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Medicaid Cuts - cutting costs for a program that went from $20 billion in 1980 to 918 billion in 2025, went up 45 times in 45 years. Projecting it out at this rate would leave little for other priorities for the Nation. Hence the need to set priorities- helping one means not helping the other in need. Helping a able bodied person means not helping the elderly who need help as by eliminating Social Security tax for about 90% of recipients over 65 years for instance. Medicaid was originally intended for able bodied. Critics of the plan say there is a lot of red tape and reporting at state levels. The correct solution would be to cut the stringent reporting requirements, cut the bureaucratic reporting, make it simple easy to report and not frequent. California, New York and other states will likely make the reporting easier. For impact on rural hospitals Collins and Murkowski have setup a $25 billion fund in this Big Beautiful Act to support rural hospitals. ...

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Medicaid is now costing the US about 880 billion dollars in 2025. Of this 69% is covered by Federal dollars sent to the states. WSJ reports- 2025 DJT action on Medicaid calls for around $800 billion  savings over 10 years in Medicaid cuts that would come from $109 billion savings over 10 years for work requirement. And $600 billion savings over 10 years from paying only 90% (not 100%) for the people added to Medicaid by Obama that are in better health than the core Medicaid population who get only 90%.

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Ron Johnson (R-Wisconsin) who seeks deeper spending cuts, Josh Hawley (R-Missouri) who sees Medicaid co pay for able bodied at 100% of federal poverty level as a "sick tax," Lisa Murkowski who differs on taxing providers, and other Congressmen and Women in the Republican party are opposing the new tax cut package of president Trump. Senator Rand Paul (R- Kentucky opposes the raising of the debt ceiling, and is also opposed.

Most of the main Medicaid cuts come after 2029 after Trump no longer is president, so that Republicans who want to see the shrinking of the Medicaid program so it meets only needs of the most needy, want to see faster cuts while Trump is president. And there are other Republicans in Congress who face tight elections and see big risks of losing their seats.

 

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U.S. states want flexibility in applying the Medicaid program which covers 53 million Americans earning lower levels of income. This amount was $11,616 a year for working parents in 2009, according to the Kaiser Fondation. Some states have a higher income level, as high as $48,400. The problem for states are serious budget deficits, with Medicaid comparing with education as a major cost. The recession and job losses has added 8 million Americans to Medicaid rolls. The Federal government supports 57% of the Meddicaid budget on average. A provision in the 2010 health care law says states cannot limit Medicaid eligibility, or they would lose funding by the federal government. The Obama adminstration's position is that eligibility or provider cuts will not bring in large savings, and will allow larger cost-sharing by Medicaid users, with only minor cuts in eligibility. Its position is also that the law does not give the federal government waiver authority. Some of the issues raised relate to the structure of Medicaid cost and its rapid escalation. Health and Human Services says 1% of benificiaries, especially the long term care, use up 25% of the Medicaid expenditures. One astonishing fact is that two thirds of all U.S. nursing home residents are on Medicaid. The total cost is rising, from $187 billion for Medicaid in 2000, to $346 billion in 2009, according to the Centers for Medicare and Medicaid Services. In July 2011, $26 billion in additional federal Medicaid funding expires, which will be added to state expenses as they struggle with large deficits. In states like Maine, with generous benefits, about one fourth of all residents are in the Medicaid program. ...

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The Biden administration is now allowing states to use Medicaid money for meeting needs for food, nutrition to prevent chronic diseases and improve health. 

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Medicaid covers 72 million people, add children care CHIP and it is 79 million, at cost of $872 billion. This is how it works in this WSJ report.

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 Americans in the southern states forget that president Kennedy made the famous statement about "a rising tide lifts all boats" in Arkansas, a poor southern state, saying that America must invest in all regions in people in all parts not just in well off northeastern states. In a handful of southern states expanding Medicaid to about $43,000 or 138% of the federal poverty level for a family of four is now being taken up by Republican leaders who show new openness- in Alabama, Georgia and Mississippi. Noah Weiland -of NYT looks at one particular battle -between Democrat Governor Laura Kelly in Kansas and Republican Speaker Hawkins- in Topeka, Kansas, where the fight goes on. Hawkins calling it the greatest Ponzi scheme devised and Kelly telling this reporter that she has included a work requirement so there is no excuse for not doing this. Republicans are coming around and so are states in other places. Missouri, Nebraska, and Oklahoma, states that lie next to Kansas have approved this through ballot initiatives. The point here is that in the years as America comes out of the pandemic there is and should rightly be a realization that this is different, that the children of low income families deserve as equal a chance as their higher income fellow Americans, that depriving them of good medical care makes America a weaker country. As Jerome Powell of the US Fed said in Stanford today about Kennedy's expression of "lifting all boats," it is just this that is needed today. It will be the No.1 election issue in Kansas in 2024, says Governor Kelly. The Republicans are also having second thoughts and are now just face saving. Consider that the Kansas Health Institute a research group, says 70% of the people becoming eligible for Medicaid expansion are working. Many are restaurant business workers who cannot provide proper medical care to children who form the next generation of America. And hiring in rural hospitals would expand for health workers instead of layoffs in southern states lifting financial strain on rural healthcare with additional Medicaid funds. This helps rural America when it needs it most. ...

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Three million additional Americans get access to Medicaid as a result of the Obama Healthcare Law (Affordable Care Act). Under the law states could expand Medicaid to people less than 65 years old with income of 133% of the federal poverty level of $15,521 for individual or $31,721 for family. About half of U.S. states expanded Medicaid and the rest kept the prior income guidelines. The figures are from a report by the Centers for Medicare and Medicaid Services, which show 58 million Americans on Medicaid in third quarter of 2013, and up to 61 million in March 2014.

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In an Op-ed in the Washington Post Mehmet Oz, Head of Medicaid and Medicare says while banning use of Medicaid and Medicare funds for transgender medical procedures- "America’s children aren’t lab mice. They deserve quality care backed by sound evidence and should not be conscripted as test subjects in risky experiments that cause irreversible harm. Federal government is banning the use of Medicaid and Children’s Health Insurance Program funds to subsidize sex-rejecting medical interventions for minors and prohibiting hospitals participating in Medicare and Medicaid from performing them. Dr Oz says "extraordinary interventions such as cross-sex hormones and double mastectomies require extraordinary evidence, especially when children are involved." He says the evidence is lacking and cites information from many countries. ...

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One Big Beautiful Act passed in US Senate with Vance casting tie breaking vote. It renews the tax cuts from DJT's first term in office in 2017 and provides tax cuts to seniors, middle class, and small business. It provides 100% expensing for business to increase investment. Mothers get child care credit that is doubled, senior citizens over 65 years get a $6000 deduction. The seniors deduction means 88% of seniors will now pay no taxes on social security benefits from 64%. Medicaid changes so that able bodied Americans will have to put in 80 hours of work to qualify.  Note that the Medicaid program was becoming unworkable and unsustainable- starting with the idea of helping people unable to work and transitioning those who could work, it jumped to $228 billion cost in 2000 from $28 billion in 1980, ten times over 20 years. Going up to $918 billion in 2024, 4 times the 2000 level. Medicaid is now 62% of what Social Security costs, $918 billion compared to $1480 billion for Social Security. ...

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WSJ Analysis of $1 trillion Medicaid Cuts in the One Big Beautiful Act-who it impacts most. It means less money for insurers, hospitals, and 9 million able bodied Medicaid recipients being moved to being covered by new employers. Under extension of Obamacare able bodied Americans were added to Medicaid in some of the states. Some states such as Texas and Florida and other southern states decided not to do this. The One Big Beautiful Act removes this extension of Obama care and the funding to states and adds the able bodied requirement to cut funding by about $1 trillion. Insurance companies who covered the insured and got payments from the federal government will lose these payments. Hospitals will also lose these payments from the federal government that sent money to the states for funding Medicaid. Overall Medicaid funding is proportionally cut more in Republican states. In Arizona, Kentucky and Virginia Medicaid cuts will be 18%, compared to 9% in New York and 13% in California. 93% of the cuts are in states that have expanded Medicaid to include able bodied adults. The Big Beautiful Act also cuts down on provider taxes which hospitals used to get more funding. Rural hospitals are given access to a $50 billion fund in the Act  so they can be kept open. ...

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This Economist magazine editorial says the Republican plan for health care with its roll back of Medicaid expansion by limiting funding to states after 2020, and by scaling back subsidies especially for older Americans and not basing them on income levels, is likely to have its own problems just as the Affordable Care Act. One concern is that keeping healthy people in the market with a mandate that everyone have insurance is present but in a milder form with premiums going up by 30% in one year if they change their mind. There is concern that this may not work among insurers leading to an increase in premiums, pricing people out of the market in "a death spiral." This could lead to more people being priced out of the market as premiums rise. About 12 million people were added to Medicaid by increasing eligibility level to $16400, or 138% of poverty line- this reduced the uninsured from 16% in 2010 to 8.8% today. The Economist concludes that the Republican health care bill has its own problems, and that this bill does not clear up the problems in Obamacare by substituting Ryancare as the Republican bill is called. Peggy Noonan writing in the WSJ says this may have negative consequences for the new Republican base shift to populist support. Critics on the right like Rand Paul see even the reduced subsidies as an entitlement program, yet the Republicans can only change parts of the Affordable Care Act as they need 60 votes in the Senate where they only have a small majority.   ...