
Trump's Medicaid disruption threatens vital resource for millions of Americans
Every January, Andrea Pitzer feels a simmering anxiety until the letter arrives: her mother's Medicaid renewal. Without it, her mother's care would cost about $10,000 a month.
On Tuesday, when the system for processing Medicaid payments to all 50 US states shut down unexpectedly, Pitzer's anxiety erupted into full-blown fear.
It seems the shutdown was related to the government-wide freeze on $3tn in grants and loans, which was paused by a federal judge until 3 February.
Medicaid systems were restored at the end of Tuesday, but the chaos and confusion could continue.
There is increasing pressure from conservative lawmakers and the Trump administration to cut back the budget for Medicaid, which provides health insurance to more than 70 million Americans, or 20% of the population, experts say.
'The potential disruptions to the finances of healthcare providers and patient care would be enormous,' said Larry Levitt, executive vice-president for health policy at the non-profit KFF.
Nearly half of births are covered by Medicaid, and the program is the primary payer of nursing home care. The funding freeze also seemed to affect programs like Head Start and federally qualified health centers.
'Finding a secure facility with dementia care for my mother once she needed round-the-clock nursing help was incredibly difficult, even after she qualified for Medicaid,' said Andrea Pitzer, 56, an author in Falls Church, Virginia.
'There are no other options for her. To play politics by threatening to withhold, even temporarily, care for some of the poorest and most vulnerable among us – the elderly and disabled – is beyond cruel.'
The system shutdown happened at the state level, but such uncertainty can quickly spread throughout the health system and beyond.
'If the federal government were to freeze funding in Medicaid, states would be left holding the bag, and federal payments for Medicaid are the biggest source of federal revenue for states,' Levitt said.
'Any freeze in Medicaid funding would send ripple effects throughout the healthcare system, with hospitals, nursing homes, clinics, physicians, all of a sudden seeing big holes in their budgets and potentially threatening their ability to provide care.'
States rely on the steady flow of federal grant money to issue payments to providers, and they use the federal infrastructure to process those payments, said Lindsay F Wiley, professor at UCLA School of Law.
'State agencies rely on federal grants for at least half of their Medicaid budgets – sometimes much more,' Wiley said.
Joan Alker, research professor at the McCourt School of Public Policy at Georgetown University, noted that 'even a short disruption in the flow of federal funding could cause huge cashflow problems for states.'
Disruptions like these, even temporary ones, can upset operations and create questions about the future of Medicaid funding.
'There was a great deal of chaos today, of panic, and it's very scary to think that if this allegedly was a mistake, that that level of incompetence exists, that the largest source of health insurance that the federal government supports would see this kind of thing happen,' Alker said.
If the freeze wasn't accidental – if it was purposeful – that would 'absolutely not' be legal, she said. 'This is mandatory spending.'
The memo freezing government grants and loans said the order 'should not be construed to impact' Medicare or social security benefits, but there were no stated exemptions for Medicaid or the Children's Health Insurance Program, known as Chip.
Uncertainty is mounting after Trump repeatedly vowed on the campaign trail to protect Medicare and social security but, Alker pointed out, he didn't say he would protect Medicaid.
Now, lawmakers are proposing dramatic cuts to the program.
'House Republicans are discussing these issues right now at their retreat in Florida, and based on leaked documents from the House budget committee, Medicaid is the No 1 target for extremely large cuts,' Alker said.
There are 'proposals floating around to reduce federal Medicaid spending by over $2tn over a decade, which would be upwards of a third of all federal Medicaid spending', Levitt said.
The freeze created 'enormous disruption for non-profit organizations, states and people, but the potential spending cuts coming could even dwarf these efforts', Levitt said.
Medicaid enjoys a great deal of popularity in the US, and 'it's really the backbone of key parts of our healthcare system,' Alker said.
Spending freezes beyond Medicaid would also affect other aspects of health in America.
Safety-net hospitals and clinics are funded by federal grants and contracts that are 'very likely to fall within the sweep of the administration's efforts' to revamp the US government's priorities, Wiley said – including efforts to refuse service to undocumented immigrants, deny gender-affirming care, and disavow commitments to diversity, equity and inclusion.
'This is a kind of a one-two punch from the administration, trying to reduce spending and direct the spending away from things that it doesn't support,' Levitt said.
Those who participate in public programs like these 'are particularly vulnerable to the whims of the federal administration', Wiley said.
Providers, facing greater uncertainty and scrutiny in the reimbursement process, Wiley continued, might choose to stop accepting Medicaid, and health system budgets 'often operate on razor-thin margins, so delays, frozen grants, or halted contracts could disrupt their ability to make payroll or purchase critical supplies'.
Freezes like these 'vastly exceed the administration's legal authority', Wiley said. Some of them also infringe on freedom of expression by requiring organizations to pledge support for the Trump administration's ideological priorities, she said.
'Judges will intervene, but court battles could last years,' Wiley said. 'In the meantime, even short-term delays in federal funding will put lives at risk.'
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Reuters
6 hours ago
- Reuters
Republican lawmaker's raucous town hall reflects challenges in promoting Trump's bill
MAHOPAC, New York, June 9 (Reuters) - Democratic voter Joe Mayhew, a union representative living in a New York swing district, was one of several people at a rowdy town hall with Republican Representative Mike Lawler on Sunday keen to point out potential pitfalls with President Donald Trump's budget. He fears proposed changes to Medicaid requirements could have a devastating effect on people unable to work through no fault of their own. "If your cuts to Medicaid pass, a person working in a low-paying job as an individual contractor who falls ill or has work interrupted because it's seasonal, or because it was a job shutdown - something not of any fault of their own - could not make your 80-hour requirement on a particular month," Mayhew, 63, told Lawler at the town hall in Mahopac, New York. Lawler defended the bill's Medicaid provision, which requires recipients age 19-64 who have no dependents to work, volunteer or be in school at least 80 hours a month starting in 2027. "The objective is to help people get into the workforce ultimately," he said. The exchange at the Sunday night event, where boos were more common than cheers, reflects the kinds of issues that are vexing some Republicans as they seek to promote and defend Trump's sweeping tax and spending bill. The two-hour-long town hall, attended by roughly 500 people, was also an indication of how voters in a swing district that narrowly voted for Lawler feel about the bill and Trump's agenda more broadly. Topics ranged from the justification of Trump's June 14 military parade to attacks on higher education, to whether ICE agents should wear masks during raids and how to fund social security in the future. A moderate Republican representing New York's 17th District, Lawler won re-election in November, defeating former Democratic Representative Mondaire Jones with over 52% of votes. He has expressed interest in running for governor. Lawler's district was the scene of one of the 2022 general election's biggest upsets when he beat Democratic Representative Sean Patrick Maloney – who was head of the Democrats' House campaign arm. Lawler has scheduled four public town hall meetings with voters this year, despite guidance from U.S. House Speaker Mike Johnson, who urged fellow Republican lawmakers to avoid them after some events turned into angry confrontations over Trump's moves to fire federal workers and defund government programs. Lawler's two previous town halls were even more raucous events where several attendees were removed by law enforcement. Trump's 1,100-page bill passed in May in a 215-214 vote, and will add about $3.8 trillion to the federal government's $36.2 trillion in debt over the next decade, according to the nonpartisan Congressional Budget Office. It would extend corporate and individual tax cuts passed in 2017 during Trump's first term in office, cancel many green-energy incentives passed by Democratic former President Joe Biden and tighten eligibility for health and food programs for the poor. Tesla and SpaceX Chief Executive Elon Musk denounced Trump's bill as a "disgusting abomination" last week, prior to the two men exchanging public insults. Other Republican representatives have also had to field jeers at town halls. During a May 28 town hall in Decorah, Iowa, Republican Congresswoman Ashley Hinson was booed after she told attendees: 'I was also proud to vote for President Trump's 'one big beautiful bill' last week.' The previous day, Republican Representative Mike Flood of Nebraska told attendees at his town hall that when he voted for the bill, he was unaware it would limit judges' power to hold people in contempt for violating court orders. The response was met with boos from the crowd, with one attendee calling his behavior 'ridiculous.' Flood said he would work to ensure the provision isn't in the final version of the bill. That said, such town halls have been few and far between. Lawler said he felt it was important to have this type of forum. "Almost all of my colleagues are not doing it, and I've been asked why I would do it. But this is your right to come and engage in this dialog. So that's why we're here." He also noted his work on pushing for increases in the so-called SALT deduction for state and local tax payments. He and other Republicans from Democratic-led, high-tax states had previously threatened to oppose Trump's legislation unless there were increases. Trump's current bill would allow taxpayers to deduct up to $40,000 for state and local tax (SALT) payments, up from $10,000 now, with benefits phasing out for households that make more than $500,000. A previous version of the bill had a cap of $30,000. Lawmakers next need to pass the bill in the Senate, where Republicans hold a 53-47 majority and are planning to use a legislative maneuver to bypass the chamber's 60-vote filibuster threshold for most legislation.


NBC News
3 days ago
- NBC News
How RFK Jr. is quickly changing U.S. health agencies
WASHINGTON — In just a few short months, Health and Human Services Secretary Robert F. Kennedy Jr. has begun to transform U.S. health policy: shrinking staff at health agencies, restructuring the focus of some regulators and researchers, changing Covid vaccine regulations and reshaping the mission of his department to focus more on alternative medicine. The directives are all part of the same issue set that drove a slice of health-conscious, left-leaning Americans to eventually vote for a Republican president whose favorite meal is from McDonald's, Trump and Kennedy catered to a type of voter who has grown distrustful of America's health care establishment — but possibly fomented a new type of distrust in federal health policy along the way. Bernadine Francis, a lifelong Democrat who backed Joe Biden for president in 2020 before supporting Donald Trump in 2024, told NBC News in an interview that she approves of Kennedy's efforts so far, despite his 'hands being tied' by entrenched forces in the administration and in Congress. 'From what I have seen so far with what RFK has been trying to do,' she said, 'I am really, really proud of what he's doing.' Francis is among the voters who left the Democratic Party and voted for Trump because 'nothing else mattered' apart from public health, which they — like Kennedy — felt was going in the wrong direction. Concerns about chemicals in food and toxins in the environment, long championed by Democrats, has become a galvanizing issue to a key portion of Trump's Republican Party, complete with an oversaturation of information that in some cases hasn't been proven. It's wrapped up, as well, in concerns about the Covid vaccine, which was accelerated under Trump, administered under Biden and weaponized by anti-vaccine activists like Kennedy amid lockdowns and firings in the wake of the devastating pandemic. 'We knew in order to get RFK in there so he can help with the situation that we have in the health industry, we knew we had to do this,' said Francis, a retired Washington, D.C., public school administrator, who said she left her 'beloved' career because she had refused the vaccine. 'It seemed to me, as soon as [Biden] became president, the vaccine was mandated, and that was when I lost all hope in the Democrats,' Francis told NBC News, referring to vaccination mandates put in place by the Biden administration for a large portion of the federal workforce during the height of the pandemic. There are not currently any federal Covid vaccine mandates. There have been 1,228,393 confirmed Covid deaths in the United States since the start of the pandemic, according to data from the Centers for Disease Control and Prevention. How RFK Jr.'s picks are changing public health agencies Dr. Marty Makary, Kennedy's hand-picked commissioner of the Food and Drug Administration and a John Hopkins scientist and researcher, told NBC News in an interview that he wants to transform the agency, which he said faced 'corruption' over influence from the pharmaceutical and food industries. 'I mean, you look at the food pyramid, it was not based on what's best for you, it was based on what companies wanted you to buy,' he said, referring to the 1992 and later iterations of official government nutritional guidance. He said there would be 'entirely new nutrition guidance' released later this year, as soon as this summer. He praised the FDA's mission of research and regulation, saying the agency is 'incredibly well-oiled, and we've got the trains running on time.' He also highlighted the 75-page 'Make America Healthy Again' commission report — which focused on ultraprocessed foods and toxins in the environment — as having set 'the agenda for research' at the FDA, HHS and agencies overseeing social safety net programs such as Medicare and food stamps moving forward. (The MAHA report initially cited some studies that didn't exist, a mistake that Kennedy adviser Calley Means said was a 'great disservice' to their mission.) 'I think there's a lot we're going to learn. For example, the microbiome, which gets attention in the MAHA report, needs to be on the map. We don't even talk about it in our medical circles,' Makary said. 'The microbiome, food is medicine, the immune response that happens when chemicals that don't appear in nature go down our GI tract.' Pressed on other areas of the administration, like the Environmental Protection Agency, making decisions that run counter to the pro-regulatory ideas presented in the MAHA report, Makary said he can 'only comment on the FDA' where they are 'committed to Secretary Kennedy's vision.' But Kennedy's public health agenda goes beyond looking at the food supply and chemicals. Recently, Kennedy said in a video posted on X last month that the Covid vaccine is no longer recommended for healthy children and pregnant women, a change in CDC guidance that skipped the normal public review period. Days later, after critics questioned the decision and raised concerns over a lack of public data behind the move, the administration updated its guidance again, urging parents to consult with their doctors instead. Pressed about the confusion and whether Americans are now trading one side of public distrust in the health system for another, Makary defended Kennedy, who has been criticized for spreading misinformation. 'My experience with Secretary Robert F. Kennedy is that he listens. He listens to myself, he listens to Jay Bhattacharya, listens to Dr. Mehmet Oz, he listens to a host of scientists that are giving him guidance,' Makary argued, referring to the director of the National Institutes of Health and the administrator for the Centers for Medicare & Medicaid Services, respectively. 'So he may have big questions, but the questions he's asking are the questions most Americans are asking.' The intersection of medicine and healthy lifestyle choices Dr. Dawn Mussallem, a breast cancer oncologist and integrative medicine doctor — a physician who combines conventional treatments with research-based alternative therapies — has tried to help her patients wade through medical misinformation they encounter online and in their social circles. Mussallem has an incredible story of personal survival: While in medical school, she was diagnosed with Stage IV cancer and, after conventional therapies like chemo saved her life, was diagnosed with heart failure. After undergoing a heart transplant, Mussallem ran a 26-mile marathon just one year later. 'I learned a lot in medical school, but nothing compared to what I learned being a patient,' said Mussallem, who dedicates, on average, 90 minutes each in one-on-one sessions with her patients. 'This is not about any one political choice. But we know lifestyle matters.' For example, a new study from the American Society of Clinical Oncology that finds eating food that lowers inflammation in the body may help people with advanced colon cancer survive longer. Mussallem's mission, along with her colleagues, is to elevate the modern medicine that saved her life, as well as encouraging her patients to live healthy lifestyles, including regular exercise, minimally processed foods, less screen time, more social connection and better sleep. But politics do get in the way for millions of Americans who are inundated daily with social media influencers and 'nonmedical experts,' as Mussallem puts it, who stoke fear in her patients. 'Patients come in with all these questions, fears,' she said. 'I've heard this many times from patients, that their nervous system is affected by what they're seeing happening in government.' Mussallem acknowledges that 'a lot of individuals out there' have questioned traditional medicine. For her, it isn't one or the other — it's both. 'We have to trust the conventional medicine,' she said. 'With the conventional care that marches right alongside more of an integrative modality to look at the root causes of disease, as well as to help to optimize with lifestyle, is where we need to be.'


Glasgow Times
3 days ago
- Glasgow Times
D-Day landings boosted by import of ‘wonder drug' to Britain, archives reveal
Production of the antibiotic penicillin had struggled to take hold at a large scale in Britain, despite being discovered in 1928 in London by Sir Alexander Fleming. Attempts to produce substantial quantities of medicine from the bacteria-killing mould had not been achieved by the start of the Second World War. Then prime minister Sir Winston Churchill became increasingly frustrated that Britain had not been able to produce enough penicillin in the preparations for the Normandy landings in 1944. Official papers released by the National Archive – containing handwritten notes by Sir Winston – highlight efforts to boost quantities of the antibiotic, with Britain eventually forced to import it from America. The documents were released ahead of the 81st anniversary of D-Day, the Allied invasion of Normandy on June 6, 1944. Official papers highlight the efforts to boost quantities of penicillin (The National Archives/PA) In one report on February 19, after the issue had been raised in the House of Commons, Sir Winston scrawled in red ink on a Ministry of Supply report noting the Americans were producing greater quantities: 'I am sorry we can't produce more.' On another paper, he complained: 'Your report on penicillin showing that we are only to get about one tenth of the expected output this year, is very disappointing.' Elsewhere in the same file he instructs: 'Let me have proposals for a more abundant supply from Great Britain.' With preparations for D-Day ramped up, efforts to deliver enough American-made penicillin for frontline military personnel soon became a matter of urgency. Decisions needed to be made on the quantities of antibiotic imported, how much to administer to individual patients, and how to get medical staff trained in time. Most British doctors did not know how to issue penicillin – until this point, doctors had nothing available to treat infections like pneumonia and many people died of blood poisoning after minor injuries because no drug existed that could cure them. Royal Navy D-Day veteran John Dennett, 101, at the British Normandy Memorial in Ver-sur-Mer to mark the 81st anniversary of the landings (Gareth Fuller/PA) Early in January 1944, Prof FR Fraser, the Ministry of Health's adviser on the organisation of wartime hospitals, wrote that 50,000-100,000 wounded could be expected from the Second Front. He proposed the Emergency Medical Services might need as many as five billion units of penicillin per month for this. Further documents show discussions on whether the antibiotic should be supplied as calcium or sodium salts, or in tablet form. Ultimately, it was agreed powdered calcium salts would be issued for superficial wounds and sodium salts for use in deep wounds. On May 24 1944, less than a fortnight before D-Day, Prof Fraser reported: 'Sufficient supplies of penicillin are now available for the treatment of battle casualties in EMS hospitals, but not for ordinary civilian patients.' Plans were made for casualties from the frontline in France to be brought back to coastal hospitals in Britain for treatment. A week before D-Day, on May 30 1944, hospitals were instructed to treat battlefield patients en route: 'In an endeavour to prevent the development of gas gangrene and sepsis in wounds the War Office have arranged for the treatment of selected cases by penicillin to be commenced as soon after injury as possible.' Military reenactors watch the sunrise over Gold Beach in Arromanches-les-Bains, Normandy, on the 81st anniversary of the D-Day landings (Gareth Fuller/PA) Injections of penicillin were to be given to them at intervals of not more than five hours and patients would be wearing a yellow label with the letters 'PEN'. The time and size of penicillin doses should be written on it, they were told. Dr Jessamy Carlson, modern records specialist at the National Archives, said: 'File MH 76/184 gives a glimpse into the extraordinary levels of preparation undertaken in advance of the D-Day landings. 'Only six weeks before, penicillin is just reaching our shores in quantities which will allow it to play a major role in improving the outcomes for service personnel wounded in action.' As Allied forces made inroads into Europe, restrictions on the use of penicillin for civilians began to relax, but only in special cases. In July 1944, Ronald Christie, professor of medicine, wrote to Prof Fraser to tell him: 'The War Office approves of American penicillin being used for medical conditions in service patients and for air raid casualties among civilians.' On the home front, demand for the new 'wonder' drug began to increase, according the National Archives. It was decided that penicillin for civilians should only be supplied to larger hospitals where the staff had been properly trained to administer it. Only in 1946 did it become fully available for the general public.