The Republicans’ Big, Terrible Tax bill won’t just increase the national deficit by $2.4 trillion over ten years, it also uses a “back door” way to kick up to 11 million people off their Medicaid coverage: imposing work requirements on Medicaid recipients.
In 2018, Arkansas implemented a work requirement for Medicaid with consequences for non-compliance. It led to over 18,000 people losing their health coverage before a federal court deemed the policy unlawful in 2019. So we already know the policy doesn’t work and is unlawful.
Republicans are telling the public they aren’t “cutting Medicaid,” but they ARE using these ineffective work requirements to make it more complicated, difficult and burdensome for people to keep their health coverage as a way to cause millions of people to lose their Medicaid health insurance coverage.
No one knows how to fix it?
Every other civilized country figured it out years ago.
You have no frame of reference here Scott, you’re like a child who wanders in the middle of a movie.
There is a circular reasoning to Reich’s argument that is troubling. He says millions will lose their medicaid coverage AND many/ most medicaid recipients are already working.
From what I know, people who are working will maintain their eligibility…so exactly where is the problem?
There’s a lot of talk about the requirements being onerous and confusing, so people just drop out. This seems like an anecdotal argument and assumes medicaid recipients can’t fill out forms.
Then we get the “the republicans want to gut medicaid to provide tax cuts for the wealthy” smear.
From what I know, this bill keeps already existing tax cuts which were initiated with Trump and kept through Biden.
Most (a lot of) people get medicaid insurance assistance through their state exchanges which came into being because of the ACA. I’d like to know more about this. Most people who take advantage of the state exchanges are already working but can’t afford coverage on their own. Their assistance is based on their income.
The Republicans apparently think there are enough people who are gaming the system to make a difference. That may or may not be accurate.
So instead of serious arguments from the dems, we get talking points like “tax cuts for the wealthy”
Medical care is expensive for lots of reasons…the cost of medical school, medical equipment, ansulary staff and have you ever wondered why Community Hospital and St Mary’s need huge architectural wonder additions? Why not just build something simple and usable?
Our medical system is an expensive mess and no one knows how to fix it, but sure as night follows day, Robert Reich (the great economist) and his fellow travelers will use the issue to slam the rebublicans.
We’re currently too big to succeed.
Badhat, I think you have excellent questions and a willingness to talk about the details. There are several ways to address the issue, and adjusting work eligibility requirements is a good start. You are right, the link is circular in logic and appeals to simplistic people who dream of other civilized countries before their own.
At this point in time, health care is not a free service that everyone should expect a right to access. Nothing about that in the Constitution. Next, the biggest cost factor affecting health care is one’s personal responsibility for their wellness, including diet, choices, and behavior. And third, late and end-of-life care consumes most health care spending. These facts remain in any civilized country. Finally, there is the supply and demand issue of population demographics including volume and location of patients, providers, and facilities. Sure, our current pay model has many problems and it will be eventually replaced by a single payor system, but that won’t solve the problem. One more thing… as I am thinking while I am typing … Information Systems to include balances of data sharing and privacy and legal tort reform have been slow to adapt to an expensive public need. There are a few other factors like conflicting interests between providers and big pharma and government regulation, but lets table those for a moment.
In addition to common sense work requirements which might seem burdensome and complicated, I would break preventative care out from all plans and have it offered provided free or for low costs to all residents. There are networks for this all over the country in place. They are often staffed by volunteers and private and public donors. Imagine, when possible, people giving back instead of always taking? What a concept to teach the youth. This will require technology to share info with other care networks. I’m guessing that people will need some ID system. Just to cover everything in this comment, in this case I would suggest privacy from ICE, though perhaps not from a criminal warrants list. Maybe you must enter the front door to get your Covid shot and exit the back door.
AI and automation will help with all of this.
Back to Medicaid reform. There is some gaming of the system from people who simply prefer not to start paying premiums even after their eligibility changes. But by far, the biggest fraud is in asset manipulation when you approach long term care. 7-10k/month for long term care and also expensive assisted living is hard to swallow. It’s cheaper to live on a perpetual cruise ship. The owners of group homes and facilities are most clearly those stealthy wealthy I mentioned. All while they pay their caregivers a minimal wage. So, many people begin estate planning 7 years ahead of time and transfer their wealth. usually to their kids, to become Medicaid eligible.
Fraud and abuse in cases like this come in many forms. I for one am thankful that we had Elon Musk and the doge kids come in and start to understand the economics as a precursor to solutioning. We should all do likewise, instead of whining.
So much information…so I’ll just go the the late/end of life issues.
We have all watched friends and family struggle with the news of a fatal disease. We all hope for the best and expect the worst. But as you note, that is where all the money is spent. You say the elderly access medicaid, but from what I know, those people are on Medicare…another agency that is going broke.
Maybe, just maybe people need to know when to call it quits, even though the treatments/medicine on offer are free (to them).
I wonder how much could be saved for others if that last year of excruciating treatments were replaced by acceptance and sitting with loved ones contemplating the wonders existence and full access to psychedelic mushrooms.
😉
This is unlikely. Too many people depend on the sick for their livelihood…everything from researchers to pharma to the minimum wage home health aid. GIving up just isn’t the American way.
So in the end it just best to blame the republicans.
So, Medicare does not cover long-term care, which is what I was describing. Some people buy insurance for this, but the care often outspends the benefit. So the choices are out-of-pocket (pension), or if you are insolvent, a lower-quality Medicaid facility. Many opt for the free option and if they have assets, transferring them to their heirs. I guess it kind of makes sense if you have a victim personality to sacrifice ‘crappy’ care for a better legacy for your loved ones. Most end-of-life systems offer and encourage hospice. It is a lot cheaper and they make it more comfortable than another round with cancer.
I always planned to rife my wheel chair off the Monument. But I guess they frown about that too. Yeah, magic mushrooms.
OK…this is my last post.
Recently, two of my friends died of pancreatic cancer. One had fought and beat lymphoma for 25 years. Both were manly men who had just retired. It shouldn’t have happened.
They both spent the last year of their lives in and out of hospitals and emergency rooms. Their wives stood by them and everyone, including the doctors held out hope they could beat it but almost no one does.
In my opinion, if anything could change the cost of medical care in our country, acceptance of death would.
PS.
I found a site you might be interested in “Becker Hospital Review”
Lots of current news about CMS, DOGE, Medicare and medicaid
I just reread your part about long term care and people giving their assets to their kids so they’re eligible for free nursing home care.
I also know of at least one person who lied about her husband’s alseimers so that he would qualify for the insurance she didn’t buy earlier.
One of the things ACA tried to address was insurance companies not being able to penalize for preexisting conditions. So who paid for that?
You say single payer is inevitable but everyone knows about the wait times, etc in Europe and they’re going broke too, despite what some people think.
Maybe the best we can hope for is stopping fraud and enforcing the laws that have been voted on.
And to quit whining.
That is interesting. You have a higher sense of ethics than I do. I would forgive the person for falsifying the insurance application. A lawyer probably could have worded the application in a way that she did not fully understand the diagnosis, etc. It was a cat-and-mouse game between insurers and insured. I guess this story predated ACA which offered amnesty to pre-existing conditions. But people are still gaming the system. They wait for a catastrophic event and then run for Medicaid if they can hide their assets.
You asked about single-payer in other countries. I can speak to that. It works, and it will come to the USA by necessity. The last time I looked for a PCP, there were wait lists and some were not taking new patients, and others were not taking new patients on Medicare or Medicaid. Private insurance in some networks and plans were paying providers more. Some of the best providers a concierge providers who charge a subscriber a monthly retainer fee to provide instant access on demand. So there will always be a component of the most wealthy having better and quicker medical coverage than the masses. Overall, the reason that healthcare is more available and more expensive in the USA is that people overall have more disposable income and are willing to pay for it. Again, the 8-10k/month for private assisted living facilities. I recall visiting a doctor for a BP check, who had an office in the Community Hospital building. If my condition was serious, the doctor who if not certified for CPR, by protocol, would need to call 911 and get an ambulance to put me on a gurney to go from the doctors office to ER. And the City of GJ or AMR would have charged me the minimum of $800 at that time to do that. And I might have died in the doctors office, waiting for the 10 minute response time. All this because nobody would put me in an office chair and roll me to the ER. If you break protocol, some lawyer will get paid.
Lets switch to Latvia. You can get ‘senior house’, they call it, for 800 euros/month which includes some level of nursing care. Emergency services are free, which also includes a transport and a EMT who is probably equivalent to a nurse practitioner. That is free for me too as an expat. I can give you lots of examples, but I am sure you have heard it all. And of course, Michael Moore says you get great free health care in Cuba.
In countries with single-payer, there is almost always an option to buy supplemental insurance. For the most part, that will let you get closer to the front of the line.
The point of this is that Medicaid is effectively the way in the back door for single-payer universal health care. At this point in time, USA is not willing to watch people die on the street in front of a hospital for lack of money as you would see in India or African democracies.
This is a case where you might have to break it to fix it. Thankfully, the Supreme Court just authorized DOGE to move forward with their data collection. It might not be Trump who champions in single-payer, but at least Musk, before the divorce, took a crack at the deep state.
She was applying for long term care insurance and she guessed there would be a time when he would have to be in a “home”. She was right and ended up paying out of pocket but she had the funds.
As far as the inevitability of a single payer system…I presume the payer is the government…just like Medicare. Like Bernie says “Medicare for everyone! ”
I’m not convinced that will be any better than the current system. We don’t ever let people die in the driveway of hospitals currently. Emergency rooms are compelled to take care of everyone. One industry which would be sure to suffer is the insurance companies but may free up doctors’ offices staff.
It will be yet another complicated mess and will take decades to get used to.
What else is new?