Report of the Task Force says rising pension expenses and healthcare costs for public sector employees and Medicaid costs are severely reducing the ability of states in the U.S. to fund essential infrastructure improvements, education for low income students and other services. The report said there were six major threats to the fiscal situation of states- including Medicaid spending, underfunding of retirement, "budgetary gimmicks" to address the short term needs, and uncertain tax revenues. Ravitch told a news conderence: "It will be a hell of a lot more expensive to deal with theses problems in five or ten years than to deal with them now." The report focussed on California, New York, New Jersey, Illinois, Virginia and Texas. It was funded by the foundation of Blackstone Group co-founder Peter Peterson, and George Soros's Open Society Foundation....

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The 2018 budget deal brings Democrats and Republicans together by increasing defense and domestic spending both by about 10%. Spending caps are to be lifted by $500 billion over 2 years with 60% of this going to defense spending increases to bolster America's defense capabilities. Defense spending is a top priority for Republicans.  For Democrats this means staving off some cuts in Medicaid and Medicare, more college affordability funding, and 4 year extension of the Children's Health Insurance program that had expired, funding community health centers for another 2 years.

This also shows that both sides can reach agreement even with divisive rhetoric and serious differences over policies.

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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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This WSJ editorial describes the choices facing states in the U.S. for Medicaid- staying in and increasing the strain on state budgets or opting out altogether from Medicaid when hospitals in the states have enlarged their Medicaid dependent programs- as being a kind of extortion. Justice Kennedy said this was not giving the states much of an option, and Justice Scalia described it with a Jack Benny humor quote about being held up by a robber saying "your money or your life." Justice Roberts described the overwillingness of states to accept federal funds that got them to this point. The overall sense of the hearings at the U.S. Supreme Court on the third day, was that of skepticism on the part of Justices Scalia, Alito, Kennedy and Roberts, leaving Solicitor General Verrilli to make an appeal to humanitarian and patriotic sentiment about millions of the poor who would go without medical care if the Court ruled against the government.

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Allan Blinder gives a spirited account of what he sees in the Paul Ryan Republican deficit reduction plan. He says that with the voucher plan retirees would fall further and further behind the increasing cost of health insurance. With no explicit cost containment proposals it assumes that some kind of miracle will occur for costs to be kept in check- especially as Republicans want to repeal the cost containment proposals in the President's healthcare plan. He asks whether someone is saying, that we have to destroy Medicare so it can be saved. Ryan woulld also turn Medicaid into a block grant, then underfund it and let the states figure it out when they are in a budget squeeze. Blinder points to the estimates of the Center on Budget and Policy Priorities, that show about two-thirds of Ryan's budget cuts would come from programs that serve low and moderate income Americans. And to make matters worse the steep spending cuts go to finance tax cuts that largely benefit the wealthy. He calls this Robin Hood operating in reverse, and coming on top of 30 plus years of rising inequality. David Stockman makes a similiar point on the editorial pages of the New York Times, April 24, 2011; also adding the point that the middle class will have to pay higher taxes for the deficit to be addressed, something President Obama's plan fails to do. Blinder says that the Bowles-Simpson and Rivlin -Domenici proposals attack the deficit reduction problem in a better way, that asks something from all classes and interests. ...

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McCain wants to ke.ep his health care plan "neutral" by paying for his health care plan from cuts in Medicare and Medicaid wasteful spending

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This story in the NYT describes how the flawed effort to pass the Republican healthcare bill or repeal the Affordable Care Act passed under president Obama failed after another effort. Many developments killed it. In the end the president lost interest, especially when he saw Republican Senator Rand Paul of Kentucky go on talk shows on the weekend before its collapse to complain about the bill. Senator Collins of Maine was exasperated by the way the bill was being rushed through Congress, and she voiced her strong opinions about this by talking to people back home in Maine and sharing her conversations with the media. The bill pushed by Senator McConnell, the Republican leader in the Senate, imposed annual caps on Medicaid spending. And did this without any discussion, shutting out committee debate, any public discussion, or formal drafting. Once this process was set in motion in this way the Republican Senators formed camps. Senator Grassley of Iowa and Jerry Moran of Kansas, normally conservative moved to the moderate side. Moran held a town hall meeting covered in the NYT, where older people voiced their concerns. Most of the patient advocacy groups, the hospital groups such as the American Hospital Association, and other medical groups also opposed it.  After Senator McCain of Arizona said he could not return following a surgery in Phoenix, Senators Lee and Moran announced their opposition. With this the bill's support crumbled including any effort to repeal the Affordable Care Act.  ...