Trump's ‘Big Beautiful Bill' Is Already Hurting Health Care Facilities
The bill will create about $930 billion in cuts to Medicaid, something that President Trump and his Republican cronies insist won't happen. But health care providers are telling a different story, with one clinic in rural Nebraska blaming its closure on the plans for Medicaid.
Community Hospital in Curtis, Nebraska, is closing its doors according to a new report from local TV station KLKN. 'Unfortunately, the current financial environment, driven by anticipated federal budget cuts to Medicaid, has made it impossible for us to continue operating all of our services, many of which have faced significant financial challenges for years,' Community Hospital CEO Troy Bruntz said in a statement to the news outlet.
A study by the University of North Carolina, commissioned by Senate Democrats, found that 338 rural hospitals will be at risk of closing thanks to the GOP bill. But it's not just rural hospitals already feeling the pinch. Two of San Diego, California's largest medical providers announced layoffs in the last week. UC San Diego Health is laying off 230 workers and cited 'mounting financial pressures' as a result of 'federal impacts to health care,' including poor reimbursement rates for Medicare and Medicaid, in a memo seen by the San Diego Union Tribune.
Sharp Healthcare, San Diego County's biggest provider, also announced it was laying off 315 employees who will work through early September. Executives at Sharp are also taking pay cuts, with CEO Chris Howard asking the board to cut his pay by 25%, according to the San Diego Union Tribune.
Bea Grause, president of the Healthcare Association of New York State told the Times Union that hospitals are going to feel this. 'It's a fiscal pandemic,' Grause said. 'Medicaid is an important funder for all hospitals, and so it will financially hurt almost every hospital across the state of New York—and hospitals are central to the economy of each community. That's what the average New Yorker should be concerned about.'
Many Americans probably don't even know they're on Medicaid, given the fact that each state administers its own program and has a different name for it. In California it's called Medi-Cal, in Massachusetts it's called MassHealth, and in New Jersey it's called NJ FamilyCare. But people also don't seem to understand that Medicaid helps hospitals pay for things that help everyone more broadly and pulling the rug out from under them will have ripple effects.
The Congressional Budget Office estimates 11.8 million people will lose Medicaid coverage between now and 2034, according to the Washington Post, but the bill also abolishes other subsidies for the Affordable Care Act that the CBO estimates will dump another 4.2 million people. Another 1 million on top of that will lose their coverage because of other health provisions in the bill, bringing the grand total to somewhere around 17 million people over the next decade.
When people lose their health insurance it doesn't mean that they're not going to need help. As Sen. Catherine Cortez Masto, a Democrat from Nevada, pointed out during a virtual roundtable this week, these cuts will 'devastate health care in Nevada,' and people will go to the ER after they get sick enough.
'More people now are going to be showing up in our emergency rooms with acute care because they now have lost the health care that they need to even provide preventative care for them,' Cortez Masto said, according to the Nevada Current.
The Republicans insist that Democrats are just fear-mongering and that nobody is going to lose their Medicaid coverage. Some Republicans will admit that people are going to get stripped of their health insurance, but they insist it's all about fighting 'waste, fraud, and abuse.' We'll see how many people who lose their health care in the coming years feel when they're simply dubbed fraudsters.
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Lembke: We're all now kind of on the spectrum of compulsive overconsumption, moving toward addiction, which is resetting our hedonic threshold –– or joy set point. We need more and more of these reinforcers to feel any pleasure at all, and when we're not using, we're dysphoric, we're irritable, we can't sleep. CNN: What kinds of things risk putting us into dopamine deficit? Lembke: A lot of different things release dopamine in the reward pathway, including things that are good for us, like learning or spending time with friends. It's not that dopamine is the villain here, that dopamine release is bad –– not at all. The problem is that we've now engineered old-fashioned drugs to be more potent than ever before, and we've also created drugs that never existed before, like digital media, like 'drugified' foods. We've even taken healthy behaviors like exercise and drugified them by (tracking) ourselves and ranking ourselves and adding in social media and social comparisons. 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We know that the easier it is to access a reinforcing substance or behavior, the more likely people are to use it and hence get addicted to it. We now live in this world of very easy, frictionless access to a lot of rewarding substances and behaviors. Digital media in particular is a 24/7 mobile access — anytime, anywhere, to an almost infinite source. The other thing that makes something addictive is the quantity and frequency of exposure. The more dopamine hits the brain gets, the more likely it is to change and adapt in a way that can create a disease of addiction. (Social media algorithms are) actually engineered to overcome tolerance and create novelty, to encourage people to keep searching for the same or similar rewards as what they've already viewed but hopefully a little bit better. The criteria for diagnosing addiction are pretty much the same across different definitions. You're looking for the four C's: out-of-control use, compulsive use, craving and consequences — especially continued use despite consequences — as well as the physiologic criteria that indicate biological dependence. Those would be tolerance, needing more (or more potent forms) over time to get the same effect, and withdrawal when you try to stop using. CNN: What can we do to address dopamine deficit? Lembke: What I recommend is a 30-day abstinence trial, colloquially called a 'dopamine fast,' from the drug of choice. Not from all rewards but just from the problematic substance or behavior to see how difficult it is to stop — and also to see if you feel better after four weeks. Why four weeks? Because that's, on average, the amount of time it takes to reset reward pathways, at least phenomenologically. I always warn people, they're going to feel worse before they feel better. But if they get through the first 10 to 14 days, often they will feel much better. After the abstinence trial, when people want to go back to using, they just need to be very specific about what they're going to use, how much, how often, in what circumstances, how they're going to track it, and what their red flags will be for slipping back into old habits. Then they can reevaluate whether they can really use in moderation. When it comes to food, obviously, people can't abstain, and nor should they try. But they can abstain from sugar. They can abstain from ultraprocessed foods. How do we engage in pleasurable things but stop before we get to dopamine deficit? Lembke: It's not about not having pleasure in life; it is about resetting the balance so that simple pleasures are rewarding again. That is not going to happen if people are constantly indulging in these frictionless, high-potency rewards. I talk a lot about 'self-binding' and making sure we don't constantly surround ourselves with easy access to these high-potency, cheap pleasures so we don't get into that problem in the first place. But it takes intentionality because we live in a world where we're constantly being invited to consume, and we're told that the more we consume, the happier we'll be. So, it does take planning and intentionality to create barriers between ourselves and the many drugs out there. Self-binding can mean physical barriers. If the issue is food, not having ultraprocessed food or sugary food in the house. If it's cannabis, not having pot in the house, not having alcohol. Now, if it's some form of digital media, you can use time as a self-binding strategy: 'I'm only going to use on these days for this amount of time with these people.' Other people are a very important form of self-binding. We tend to do what those around us are doing, so try to hang out with people who are using substances and behaviors in a way that you want to use them. Sign up for CNN's Stress, But Less newsletter. Our six-part mindfulness guide will inform and inspire you to reduce stress while learning how to harness it.
