One Big Beautiful Bill Will Be One Big Ugly Mess For Millions Who'll Lose Health Care
In this newsletter we’ll take a look at how the Republican’s budget bill will hurt millions as it recks havoc with our health care system. Oh well, at least the rich will get their tax cuts.
American Carnage: A Health Care Hellscape
So, here’s what we’re looking at: The Republicans’ One Big Beautiful Bill Act is projected to cause an additional 16 million people to be without health insurance in a decade, according to a story in the New York Times.
That’s the analysis from the Congressional Budget Office. It breaks down like this:
*The bill’s many changes to Medicaid would cause about 7.8 million more people to be uninsured.
*Technical changes to the Affordable Care Act (Obamacare) would leave an additional 4 million uninsured.
*The Republicans going through with their plan to not extend additional funding now being used for subsidies to keep ACA premiums down would cause about 4.2 million to be added to uninsured rolls.
All to help pay for trillions of dollars in tax cuts for the rich.
“Taken together, proposed changes and the expiration of the subsidies could threaten the viability of the Obamacare markets themselves, which have more than tripled in size since 2014, and currently cover 24 million people,” the Times reported.
“This bill poses a seriously existential threat to the future of the Affordable Care Act marketplaces in a way that we haven’t seen since 2017,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.
This is the Republican wet dream, and the combination of their party controlling both chambers of Congress, the presence of four-time indicted, twice-impeached, sexual assaulter, tax fraudster, insurrection inspirer, wannabe fascist dictator, convicted felon, Russian puppet, President Donald Trump in the White House, and the corrupt, ruthless, uncaring philosophy that permeates the Trump administration, has brought them to this opportunity.
You can read the Times story here.
This is a mean thing to say, but if there’s any consolation in all this it’s that Trump’s voters are expected to be the hardest hit by his assault on health care and other policy decisions. This could be a good thing because the thought here has long been that the president’s cult will only consider leaving him if he made their lives much worse.
This has the potential to do that. Let’s take a closer look in the next two stories.
Rural Areas Loaded With Trump Voters Will Be Devastated by GOP Bill
This sounds pretty succinct to me: “MAGA Will Devastate Rural America.”
So does this: “Trump’s policies will hit the American heartland hard, very hard.”
That’s the title and subtitle of a recent Substack post by economist Paul Krugman.
As Republicans in Congress work on their plan to fund $4.5 trillion in tax cuts, mainly for the rich, in part by cutting Medicaid and food stamps for poorer Americans, Krugman warns that “while the human damage from these policies will be very widespread, it will be especially severe in rural areas and small towns – the very areas that overwhelmingly supported Trump in 2024.”
Noting that poorer, more rural states are heavily subsidized by taxes from richer states like Massachusetts and New Jersey, Krugman wrote, “This reality makes it inevitable that the standard conservative fiscal agenda – tax cuts for the rich, benefit cuts for the poor and middle class – hurts the heartland more than it hurts major metropolitan areas. But MAGA’s Reverse Robin Hoodism goes beyond the standard conservative agenda, in ways that will be especially devastating to rural areas and small towns.”
With passage of the GOP’s One Big Beautiful Bill Act, “it’s almost certain that there will be savage cuts to Medicaid and food stamps, programs that disproportionately help Trump-supporting rural areas.”
Medicaid covers a higher percentage of the population in rural areas than in urban areas, Krugman explained. Almost 40 percent of children are covered by Medicaid, with some of the highest percentages in deep red states like Alabama and Mississippi. Medicaid pays for 42 percent of the births in this country.
Republicans have been lying about their proposed Medicaid cuts, claiming that they’re really only the result of cracking down on waste and fraud, such as by establishing work requirements.
But, as Krugman writes, “We know from repeated experience that such requirements don’t actually lead to significant increases in employment. What they do instead is block access to health care by creating bureaucratic hurdles for beneficiaries – hurdles that rural Americans, often burdened by limited formal education and inadequate internet access, find especially hard to overcome.”
The loss of millions of Medicaid patients will be a direct hit on rural hospitals, many of which are already struggling financially.
And it’s not just the hospitals that will be hurt, as Krugman says, “federal health spending, both Medicaid and Medicare, is disproportionally important in supporting rural and left-behind local economies.”
The next story offers a deeper dive into the disastrous effect Medicaid cuts will have on hospitals.
You can read Krugman’s piece here.
‘A Hospital Apocalypse’
Well, this doesn’t sound good: “Republicans Threaten a Hospital Apocalypse. Experts warn of potentially hundreds of hospital closures, which would degrade the entire medical system.”
That’s the headline and subhead on a piece by the American Prospect’s David Dayen, which starts by reporting that the Senate’s version of the One Big Beautiful Bill Act, despite predictions that it would be more moderate than the House version, is really more extreme as it stands now.
And it’s not just the hundreds of rural hospitals that are in danger from the bill’s proposed huge cut in Medicaid spending. “The entire health care provider network would come under heavy strain, and possible collapse. That’s because each node of the system is interdependent,” Dayen wrote.
Here’s some data from the story:
*We’re looking at Medicaid cuts and changes to the Affordable Care Act that would create potentially millions of uninsured people.
*A Center for American Progress report said that 190 rural hospitals in 34 Medicaid expansion states are at immediate risk of closure, and Medicaid cuts could push them into shutting down.
*Lost revenues from Medicaid could lead to closing important services. Fifty-six hospitals in California have ended maternity care since 2012.
*The Sheps Center for Health Services Research at the University of North Carolina said 213 rural hospitals serve a disproportionately high share of Medicaid patients.
*Uncompensated care – as hospitals fulfill their legal obligation to take care of patients in an emergency regardless of their ability to pay -- would increase by $204 billion over the next decade if the House version of the bill was passed, according to the Robert Wood Johnson Foundation. The Senate bill is even worse
*Medicaid is often the biggest line item in the accounts receivable budgets for nursing homes, rural hospitals, and maternity wards,” Family USA’s Anthony Wright told the Bulwark.
Here’s the domino effect Dayen is talking about: As rural hospitals close their patients must find other medical facilities. A lot of them won’t have insurance anymore, so you have more cases of folks showing up needing emergency help but without the ability to pay. This puts a financial strain on the hospitals left behind.
Patients will experience hardships because they have further distances to travel to get to a hospital. Hospitals will face overcrowding and overburdened staff. There’s a projected shortage of over 187,000 physicians over the next decade, according to a November 2024 report of the National Center for Health Workforce Analysis.
As Dayen writes: “The health care system as it stands today reflects a fragmented patchwork of providers and insurance systems, which are ill-equipped to handle a shock of this magnitude.”
Of course, the Republicans and the rich people they want to make richer at the expense of the poor and middle class couldn’t care less. They’ll always have access to good health care.
You can read the American Prospect piece here.
MUST* READS FROM OUR BLOG: MUSINGS OF A NOBODY
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And after a depressing newsletter, let’s end with the great Bob and Ray.
*In this case the term “must” doesn’t take on the usual meaning of something important or urgent to do. It means please click on our stuff because if you don’t, we don’t know if anyone else will.