With the big, ugly bill, the rich get richer and everybody else pays
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Even after people at the bottom of the ladder get hosed, those tax cuts (plus big boosts in funding for defense and so-called border security) are projected to
Hey, it's all for a noble cause: Remaking the country into a GOP utopia, where the rich get more handouts, and the poor have only themselves to blame.
To sell this money grab, Republicans are using a tactic that has worked ever since
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'If you don't want to work, you're the one that decided you don't want health care,'
You tell 'em, Senator! Scott and his fellow-travelers deplore those who abuse the system. Never mind that most Medicare fraud happens on the provider side. Or that Scott himself once headed a hospital chain
States like ours have pretty good systems to catch all kinds of fraud, which,
'
$20 billion budget for Medicaid, known here as MassHealth, in 2024.
Be that as it may, Republicans want to introduce Medicaid work requirements that will finally get the freeloaders off their butts. Let's take a closer look at these miscreants, shall we? Of the 2 million people who get MassHealth to cover their medical care,
Republicans are using a problem that barely exists to kick millions out of the system, and proposing a so-called solution that doesn't work anyway. In
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In addition to the work requirements, the giant bill being debated in Washington means Massachusetts would lose billions more in Medicaid funding in coming years – as punishment for
The thing is, the medical needs of those kicked off MassHealth won't go away. They'll just get worse, more deadly, and more expensive for everyone. They'll get dealt with in emergency rooms already at their breaking points. And they'll put the squeeze on struggling health centers, hospitals and, ultimately, state budgets.
'These are cuts that are going to impact the entire program, and have a ripple effect across the Massachusetts economy,' said Kate Symmonds, senior health law attorney at the Massachusetts Law Reform Institute. 'It will reduce revenues for community health centers, hospitals, and medical providers, and it will destabilize our health industry.'
Guy Fish, CEO of Codman Square Health Center, has a good idea how much it will cost if Republicans get their way on Medicaid. His Dorchester health center serves about 26,000 patients each year, almost all of them
Fish said his MassHealth patients are often working multiple part time jobs with no benefits, and that even then, some have to be convinced to apply for the program.
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'The narrative couldn't be more wrong,' he said. 'These are hard working people, some who don't know how to access the system.'
Kicking them off MassHealth won't make them any healthier.
'They will still have medical needs, and if they can't see us, where are they going to go,' he said. 'The state will have to pick that up, or they are not going to be seen, so they are going to be sicker and end up in emergency rooms. You pay more later for not paying for coverage now.'
If Codman loses funding from MassHealth, that will mean staff cuts. Unemployment ripples out into families, and to local businesses, because fewer people have money to spend. The whole community will be worse off.
'There is a whole domino effect that happens here,' Fish said. 'And the tragedy is, it is not just in Massachusetts or blue states, but in red states too. There are community health centers in every single state… including deep red ones.'
Those states will be left holding the bag, pulling money from education and transportation and law enforcement to make up the shortfalls.
Ah yes, but by then, the billionaires' pockets will be even fatter.
Downright evil.
Globe columnist Yvonne Abraham can be reached at
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Axios
25 minutes ago
- Axios
Amid backlash, Tesla remained resilient in Texas
Even as Tesla deliveries plunged nationally this year amid Elon Musk's very visible (if short-lived) alliance with President Trump, there was at least one state where Tesla registrations were up: Texas. Why it matters: The registration data, obtained by Axios through public information requests, indicates loyalty to the brand in its home base, including Texas' large urban and suburban counties. The depth of conservatives' enthusiasm for Musk's automobiles now faces a major test amid the absolute meltdown last week between the Tesla CEO and the president. By the numbers: Texans registered 12,918 new Teslas in the first three months of 2025, a period when Musk, who contributed more than $250 million to a pro-Trump super PAC during the 2024 election campaign, was enmeshed in the Trump administration as the overseer of DOGE, the president's cost-cutting initiative. Over the same period in 2024, Texans registered 10,679 Teslas. That's a 21% increase year over year. The intrigue: The spike in Texas registrations came as Tesla was flailing elsewhere. Tesla's vehicle deliveries plunged 13% globally in the first quarter of 2025 (336,681 electric vehicles) compared with Q1 2024 (386,810). Tesla vehicles were torched at showrooms and the brand's reputation cratered. Zoom in: Tesla saw year-over-year improvements in its sales in some of the most populous Texas counties. In Travis County, new Tesla registrations grew from 1,369 in the first quarter of 2024 to 1,424 during the first quarter of 2025. In Harris County, they grew from 1,526 to 1,837 during the same period. Tesla registration grew from 1,316 to 1,546 in Collin County and from 990 to 1,146 in Dallas County. In Bexar County, registrations grew from 631 to 664. What they're saying:"It's homegrown pride," is how Matt Holm, president and founder of the Tesla Owners Club of Austin, explains the car company's resilience to Axios. "And regardless of all the drama going on these days, people can differentiate between the product and everything else going on, and it's just a great product." "Elon has absolutely and irreversibly blown up bridges to some potential customers," says Alexander Edwards, president of California-based research firm Strategic Vision, which has long surveyed the motivations of car buyers. "People who bought Teslas for environmental friendliness, that's pretty much gone," Edwards tells Axios. Yes, but: The company had been enjoying an increasingly positive reputation among more conservative consumers. Musk was viewed favorably by 80% of Texas Republicans polled by the Texas Politics Project in April — and unfavorably by 83% of Democrats. In what now feels like a political lifetime ago, Trump himself even promoted Teslas by promising to buy one in support of Musk earlier this year. "In some pockets, like Austin, you have that tech group that loves what Tesla has to offer, can do some mental gymnastics about Musk, and looks at Rivian and says that's not what I want or might be priced out," Edwards says. Between the lines:"Being in the state of Texas, you're naturally conditioned to think you're better than everyone else in the U.S. And when you buy a Tesla" — a status symbol — "that's what you're saying. It doesn't surprise me that there's an increase in sales" in Texas, Edwards says. Plus: Tesla's resilience in Texas could have practical reasons as well, Edwards says. Texas homes — as opposed to, say, apartments in cities on the East Coast — are more likely to have a garage to charge a car in, he adds. What's next: Musk said late last month that Tesla was experiencing a "major rebound in demand" — without providing specifics. But that was before things went absolutely haywire with Trump and Tesla stock took a bath last week.
Yahoo
28 minutes ago
- Yahoo
The Wyoming Hospital Upending the Logic of Private Equity
The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here. After years of trying to improve his hospital in Riverton, Wyoming—first as a doctor, then as a board member and volunteer activist—Roger Gose was ready to give up. Gose, a Texas native, had been in Wyoming since 1978, when he saw an ad in a medical journal looking for a small-town internist. Ever since he was a kid, he had wanted to be a community doctor, the kind who made house calls and treated his neighbors from birth into adulthood. He found his calling in Riverton, a town of 10,000 people in one of the state's poorer counties. For 35 years, he ran a private practice and worked shifts at Riverton Memorial Hospital, even serving for a time as the chief of medicine there. After retiring from his practice in 2012, he joined the hospital board, still eager to do whatever he could to help. 'You want to leave a place better than you found it,' he told me. And for a long time, he felt like he had. But that was before LifePoint Health, one of the biggest rural-hospital chains in the country, saw his hospital as a distressed asset in need of saving through a ruthless search for efficiencies, and before executives at Apollo Global Management, a private-equity firm whose headquarters looms above the Plaza Hotel in Midtown Manhattan, began calling the shots. That was before Gose realized that, in the private-equity world, hospitals were just another widget, a tool to make money and nothing more. In late 2018, Gose and a group of his neighbors decided that trying to save their hospital was futile. It had already lost its maternity ward, leaving pregnant people to drive nearly 30 miles to deliver a baby. Data from the Wyoming Department of Health show that the number of air-ambulance flights from the county where Riverton sits to hospitals elsewhere in the state rose from 155 in 2014 to 937 in 2019. By the time I spent several days with Gose and a dozen other Rivertonians in the spring of 2023, they didn't even have a hospital anymore, they told me; they had a 'Band-Aid station.' The only way to ensure that their town had a real hospital, they decided, was to build one themselves. The conventional wisdom about rural hospitals in the 21st century is that they are, in a word, screwed. Young people move away; older residents left behind need more expensive care and are less likely than urban and suburban residents to have private insurance, which is more lucrative for providers than Medicare and Medicaid. A 2018 report from the U.S. Government Accountability Office found that twice as many rural hospitals closed from 2013 to 2017 than in the five years prior, and the ones that remained were in much worse financial shape than their nonrural counterparts. Emergency funding during the coronavirus pandemic improved the financial health of rural hospitals, but after that funding dried up, many were left facing labor shortages and supply-chain problems that increased prices. House Republicans' proposed cuts to Medicaid could drive even more hospitals out of business, the American Hospital Association argued in a letter to congressional leaders this April. The ability to stave off closure has been the chief value proposition that private-equity firms offer to rural hospitals. In my reporting on private equity's growing dominance in health care, I heard versions of the story that LifePoint and Apollo told Riverton residents again and again: Without us, you will be left with no hospital at all. Yours is running out of money, and our ability to consolidate and find efficiencies across our ever-growing system is the only thing that can keep it alive. Your community is too small and poor to support an obstetrics department, or general surgery, or mental-health services, so you won't have those anymore, but isn't something better than nothing? Accepting that private equity is the only option for rural hospitals, though, requires accepting that rural Americans deserve less access to care than their urban and suburban counterparts, and that the care they do receive will be measurably worse. A landmark 2023 study found that in the three years after a private-equity acquisition, the rate of serious preventable medical complications increased significantly. (LifePoint hospitals were not included in the study, which focused on acquisitions made before 2018.) Patients were more likely to fall in the hospital and more likely to acquire infections at the site of a surgical incision. The number of central-line infections, which often result from improper insertion or cleaning, rose 38 percent. Though the study didn't delve into the reasons for the increases, the implication was clear: Focusing on short-term profits was leading to cost cutting that could be dangerous for patients. In Riverton, the hospital's owner was cutting costs aggressively, while also raising prices. In 2014, LifePoint formally merged the hospital with one in wealthier Lander, a town 25 miles away, and renamed them SageWest Riverton and SageWest Lander. In 2017, the year before Apollo bought LifePoint, researchers examined hospital data for 14 individual Wyoming facilities and found that SageWest charged the highest relative prices; data from 2020 show that SageWest maintained the largest price disparity of any general hospital in the state after the Apollo acquisition. (LifePoint referred questions about the Riverton and Lander hospitals to SageWest; SageWest leaders did not respond to several requests for comment.) At the same time, the Riverton hospital was shrinking. In quick succession, SageWest suspended its obstetrics services, closed its inpatient mental-health unit, and shrunk other basic services. By 2022, the last year for which Centers for Medicare and Medicaid Services data are available, SageWest employed 227 people across its two campuses, nearly 40 percent fewer than before the Riverton-Lander merger. According to Gose, the number of physicians based in Riverton had dwindled from 20-something to just seven. If they were going to build a new hospital, Gose and his neighbors first needed to know whether it could theoretically be financially viable. By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank's 14 branches across Wyoming, and the kind of person who can't leave the grocery store without stopping four times to ask about someone's kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances. The Riverton nonprofit was not Stroudwater Associates' typical client. The company's chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-wide strategic planning. Gose, Watkins, and their allies didn't have a hospital, didn't have concrete plans for a hospital, didn't even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up. After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he's seen cuts damage a hospital's business further: 'You win the battle, but you lose the war,' he told me. Instead of cutting costs by 'doing more with less' (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital's business. One of Shell's go-to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—a former NFL linebacker—ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up. The bet paid off. After the drop in 2020, the number of non-COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn't been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials. Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. 'When I look at what they're doing in Lander and Riverton, I shake my head and say, 'That's not the way I'd be running the company,'' Shell told me. 'But I'm not running the company, and they're driven by an external force. If they're not beating the market rate of compensation for their investors, their investors are going to walk.' Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton's economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell's firm handed over its report. Its takeaway: The area had the ability to 'support a financially viable rural health system with a range of medical, surgical, and specialty services.' The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is. Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions. Shell didn't think they could pull it off. He told them so outright. He's an accountant, which means always assuming the worst. He couldn't fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell's fears weren't going to stop them. They were the ones who lived there; they were the ones who, in Gose's words, felt an obligation to leave Riverton better than they found it. After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the 'lender of last resort'—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-interest loans. Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—not for funding, just for consideration. Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time. Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion's share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming. The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me. In its report, USDA was more bullish than Shell and Stroudwater had been; the agency's official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest's 44 percent. The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-speak, but at one point the author slipped into first person: 'The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.' In December 2024, just before the soil froze for the season, work crews broke ground on Riverton's new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility. Building a new, locally owned hospital isn't a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District's recipe baked into something resembling a miracle. But to Gose's mind, following Riverton's example doesn't require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs. 'Often you'll see a lot of people get excited and involved in something for two or three months or six or whatever, but then they get disillusioned and quit,' Gose told me. 'And I think that's what LifePoint thought we were doing. And they underestimated that failure was not an option.' This article has been adapted from Megan Greenwell's forthcoming book, Bad Company: Private Equity and the Death of the American Dream. Article originally published at The Atlantic
Yahoo
28 minutes ago
- Yahoo
This AI Company Wants Washington To Keep Its Competitors Off the Market
Dario Amodei, CEO of the artificial intelligence company Anthropic, published a guest essay in The New York Times Thursday arguing against a proposed 10-year moratorium on state AI regulation. Amodei argues that a patchwork of regulations would be better than no regulation whatsoever. Skepticism is warranted whenever the head of an incumbent firm calls for more regulation, and this case is no different. If Amodei gets his way, Anthropic would face less competition—to the detriment of AI innovation, AI security, and the consumer. Amodei's op-ed came in a response to a provision of the so-called One Big Beautiful Bill Act, which would prevent any states, cities, and counties from enforcing any regulation that specifically targets AI models, AI systems, or automated decision systems for 10 years. Senate Republicans have amended the clause from a simple requirement to a condition for receiving federal broadband funds, in order to comply with the Byrd Rule, which in Politico's words "blocks anything but budgetary issues from inclusion in reconciliation." Amodei begins by describing how, in a recent stress test conducted at his company, a chatbot threatened an experimenter to forward evidence of his adultery to his wife unless he withdrew plans to shut the AI down. The CEO also raises more tangible concerns, such as reports that a version of Google's Gemini model is "approaching a point where it could help people carry out cyberattacks." Matthew Mittelsteadt, a technology fellow at the Cato Institute, tells Reason that the stress test was "very contrived" and that "there are no AI systems where you must prompt it to turn it off." You can just turn it off. He also acknowledges that, while there is "a real cybersecurity danger [of] AI being used to spot and exploit cyber-vulnerabilities, it can also be used to spot and patch" them. Outside of cyberspace and in, well, actual space, Amodei sounds the alarm that AI could acquire the ability "to produce biological and other weapons." But there's nothing new about that: Knowledge and reasoning, organic or artificial—ultimately wielded by people in either case—can be used to cause problems as well as to solve them. An AI that can model three-dimensional protein structures to create cures for previously untreatable diseases can also create virulent, lethal pathogens. Amodei recognizes the double-edged nature of AI and says voluntary model evaluation and publication are insufficient to ensure that benefits outweigh costs. Instead of a 10-year moratorium, Amodei calls on the White House and Congress to work together on a transparency standard for AI companies. In lieu of federal testing standards, Amodei says state laws should pick up the slack without being "overly prescriptive or burdensome." But that caveat is exactly the kind of wishful thinking Amodei indicts proponents of the moratorium for: Not only would 50 state transparency laws be burdensome, says Mittelsteadt, but they could "actually make models less legible." Neil Chilson of the Abundance Institute also inveighed against Amodei's call for state-level regulation, which is much more onerous than Amodei suggests. "The leading state proposals…include audit requirements, algorithmic assessments, consumer disclosures, and some even have criminal penalties," Chilson tweeted, so "the real debate isn't 'transparency vs. nothing,' but 'transparency-only federal floor vs. intrusive state regimes with audits, liability, and even criminal sanctions.'" Mittelsteadt thinks national transparency regulation is "absolutely the way to go." But how the U.S. chooses to regulate AI might not have much bearing on Skynet-doomsday scenarios, because, while America leads the way in AI, it's not the only player in the game. "If bad actors abroad create Amodei's theoretical 'kill everyone bot,' no [American] law will matter," says Mittelsteadt. But such a law can "stand in the way of good actors using these tools for defense." Amodei is not the only CEO of a leading AI company to call for regulation. In 2023, Sam Altman, co-founder and then-CEO of Open AI, called on lawmakers to consider "intergovernmental oversight mechanisms and standard-setting" of AI. In both cases and in any others that come along, the public should beware of calls for AI regulation that will foreclose market entry, protect incumbent firms' profits from being bid away by competitors, and reduce the incentives to maintain market share the benign way: through innovation and product differentiation. The post This AI Company Wants Washington To Keep Its Competitors Off the Market appeared first on
