Latest news with #AdamGaffney
Yahoo
9 hours ago
- Health
- Yahoo
The devastating impact of Trump's big beautiful bill, in one chart
While public attention has largely been focused on the Middle East and on President Donald Trump's immigration policy, Republicans in Congress are on the verge of passing massive Medicaid cuts as part of a budget bill that could lead to millions of Americans losing their health insurance benefits and, according to one recent estimate, thousands of unnecessary deaths every year. While the GOP's so-called 'big, beautiful' bill is a smorgasbord of policy — potentially including everything from blocking AI regulation to restricting the power of the federal courts — perhaps the most consequential changes would be to Medicaid. The program, which covers low-income Americans of all ages, is now the country's single largest insurer, covering more than 70 million people. The legislation approved by House Republicans, which is now being debated and amended by the Senate, would cut Medicaid spending by $793 billion over 10 years. The upshot is that 10.3 million fewer people would be enrolled in the program by 2034. Those coverage losses would more than undo the progress the US has made in reducing the ranks of the uninsured over the past few years. On Tuesday, the National Center for Health Statistics reported that the number of US adults without insurance in 2024 had fallen to 27.2 million, down from 31.6 million in 2020. The GOP bill would reverse those gains and then some within a decade. The consequences would be much more severe than the mere loss of a government health insurance card. According to one analysis of the House bill published last week in the Annals of Internal Medicine by a trio of Harvard-affiliated researchers, those losses of Medicaid coverage would lead to fewer Americans reporting good health, fewer patients getting preventive health screenings, and, at the end of the day, between 8,200 and 24,600 additional annual deaths. Senate Republicans are not going to adopt the House bill exactly as it is, which means any estimates of its effects are preliminary. But it appears likely GOP senators will keep at least two impactful provisions: new work requirements for many of the people on Medicaid and limits on the financing tools that the states can use to access more federal Medicaid funding. The Harvard study broke out the estimated effects by provision and the results are still foreboding: between 3,000 and 9,000 annual deaths attributable to Medicaid work requirements, and between 4,200 and 12,600 deaths if state provider taxes were completely eliminated. Even short of the worst-case scenario, Americans' health would be worse off under the Republican bill, according to researchers Adam Gaffney, David Himmelstein, and Steffie Woolhandler. The number of Americans who have a personal doctor would drop by 700,000 under Medicaid work requirements; 285,000 fewer people would ever get their blood cholesterol checked, and 235,000 fewer patients would ever have their blood sugar tested. The number of women getting a recommended mammogram within the past 12 months would drop by nearly 139,000. And an additional 385,000 people would have to borrow money or skip paying other bills to afford their medical care. The people affected are low-income and disproportionately Black and Hispanic. There is plenty of uncertainty in these projections. It is also hard to be sure how these policies would interact with each other: The Harvard researchers noted in their cumulative estimate of the House bill's effects that there would likely be some overlap in the policies' projected effects when combined together. Some of the people who lose their Medicaid coverage would be able to get insurance by other means, offsetting the losses to a degree that can be difficult to predict. But the takeaway from the analysis is clear: A lot of people are going to suffer if these proposals become law. The debate in the Senate has not yet concluded, and the bill could still change. Hospitals are busy on Capitol Hill, lobbying Republicans to reduce the spending cuts and warning lawmakers of the devastating consequences that the legislation would have. Some GOP senators are reportedly open to providing additional funding for rural hospitals, to relieve the impact on the facilities that would be hardest hit by the proposed Medicaid cuts. But after Republicans narrowly failed to roll back Medicaid during Trump's first term, they seem likely to succeed this time — a step backward from building a true universal health care system. America's lack of universal health care is the main reason we spend more money than any other country in the world while seeing worse outcomes. One recent JAMA analysis found that deaths that could be prevented by accessible health care increased in the United States from 2009 to 2019, while declining in most other comparable countries. You can achieve universal health care via a variety of strategies, including the expansion of private health insurance, but the Republican bill could instead lead to more unnecessary deaths by taking existing benefits away from people, according to the Annals of Internal Medicine study. Medicaid has actually been a rare bright spot in America's often dysfunctional health care system. The program has its own problems — not enough doctors participate because of its low reimbursement rates, for one — but since its expansion through the Affordable Care Act in 2010, research has shown that Medicaid allowed more people to access health care, reduced their financial burden from medical services, and improved their physical and mental well-being. Republican lawmakers and Trump administration officials justify the Medicaid cuts by saying that people who can work should be required to work in order to receive government benefits. They claim nobody who deserves to be on Medicaid will lose their coverage. As one White House official put it to Politico earlier this month: 'Medicaid does not belong to people who are here illegally, and it does not belong to capable and able-bodied men who refuse to work. So no one is getting cut.' (Undocumented migrants are already ineligible for federal Medicaid funding. Six states cover undocumented adults through Medicaid using the state's own funds, and 14 cover undocumented children.) But independent analysts say that most of the people on Medicaid are either children, elderly, disabled — or adults who are already working or caring for another person — meaning they are limited in their ability to work. Most of the projected coverage losses result from people having paperwork problems in documenting their work or proving they should be exempt from the requirements, not because people are actually ineligible under the new rules. That aligns with the experience of Arkansas during Trump's first term. That state tested work requirements in the real world for the first time and 18,000 people lost their health insurance in a matter of months, with no meaningful effect on their employment. The US has made halting progress in its pursuit of a better health system. In 2010, the uninsured rate was 16 percent. Today, it's half of that. But in the GOP's proposed future, the problems that have left Americans so frustrated with their health care system are going to get worse.
Vox
11 hours ago
- Health
- Vox
The devastating impact of Trump's big beautiful bill, in one chart
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. While public attention has largely been focused on the Middle East and on President Donald Trump's immigration policy, Republicans in Congress are on the verge of passing massive Medicaid cuts as part of a budget bill that could lead to millions of Americans losing their health insurance benefits and, according to one recent estimate, thousands of unnecessary deaths every year. While the GOP's so-called 'big, beautiful' bill is a smorgasbord of policy — potentially including everything from blocking AI regulation to restricting the power of the federal courts — perhaps the most consequential changes would be to Medicaid. The program, which covers low-income Americans of all ages, is now the country's single largest insurer, covering more than 70 million people. The legislation approved by House Republicans, which is now being debated and amended by the Senate, would cut Medicaid spending by $793 billion over 10 years. The upshot is that 10.3 million fewer people would be enrolled in the program by 2034. Those coverage losses would more than undo the progress the US has made in reducing the ranks of the uninsured over the past few years. On Tuesday, the National Center for Health Statistics reported that the number of US adults without insurance in 2024 had fallen to 27.2 million, down from 31.6 million in 2020. The GOP bill would reverse those gains and then some within a decade. The consequences would be much more severe than the mere loss of a government health insurance card. According to one analysis of the House bill published last week in the Annals of Internal Medicine by a trio of Harvard-affiliated researchers, those losses of Medicaid coverage would lead to fewer Americans reporting good health, fewer patients getting preventive health screenings, and, at the end of the day, between 8,200 and 24,600 additional annual deaths. Senate Republicans are not going to adopt the House bill exactly as it is, which means any estimates of its effects are preliminary. But it appears likely GOP senators will keep at least two impactful provisions: new work requirements for many of the people on Medicaid and limits on the financing tools that the states can use to access more federal Medicaid funding. The Harvard study broke out the estimated effects by provision and the results are still foreboding: between 3,000 and 9,000 annual deaths attributable to Medicaid work requirements, and between 4,200 and 12,600 deaths if state provider taxes were completely eliminated. Even short of the worst-case scenario, Americans' health would be worse off under the Republican bill, according to researchers Adam Gaffney, David Himmelstein, and Steffie Woolhandler. The number of Americans who have a personal doctor would drop by 700,000 under Medicaid work requirements; 285,000 fewer people would ever get their blood cholesterol checked, and 235,000 fewer patients would ever have their blood sugar tested. The number of women getting a recommended mammogram within the past 12 months would drop by nearly 139,000. And an additional 385,000 people would have to borrow money or skip paying other bills to afford their medical care. The people affected are low-income and disproportionately Black and Hispanic. There is plenty of uncertainty in these projections. It is also hard to be sure how these policies would interact with each other: The Harvard researchers noted in their cumulative estimate of the House bill's effects that there would likely be some overlap in the policies' projected effects when combined together. Some of the people who lose their Medicaid coverage would be able to get insurance by other means, offsetting the losses to a degree that can be difficult to predict. But the takeaway from the analysis is clear: A lot of people are going to suffer if these proposals become law. The US is sabotaging its own health care system The debate in the Senate has not yet concluded, and the bill could still change. Hospitals are busy on Capitol Hill, lobbying Republicans to reduce the spending cuts and warning lawmakers of the devastating consequences that the legislation would have. Some GOP senators are reportedly open to providing additional funding for rural hospitals, to relieve the impact on the facilities that would be hardest hit by the proposed Medicaid cuts. But after Republicans narrowly failed to roll back Medicaid during Trump's first term, they seem likely to succeed this time — a step backward from building a true universal health care system. America's lack of universal health care is the main reason we spend more money than any other country in the world while seeing worse outcomes. One recent JAMA analysis found that deaths that could be prevented by accessible health care increased in the United States from 2009 to 2019, while declining in most other comparable countries. You can achieve universal health care via a variety of strategies, including the expansion of private health insurance, but the Republican bill could instead lead to more unnecessary deaths by taking existing benefits away from people, according to the Annals of Internal Medicine study. Medicaid has actually been a rare bright spot in America's often dysfunctional health care system. The program has its own problems — not enough doctors participate because of its low reimbursement rates, for one — but since its expansion through the Affordable Care Act in 2010, research has shown that Medicaid allowed more people to access health care, reduced their financial burden from medical services, and improved their physical and mental well-being. Republican lawmakers and Trump administration officials justify the Medicaid cuts by saying that people who can work should be required to work in order to receive government benefits. They claim nobody who deserves to be on Medicaid will lose their coverage. As one White House official put it to Politico earlier this month: 'Medicaid does not belong to people who are here illegally, and it does not belong to capable and able-bodied men who refuse to work. So no one is getting cut.' (Undocumented migrants are already ineligible for federal Medicaid funding. Six states cover undocumented adults through Medicaid using the state's own funds, and 14 cover undocumented children.) But independent analysts say that most of the people on Medicaid are either children, elderly, disabled — or adults who are already working or caring for another person — meaning they are limited in their ability to work. Most of the projected coverage losses result from people having paperwork problems in documenting their work or proving they should be exempt from the requirements, not because people are actually ineligible under the new rules. That aligns with the experience of Arkansas during Trump's first term. That state tested work requirements in the real world for the first time and 18,000 people lost their health insurance in a matter of months, with no meaningful effect on their employment.
Vox
13 hours ago
- Health
- Vox
Health care after the Medicaid cuts in Trump's big, beautiful bill: less care, more deaths
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. While public attention has largely been focused on the Middle East and on President Donald Trump's immigration policy, Republicans in Congress are on the verge of passing massive Medicaid cuts as part of a budget bill that could lead to millions of Americans losing their health insurance benefits and, according to one recent estimate, thousands of unnecessary deaths every year. While the GOP's so-called 'big, beautiful' bill is a smorgasbord of policy — potentially including everything from blocking AI regulation to restricting the power of the federal courts — perhaps the most consequential changes would be to Medicaid. The program, which covers low-income Americans of all ages, is now the country's single largest insurer, covering more than 70 million people. The legislation approved by House Republicans, which is now being debated and amended by the Senate, would cut Medicaid spending by $793 billion over 10 years. The upshot is that 10.3 million fewer people would be enrolled in the program by 2034. Those coverage losses would more than undo the progress the US has made in reducing the ranks of the uninsured over the past few years. On Tuesday, the National Center for Health Statistics reported that the number of US adults without insurance in 2024 had fallen to 27.2 million, down from 31.6 million in 2020. The GOP bill would reverse those gains and then some within a decade. The consequences would be much more severe than the mere loss of a government health insurance card. According to one analysis of the House bill published last week in the Annals of Internal Medicine by a trio of Harvard-affiliated researchers, those losses of Medicaid coverage would lead to fewer Americans reporting good health, fewer patients getting preventive health screenings, and, at the end of the day, between 8,200 and 24,600 additional annual deaths. Senate Republicans are not going to adopt the House bill exactly as it is, which means any estimates of its effects are preliminary. But it appears likely GOP senators will keep at least two impactful provisions: new work requirements for many of the people on Medicaid and limits on the financing tools that the states can use to access more federal Medicaid funding. The Harvard study broke out the estimated effects by provision and the results are still foreboding: between 3,000 and 9,000 annual deaths attributable to Medicaid work requirements, and between 4,200 and 12,600 deaths if state provider taxes were completely eliminated. Even short of the worst-case scenario, Americans' health would be worse off under the Republican bill, according to researchers Adam Gaffney, David Himmelstein, and Steffie Woolhandler. The number of Americans who have a personal doctor would drop by 700,000 under Medicaid work requirements; 285,000 fewer people would ever get their blood cholesterol checked, and 235,000 fewer patients would ever have their blood sugar tested. The number of women getting a recommended mammogram within the past 12 months would drop by nearly 139,000. And an additional 385,000 people would have to borrow money or skip paying other bills to afford their medical care. The people affected are low-income and disproportionately Black and Hispanic. There is plenty of uncertainty in these projections. It is also hard to be sure how these policies would interact with each other: The Harvard researchers noted in their cumulative estimate of the House bill's effects that there would likely be some overlap in the policies' projected effects when combined together. Some of the people who lose their Medicaid coverage would be able to get insurance by other means, offsetting the losses to a degree that can be difficult to predict. But the takeaway from the analysis is clear: A lot of people are going to suffer if these proposals become law. The US is sabotaging its own health care system The debate in the Senate has not yet concluded, and the bill could still change. Hospitals are busy on Capitol Hill, lobbying Republicans to reduce the spending cuts and warning lawmakers of the devastating consequences that the legislation would have. Some GOP senators are reportedly open to providing additional funding for rural hospitals, to relieve the impact on the facilities that would be hardest hit by the proposed Medicaid cuts. But after Republicans narrowly failed to roll back Medicaid during Trump's first term, they seem likely to succeed this time — a step backward from building a true universal health care system. America's lack of universal health care is the main reason we spend more money than any other country in the world while seeing worse outcomes. One recent JAMA analysis found that deaths that could be prevented by accessible health care increased in the United States from 2009 to 2019, while declining in most other comparable countries. You can achieve universal health care via a variety of strategies, including the expansion of private health insurance, but the Republican bill could instead lead to more unnecessary deaths by taking existing benefits away from people, according to the Annals of Internal Medicine study. Medicaid has actually been a rare bright spot in America's often dysfunctional health care system. The program has its own problems — not enough doctors participate because of its low reimbursement rates, for one — but since its expansion through the Affordable Care Act in 2010, research has shown that Medicaid allowed more people to access health care, reduced their financial burden from medical services, and improved their physical and mental well-being. Republican lawmakers and Trump administration officials justify the Medicaid cuts by saying that people who can work should be required to work in order to receive government benefits. They claim nobody who deserves to be on Medicaid will lose their coverage. As one White House official put it to Politico earlier this month: 'Medicaid does not belong to people who are here illegally, and it does not belong to capable and able-bodied men who refuse to work. So no one is getting cut.' (Undocumented migrants are already ineligible for federal Medicaid funding. Six states cover undocumented adults through Medicaid using the state's own funds, and 14 cover undocumented children.) But independent analysts say that most of the people on Medicaid are either children, elderly, disabled — or adults who are already working or caring for another person — meaning they are limited in their ability to work. Most of the projected coverage losses result from people having paperwork problems in documenting their work or proving they should be exempt from the requirements, not because people are actually ineligible under the new rules. That aligns with the experience of Arkansas during Trump's first term. That state tested work requirements in the real world for the first time and 18,000 people lost their health insurance in a matter of months, with no meaningful effect on their employment.
NBC News
16-06-2025
- Health
- NBC News
Proposed Medicaid cuts could lead to thousands of deaths, study finds
The proposed Medicaid cuts in the House Republicans' sprawling domestic policy bill could cause an estimated 7.6 million Americans to lose health insurance, leading to thousands of preventable deaths, according to an analysis published Monday in the Annals of Internal Medicine. The study estimated the cuts could cause nearly 2 million people to lose their primary doctor, 1.3 million people to not fill medications they need and 380,270 women to skip a mammogram. More than 16,600 people could die as a result of losing access to or forgoing care, the researchers estimated. 'Patients who go without care because they cannot afford it often get sicker and sicker, until they end up with chronic illness,' said lead study author Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School. The reconciliation bill, which passed the House in late May and is working its way through the Senate, proposes deep cuts to federal Medicaid spending — at least $625 billion over 10 years, according to the study. 'Parts of the bill that seem innocuous, that seem like they may be aimed at cutting fraud and abuse, will disenroll people who should be on Medicaid under the stated criteria,' said Dr. Rachel Werner, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, who was not involved in the analysis. 'It's not just about saving dollars and cents, it's costing lives.' Of the Medicaid cuts included in the bill, the analysis highlighted the three that would have the largest impact on people losing health insurance: establishing work requirements, limiting states' ability to collect taxes from Medicaid providers and ending a Biden-era rule that streamlined Medicaid enrollment. Several smaller cuts in the bill, including penalizing states that used Medicaid funds to cover undocumented immigrants, brought the total to an estimated 7.6 million people becoming uninsured. (The estimate assumes that while closer to 10.3 million people would lose their Medicaid coverage, some would find other health insurance — though the authors noted this assumption 'may be overly optimistic.') The report was based on figures from the House Budget Committee, analyses from the Congressional Budget Office and past studies on Medicaid. Gaffney noted that the work requirements in the bill passed in May were wider than what the analysis originally estimated, and could lead to the greatest number of deaths. Michael Shepherd, an assistant professor of health management and policy at the University of Michigan School of Public Health, agreed that the work requirements are a particularly worrying part of the bill. 'They sound reasonable for folks, if you're able to work, you should be working,' said Shepherd, who was not involved in the new analysis. 'The majority of people on Medicaid are already working and most of those who are not are either in a caregiving role or are disabled and cannot work.' If federal lawmakers do pass work requirements, people would need to routinely submit proof that they are employed for a specific number of hours. It's unclear how often this would be, but the process would create more obstacles for people to get care, particularly for people who work seasonally or who are between jobs when the work requirement documentation is due, Shepherd said. 'It's a good example of kicking people while they're down or putting roadblocks in the way of people who are already doing what they are supposed to,' he said. 'The last thing you want to do for someone who is in a financially precarious position is to take away their health care.' Georgia and Arkansas have already experimented with implementing work requirements for Medicaid recipients in their states. Georgia's is still in effect, but a judge reversed Arkansas' requirement in 2019, about a year after it went into effect. Shepherd said what happened in these states can act as a warning for what could come of federal work requirements for Medicaid recipients: 'What we observed was a large number of people not being able to enroll in Medicaid, even though they qualify and they are working, and an increase in administrative costs.' A ripple effect Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University, said potential preventable deaths aren't his only concern. 'There will be many Americans who develop chronic diseases that they will have to live with for the rest of their lives,' said Woolf, who was not involved with the analysis. 'Someone who has signs of a stroke and doesn't seek immediate care because they don't have access to Medicaid will live with neurological effects for the rest of their lives.' Woolf said Medicaid cuts would be compounded by cuts to SNAP benefits — which are also in the bill — as well as cuts to programs, funding and staff at the Centers for Disease Control and Prevention. 'The health consequences of this are huge,' he said. Werner said she worries that the cuts would cause confusion for people who are still eligible and enrolled in Medicaid, potentially causing them to believe they or their child has lost coverage. The disenrollment of kids is unlikely, she said: 'What is more likely is that when parents become disenrolled they mistakenly think their kids will be disenrolled.' Another provision in the bill would delay a mandate requiring staffing minimums at nursing homes, which Werner said could lead to additional deaths among residents. The ripple effects would also affect the health system at large, especially in rural areas, and could lead to loss of care and deaths even among people with private insurance, Shepherd said. Medicaid cuts would strain rural hospitals, which would be left to increasingly absorb the cost of care for uninsured people who cannot pay their medical bills. (Even without the cuts, one-third of all rural hospitals are at risk of closing due to financial strains, according to the Center for Healthcare Quality and Payment Reform.) 'We are looking at substantial numbers of rural health clinics and hospitals closing,' Shepherd said. 'If you are living in a rural community, there is a pretty decent chance these cuts will cost you your local access to a hospital regardless of what insurance you have.' Shepard said that while the authors did a good job in their estimations, the numbers do not take into account these spillover effects. Woolf agreed.
