I'll start off by saying that I agree that cuts to Medicaid are political suicide. They are also idiotic in that if you're trying to "fix" Medicaid, meaning cut the waste and fraud, just cutting the program isn't going to do a thing for that. The problem still remains and you'll have horror stories of people not being able to get the help they need with none of the blame put where it should go.
What I find more interesting is the chance that the ACA subsidies might end. If you want to see a Potemkin village, it's the ACA. I get no subsidies. I never have. And especially to begin with (though it changed during COVID), one didn't have to make much at all not to receive a subsidy. A couple making $60,000 a year wasn't eligible. That same couple, in their late 50s or early 60s, would spend at least a $1000 a month each on a "bronze" plan, the kind of plan with a $6000 per person or $12,000 total deductible. So in a single year, this couple, if something went wrong with both of them, was looking at, between insurance and medical expenses, well over $30,0000, which is half their combined *gross* income (no social security or taxes taken out).
If the subsidies end and people see what these plans *actually cost* it might actually be a good thing, in the long run, though in the short run it will make health insurance utterly unaffordable for the masses, with no options for even catastrophic policies. The same with Medicaid. Our health care system is a bloated tick sucking the lifeblood out of the system but most people don't notice because they have subsidies or they have Medicaid or they have insurance through work or are too wealthy to notice. But for those of us who have been watching health care take a bigger and bigger bite out of our budgets . . . the ACA and Medicaid are only putting a BandAid on the problem.
Agreed. Any cut to medicare, medicaid or social security will be disasterous for Republicans. Even I, a conservative may vote my Republican rep out. We know there is much fraud in these programs, but wholesale cuts just for cuts sake are wrong. The fraud can be taken out with diligent investigation within the departments by trained people who have the wherewithall to ferret it out.
Do as you please. Ignorance is bliss. Social Security's Trust Fund went into the red a few years ago. Right now the Trustee is selling off the government bonds that are the Fund to cover current retirement benefits. In 2033 that accounting maneuver will be exhausted and the Trustee is legally obligated to impose an across the board reduction in monthly benefit checks of 17% to keep the program solvent.
Democrats have been an impediment to reform for over a decade. Republicans get criticized and slammed whenever they suggest proactive reforms to stave off the 17% cuts. You Boomers are the ones that will be punished for reflexively blocking any reform.
The Social Security fund would have a great deal of its fiscal problems fixed by raising the cap on income subject to FICA taxation. That is never up for debate because only the wealthy benefit from the cap, and what they got, they don't let go. I hope you are among those working to get your representatives to vote for lifting, or abolishing entirely that income cap? Do you support this method of infusing cash into this system? Everyone is entitled to Social Security payments as there is no cap on receiving Social Security payments; there shouldn't be a cap on the income that is taxed to fund Social Security.
Aside from these anecdotes and hypotheticals the fact remains that Medicaid spending is swelling the federal budget and is on an unsustainable trajectory. The picture is also murky on the quality of care provided through Medicaid with some studies showing health outcomes that worse than people without healthcare. Although these studies could be affected by adverse selection it remains a fact that most healthcare practices, particularly specialists, do not accept Medicaid patients. This should remind us that healthcare coverage does not equal access to quality care.
If we zoom out and look at the healthcare system as whole, not just who pays, but how care is provided, we see costly ineffective system with major dysfunctions. The root cause imo is the third-payer payment model. Doesn't matter if that third payer is an insurance company or a government agency. Inserting an outside entity into the transaction process directly and indirectly leads to market dysfunction, fraud, abuse, and patient irresponsibility.
This system needs to be torn down. In its place the federal government should provide each American with an annual healthcare stipend of, let's say, $10,000 to spend on qualified healthcare services. To promote the productive and diligent use of those funds at the end of each year each American would receive 20% of any unspent funds in the form of a cash tax credit when they file their taxes. The hardcap stipend amount and the tax credit on unspent funds would create a cascade of positive market incentives from the patient to the providers that will improve care, reduce waste, and spur technological innovation.
The healthcare field is fertile ground for innovation on healthcare delivery but the market forces to incentivize change have been smothered by government and insurance company policies.
The ACA is a disaster, which ruined affordable health care for those who make too much money to qualify for "subsidies." The plans it offers cost several hundred dollars a month for one person, and have deductibles of thousands of dollars. These plans are awful.
The ACA allowed the IRS to seize my entire refund one year (which I had planned to use on my summer electric bills in Phoenix) because I was too poor to afford to buy insurance. The ACA REQUIRED me to have health insurance.
The ACA is flawed and I'm hardly here to defend it as a functional solution to the nation's healthcare problems. But we are talking about it's expansion of Medicaid. Rolling back those subsidies will cause real suffering for millions of people.
Why are you following Lee Fang's substack when it's clear you drink the legacy media Kool aid? Everything you spray out on the interwebs is simply regurgitated propaganda from the Establishment Media - Deep State misinformation complex.
Well written. You make a very compelling case. Hopefully they’ll find a “compromise” that will partially satisfy all affected. We are $36 Trillion in debt which actually jeopardizes all programs.
Thank you for focusing on Medicaid cuts -- all politicians need to know the kind of details (and budgetary math for ordinary people) you provided, Evan.
Democrats used to represent the poor, the disenfranchised, the voiceless, but during the 80s and 90s they moved to become the party of "the middle class" because, well, poor people don't vote. Lately, they've become then party of Big Pharma, Big Tech, funding misbegotten wars, and so on.
As for the Republicans, what you've focused on is an example of what seems to be the gap between Trump's populism and the Congressional GOP's tax-cutting for the wealthy, and "fiscal responsibility" for the rest.
So yes, please keep your focus on writing about the impact of legislation and policies on those living at or beneath the poverty line. Thank you!
Evan, you do raise some valid points but the Medicaid system is broken. The fraud that happens is why the cost is so high. The rules need to change at some point because it can’t just be a trillion dollar drain each year the budget comes due. A serious audit would benefit the program and there needs to be guardrails instituted somewhere or it’s just going to get bigger and bigger and hamstring our nations budget every year. Obamacare is heavily subsidized and if someone can get health insurance for $20/month instead of getting it for free isn’t that a better solution. Either the ACA gets cut or Medicaid trims the fat. We are BROKE and carrying 36 TRILLION of debt and we are paying a BILLION DAILY in interest ALONE! There can be more allowances so more people don’t fall into the cracks but this is a program rife with fraud and it needs to end.
An audit will not solve the problem or even scratch the surface of it. Most healthcare spending is not fraudulent, it's just wasteful or unnecessary. The reason why this pile of waste has snowballed over the decades is because of the third-payer payment system. Providers have every incentive to push costly treatments with questionable efficacy because the patient is not directly footing the bill. Someone else is.
On the one hand, I know that a lot of people who COULD be working are not, because I visit a lot of welfare offices with my elderly, disabled sister.
It depends on how it's structured. If people are genuinely too disabled to work at any job, then provide medical care; if not, require them to work 20 hours a week. It should be easy to work with the states to maybe standardize requirements, so as not to leave anyone out.
The fact is, a lot of young adults don't need health insurance. I went for most of my adult life without any health insurance. My husband & I went to a clinic for the working poor run by a local Catholic hospital when we needed health care.
You don't need health insurance for routine stuff, and that's where savings can be found. Ppl need health insurance for unforeseen illnesses and accidents. I was grateful for the employer-sponsored health care plan that my healthy 54 year old husband had when he was diagnosed out-of-the-blue with terminal cancer. It paid for everything. I'm a widow, but at least I don't have to worry about crushing medical debt.
Trump's "honeymoon" will come to an abrupt end if he does not veto this budget. 72 million people is not chump-change. And as good as he is at "tap-dancing" out of situations like this, the music will end the second that pen hits the paper. It is also another opportunity where the democrats will face-plant.
Evan, there were way too many images and old reminders for me to want to read what you had to say - but eventually I did. Change the photo of you holding on to one of the most recently despicable creatures in the Senate - Bernie, king of the onesies and now with his new anti-billionaire schtick. Then there's your support of Obamanable Care - made the insurance companies rich and maybe him one more mansion from speeches about how great he was as prez. What the hell is wrong with mentioning a universal healthcare system for the US? We could take the health out of Medicaid, redesign it with real support for Americans who are experiencing work/health/employment challenges rather than hours of paperwork and get what every US citizen (emphasis on citizen) deserves - whoever they are - a healthcare system.
Evan, there's a reason you campaigned for Bernie Sanders. You recognized the utter uselessness of the Clinton/Biden wing of the Democratic Party, but you also realized Trump and the Republicans will always put the poor and disadvantaged last.
Republican efforts to cut Medicaid were and are utterly predictable. Trump may go along with those cuts in the name of "efficiency" even as the Pentagon budget continues to soar. Same ol', same ol'.
You had it right in 2020: we need someone like Bernie Sanders, except Bernie sold out to the DNC after being beaten in two primaries rigged against him by the DNC.
Help for the poor and workers isn't coming from either major party. And you shouldn't be surprised by this.
The premise of this article rests on the idea that Trump gives two **its about medicaid and healthcare for the working class. And that my friend, is simply wishful thinking. Trump’s position on this has been inconsistent at best. He endorsed the house budget with these cuts last week. The work requirements proposed are 100% in line with Project 2025 and has always been the plan. As a former campaign operative, shouldn’t you know that campaign promises are just random words that carry no meaning? Or were you just so bad at your job that you had to move to a different party?
I'll start off by saying that I agree that cuts to Medicaid are political suicide. They are also idiotic in that if you're trying to "fix" Medicaid, meaning cut the waste and fraud, just cutting the program isn't going to do a thing for that. The problem still remains and you'll have horror stories of people not being able to get the help they need with none of the blame put where it should go.
What I find more interesting is the chance that the ACA subsidies might end. If you want to see a Potemkin village, it's the ACA. I get no subsidies. I never have. And especially to begin with (though it changed during COVID), one didn't have to make much at all not to receive a subsidy. A couple making $60,000 a year wasn't eligible. That same couple, in their late 50s or early 60s, would spend at least a $1000 a month each on a "bronze" plan, the kind of plan with a $6000 per person or $12,000 total deductible. So in a single year, this couple, if something went wrong with both of them, was looking at, between insurance and medical expenses, well over $30,0000, which is half their combined *gross* income (no social security or taxes taken out).
If the subsidies end and people see what these plans *actually cost* it might actually be a good thing, in the long run, though in the short run it will make health insurance utterly unaffordable for the masses, with no options for even catastrophic policies. The same with Medicaid. Our health care system is a bloated tick sucking the lifeblood out of the system but most people don't notice because they have subsidies or they have Medicaid or they have insurance through work or are too wealthy to notice. But for those of us who have been watching health care take a bigger and bigger bite out of our budgets . . . the ACA and Medicaid are only putting a BandAid on the problem.
Agreed. Any cut to medicare, medicaid or social security will be disasterous for Republicans. Even I, a conservative may vote my Republican rep out. We know there is much fraud in these programs, but wholesale cuts just for cuts sake are wrong. The fraud can be taken out with diligent investigation within the departments by trained people who have the wherewithall to ferret it out.
Do as you please. Ignorance is bliss. Social Security's Trust Fund went into the red a few years ago. Right now the Trustee is selling off the government bonds that are the Fund to cover current retirement benefits. In 2033 that accounting maneuver will be exhausted and the Trustee is legally obligated to impose an across the board reduction in monthly benefit checks of 17% to keep the program solvent.
Democrats have been an impediment to reform for over a decade. Republicans get criticized and slammed whenever they suggest proactive reforms to stave off the 17% cuts. You Boomers are the ones that will be punished for reflexively blocking any reform.
The Social Security fund would have a great deal of its fiscal problems fixed by raising the cap on income subject to FICA taxation. That is never up for debate because only the wealthy benefit from the cap, and what they got, they don't let go. I hope you are among those working to get your representatives to vote for lifting, or abolishing entirely that income cap? Do you support this method of infusing cash into this system? Everyone is entitled to Social Security payments as there is no cap on receiving Social Security payments; there shouldn't be a cap on the income that is taxed to fund Social Security.
Exactly. An easy fix they refuse to approve. It’s maddening.
Aside from these anecdotes and hypotheticals the fact remains that Medicaid spending is swelling the federal budget and is on an unsustainable trajectory. The picture is also murky on the quality of care provided through Medicaid with some studies showing health outcomes that worse than people without healthcare. Although these studies could be affected by adverse selection it remains a fact that most healthcare practices, particularly specialists, do not accept Medicaid patients. This should remind us that healthcare coverage does not equal access to quality care.
If we zoom out and look at the healthcare system as whole, not just who pays, but how care is provided, we see costly ineffective system with major dysfunctions. The root cause imo is the third-payer payment model. Doesn't matter if that third payer is an insurance company or a government agency. Inserting an outside entity into the transaction process directly and indirectly leads to market dysfunction, fraud, abuse, and patient irresponsibility.
This system needs to be torn down. In its place the federal government should provide each American with an annual healthcare stipend of, let's say, $10,000 to spend on qualified healthcare services. To promote the productive and diligent use of those funds at the end of each year each American would receive 20% of any unspent funds in the form of a cash tax credit when they file their taxes. The hardcap stipend amount and the tax credit on unspent funds would create a cascade of positive market incentives from the patient to the providers that will improve care, reduce waste, and spur technological innovation.
The healthcare field is fertile ground for innovation on healthcare delivery but the market forces to incentivize change have been smothered by government and insurance company policies.
Brilliant! Thank you for raising the alarm.
This entire column is self-justifying slop. You voted for this.
Were you sentient for Trump's first term where he tried to massively cut Medicaid by repealing the ACA or no?
The ACA is a disaster, which ruined affordable health care for those who make too much money to qualify for "subsidies." The plans it offers cost several hundred dollars a month for one person, and have deductibles of thousands of dollars. These plans are awful.
The ACA allowed the IRS to seize my entire refund one year (which I had planned to use on my summer electric bills in Phoenix) because I was too poor to afford to buy insurance. The ACA REQUIRED me to have health insurance.
The premiums that Healthcare Marketplace quoted me for 2025 were astronomical. $640 per month for a healthy mid-40s aged non smoking male.
The ACA is flawed and I'm hardly here to defend it as a functional solution to the nation's healthcare problems. But we are talking about it's expansion of Medicaid. Rolling back those subsidies will cause real suffering for millions of people.
When you get the nuclear war with Russia you voted for you'll no longer have to worry about medial care.
Why are you following Lee Fang's substack when it's clear you drink the legacy media Kool aid? Everything you spray out on the interwebs is simply regurgitated propaganda from the Establishment Media - Deep State misinformation complex.
So you don't think it's true that Trump tried to cut Medicaid in his first term? Is that deep state misinformation?
Well written. You make a very compelling case. Hopefully they’ll find a “compromise” that will partially satisfy all affected. We are $36 Trillion in debt which actually jeopardizes all programs.
Thank you for focusing on Medicaid cuts -- all politicians need to know the kind of details (and budgetary math for ordinary people) you provided, Evan.
Democrats used to represent the poor, the disenfranchised, the voiceless, but during the 80s and 90s they moved to become the party of "the middle class" because, well, poor people don't vote. Lately, they've become then party of Big Pharma, Big Tech, funding misbegotten wars, and so on.
As for the Republicans, what you've focused on is an example of what seems to be the gap between Trump's populism and the Congressional GOP's tax-cutting for the wealthy, and "fiscal responsibility" for the rest.
So yes, please keep your focus on writing about the impact of legislation and policies on those living at or beneath the poverty line. Thank you!
Evan, you do raise some valid points but the Medicaid system is broken. The fraud that happens is why the cost is so high. The rules need to change at some point because it can’t just be a trillion dollar drain each year the budget comes due. A serious audit would benefit the program and there needs to be guardrails instituted somewhere or it’s just going to get bigger and bigger and hamstring our nations budget every year. Obamacare is heavily subsidized and if someone can get health insurance for $20/month instead of getting it for free isn’t that a better solution. Either the ACA gets cut or Medicaid trims the fat. We are BROKE and carrying 36 TRILLION of debt and we are paying a BILLION DAILY in interest ALONE! There can be more allowances so more people don’t fall into the cracks but this is a program rife with fraud and it needs to end.
An audit will not solve the problem or even scratch the surface of it. Most healthcare spending is not fraudulent, it's just wasteful or unnecessary. The reason why this pile of waste has snowballed over the decades is because of the third-payer payment system. Providers have every incentive to push costly treatments with questionable efficacy because the patient is not directly footing the bill. Someone else is.
I have mixed emotions about this.
On the one hand, I know that a lot of people who COULD be working are not, because I visit a lot of welfare offices with my elderly, disabled sister.
It depends on how it's structured. If people are genuinely too disabled to work at any job, then provide medical care; if not, require them to work 20 hours a week. It should be easy to work with the states to maybe standardize requirements, so as not to leave anyone out.
The fact is, a lot of young adults don't need health insurance. I went for most of my adult life without any health insurance. My husband & I went to a clinic for the working poor run by a local Catholic hospital when we needed health care.
You don't need health insurance for routine stuff, and that's where savings can be found. Ppl need health insurance for unforeseen illnesses and accidents. I was grateful for the employer-sponsored health care plan that my healthy 54 year old husband had when he was diagnosed out-of-the-blue with terminal cancer. It paid for everything. I'm a widow, but at least I don't have to worry about crushing medical debt.
Sorry to hear about your husband. I also lost my husband to terminal cancer.
Thank you. It happened so fast. BCBS paid for everything, even second opinions at MD Anderson. But it was too late.
Trump's "honeymoon" will come to an abrupt end if he does not veto this budget. 72 million people is not chump-change. And as good as he is at "tap-dancing" out of situations like this, the music will end the second that pen hits the paper. It is also another opportunity where the democrats will face-plant.
Thanks for this. Hope you keep us updated!
Evan, there were way too many images and old reminders for me to want to read what you had to say - but eventually I did. Change the photo of you holding on to one of the most recently despicable creatures in the Senate - Bernie, king of the onesies and now with his new anti-billionaire schtick. Then there's your support of Obamanable Care - made the insurance companies rich and maybe him one more mansion from speeches about how great he was as prez. What the hell is wrong with mentioning a universal healthcare system for the US? We could take the health out of Medicaid, redesign it with real support for Americans who are experiencing work/health/employment challenges rather than hours of paperwork and get what every US citizen (emphasis on citizen) deserves - whoever they are - a healthcare system.
So many liberal critters are jumping on the Trump train to remain viable on social media.
Evan, there's a reason you campaigned for Bernie Sanders. You recognized the utter uselessness of the Clinton/Biden wing of the Democratic Party, but you also realized Trump and the Republicans will always put the poor and disadvantaged last.
Republican efforts to cut Medicaid were and are utterly predictable. Trump may go along with those cuts in the name of "efficiency" even as the Pentagon budget continues to soar. Same ol', same ol'.
You had it right in 2020: we need someone like Bernie Sanders, except Bernie sold out to the DNC after being beaten in two primaries rigged against him by the DNC.
Help for the poor and workers isn't coming from either major party. And you shouldn't be surprised by this.
Why should the "poor and disadvantaged" be put "first"?
The premise of this article rests on the idea that Trump gives two **its about medicaid and healthcare for the working class. And that my friend, is simply wishful thinking. Trump’s position on this has been inconsistent at best. He endorsed the house budget with these cuts last week. The work requirements proposed are 100% in line with Project 2025 and has always been the plan. As a former campaign operative, shouldn’t you know that campaign promises are just random words that carry no meaning? Or were you just so bad at your job that you had to move to a different party?
Thank you for publishing this very important piece
We’re supporting Fang research, not random musings. Cut the dross.