Latest news with #AnthonyWright
Yahoo
9 hours ago
- Health
- Yahoo
Republican senators' proposed Medicaid cuts threaten to send red states ‘backwards'
Advocates are urging Senate Republicans to reject a proposal to cut billions from American healthcare to extend tax breaks that primarily benefit the wealthy and corporations. The proposal would make historic cuts to Medicaid, the public health insurance program for low-income and disabled people that covers 71 million Americans, and is the Senate version of the 'big beautiful bill' act, which contains most of Donald Trump's legislative agenda. 'With the text released earlier this week, somehow the Senate made the House's 'big, bad budget bill' worse in many ways,' said Anthony Wright, the executive director of Families USA, a consumer healthcare advocacy group, in a press call. The Senate's version makes deeper cuts to Medicaid and so-called Obamacare (Affordable Care Act) plans, 'both by expanding paperwork requirements and making it harder for states to fund Medicaid coverage for their residents', said Wright. Related: Democratic senators call on private firm to reveal how it will profit from Trump's Medicaid cuts If passed, the House-passed bill would have already made the biggest cuts to Medicaid since the program's enactment in 1965. With red tape and an expiration of additional healthcare subsidies to Obamacare, the Congressional Budget Office (CBO) estimated that the House version would leave 16 million people without health insurance by 2034. CBO has not yet released estimates, or 'scored', the impact of the Senate proposal, but advocates and experts said the cuts are more draconian, 'punish' states that expanded Medicaid, and attack Medicaid by going after its byzantine financing structures. 'If we look at the big picture of our healthcare system that's where the inefficiencies are – not in Medicaid – but in all the groups profiting off the system,' said David Machledt, a senior policy analyst at the National Health Law Program, referring to Republicans' assertions that they are targeting 'waste, fraud and abuse' with cuts. 'What these cuts are going to do is look at the most cost-efficient program and squeeze it further, and take us backwards, and put us back at a system where the people at the low end are literally dying to fund these tax cuts for rich people and businesses.' A recent study found that expanding Medicaid, as was done during the Obama administration, probably saved an additional 27,400 lives over a 12-year period, and did so cheaper than other insurance programs. The same study found that about a quarter of the difference in life expectancy between low- and high-income Americans is due to lack of health insurance. Republicans, such as Senator John Thune of South Dakota, argue that their bill 'protects' Medicaid by 'removing people who should not be on the rolls', including working-age adults, legal and undocumented immigrants; by adding work requirements and by going after a tax maneuver states use to bring in more federal Medicaid funding. Related: 'Fiscally irresponsible': Trump's 'big, beautiful bill' benefits the rich at the expense of the poor 'Removing these individuals is just basic, good governance,' said Thune. But experts and advocates argue the cuts will not only remove the targeted individuals, including many who are working but struggle to get through red tape, but will also place states in impossible situations with potentially multibillion-dollar shortfalls in their budgets. Both versions contain so-called work requirements, which analyses show will cause people to lose coverage even if they are eligible, experts said. Instead, the largest difference between the Senate and House versions of the bill is the Senate's attack on Medicaid's complex financing arrangements. Medicaid is jointly financed by states and the federal government, making it simultaneously one of states' largest expenditures and sources of revenue. The Senate's version specifically attacks two ways states finance Medicaid, through provider taxes and state-directed payments. With a provider tax, states bring in additional federal revenue by increasing payments to providers. Because the federal portion of Medicaid is based on a percentage rate, increasing payments to providers in turn increases the amount that federal officials pay the state. States then tax those same providers, such as hospitals, to bring the funding back to the state. Although this maneuver has been criticized, it has also now been used for decades. It's in place in every state except for Alaska, is legal and openly discussed. The Senate bill caps this manuever by cutting the tax rate by about half, from 6% to 3.5%, according to Machledt. [Cuts will] put us back at a system where the people at the low end are literally dying to fund these tax cuts for rich people and businesses David Machledt, National Health Law Program In a 2024 analysis, the Congressional Research Service estimated that lowering the provider tax cap to 2.5% would effectively cut $241bn from Medicaid payments to states. Although the exact impacts of the Senate tax cap are not yet known, Machledt expects it would be in the billions, which states would then be under pressure to make up. 'We took great pains to close a $1.1bn shortfall caused by rising healthcare costs,' said the Colorado state treasurer, Dave Young, in a press call. 'To protect healthcare and education, we had to cut transportation projects, maternal health programs and even $1m in aid to food banks.' Because of taxing provisions in Colorado's state constitution, Young said: 'It will be nearly impossible to raise taxes or borrow money to make up the difference.' Similarly, the Senate bill goes after 'state-directed payments'. To understand state-directed payments, it's helpful to understand a big picture, and often hidden, aspect of American healthcare – health insurance pays providers different rates for the same service. Providers are almost universally paid the worst for treating patients who have Medicaid. Medicare pays roughly the cost of providing care, although many doctors and hospitals complain it is still too little. Commercial insurance pays doctors and hospitals most handsomely. To encourage more providers to accept Medicaid, lawmakers in some states have chosen to pay providers treating Medicaid patients additional funds. In West Virginia, a federally approved plan allows the state to pay providers more for certain populations. In North Carolina, state-directed payments allow the state to pay hospitals rates equal to the average commercial insurance rate, if they agree to medical debt forgiveness provisions. The first state-directed payment plan was approved in 2018, under the first Trump administration. These kinds of payments were criticized by the Government Accountability Office during the Biden administration. Related: Trump's 'big, beautiful' spending bill, from tax cuts to mass deportations However, the Senate bill goes after these rates by tying them to Medicaid expansion – a central tenet of Obamacare – and gives stricter limits to the 41 states that expanded the program. Doing this will effectively be 'punishing them', Machledt said, referring to states that participated in this key provision of Obamacare, 'by limiting the way they can finance'. Advocates also warned of unintended knock-on effects from such enormous disruption. Medical debt financing companies are already readying new pitches to hospitals. Even people who don't lose their insurance and are not insured through Medicaid could see prices increase. When Medicaid is cut, hospital emergency rooms are still obliged to provide stabilizing care to patients, even if they can't pay. Hospitals must then make up that shortfall somewhere, and the only payers they can negotiate with are commercial: for example, the private health insurance most people in the US rely on. 'Folks who do not lose their health insurance will see increased costs,' said Leslie Frane, the executive vice-president of SEIU, a union that represents about 2 million members, including in healthcare. 'Your copays are going to go up, your deductibles are going to go up, your bills are going to go up.' Republicans hope to pass the bill by 4 July.
The Guardian
9 hours ago
- Health
- The Guardian
Republican senators' proposed Medicaid cuts threaten to send red states ‘backwards'
Advocates are urging Senate Republicans to reject a proposal to cut billions from American healthcare to extend tax breaks that primarily benefit the wealthy and corporations. The proposal would make historic cuts to Medicaid, the public health insurance program for low-income and disabled people that covers 71 million Americans, and is the Senate version of the 'big beautiful bill' act, which contains most of Donald Trump's legislative agenda. 'With the text released earlier this week, somehow the Senate made the House's 'big, bad budget bill' worse in many ways,' said Anthony Wright, the executive director of Families USA, a consumer healthcare advocacy group, in a press call. The Senate's version makes deeper cuts to Medicaid and so-called Obamacare (Affordable Care Act) plans, 'both by expanding paperwork requirements and making it harder for states to fund Medicaid coverage for their residents', said Wright. If passed, the House-passed bill would have already made the biggest cuts to Medicaid since the program's enactment in 1965. With red tape and an expiration of additional healthcare subsidies to Obamacare, the Congressional Budget Office (CBO) estimated that the House version would leave 16 million people without health insurance by 2034. CBO has not yet released estimates, or 'scored', the impact of the Senate proposal, but advocates and experts said the cuts are more draconian, 'punish' states that expanded Medicaid, and attack Medicaid by going after its byzantine financing structures. 'If we look at the big picture of our healthcare system that's where the inefficiencies are – not in Medicaid – but in all the groups profiting off the system,' said David Machledt, a senior policy analyst at the National Health Law Program, referring to Republicans' assertions that they are targeting 'waste, fraud and abuse' with cuts. 'What these cuts are going to do is look at the most cost-efficient program and squeeze it further, and take us backwards, and put us back at a system where the people at the low end are literally dying to fund these tax cuts for rich people and businesses.' A recent study found that expanding Medicaid, as was done during the Obama administration, probably saved an additional 27,400 lives over a 12-year period, and did so cheaper than other insurance programs. The same study found that about a quarter of the difference in life expectancy between low- and high-income Americans is due to lack of health insurance. Republicans, such as Senator John Thune of South Dakota, argue that their bill 'protects' Medicaid by 'removing people who should not be on the rolls', including working-age adults, legal and undocumented immigrants; by adding work requirements and by going after a tax maneuver states use to bring in more federal Medicaid funding. 'Removing these individuals is just basic, good governance,' said Thune. But experts and advocates argue the cuts will not only remove the targeted individuals, including many who are working but struggle to get through red tape, but will also place states in impossible situations with potentially multibillion-dollar shortfalls in their budgets. Both versions contain so-called work requirements, which analyses show will cause people to lose coverage even if they are eligible, experts said. Instead, the largest difference between the Senate and House versions of the bill is the Senate's attack on Medicaid's complex financing arrangements. Medicaid is jointly financed by states and the federal government, making it simultaneously one of states' largest expenditures and sources of revenue. The Senate's version specifically attacks two ways states finance Medicaid, through provider taxes and state-directed payments. With a provider tax, states bring in additional federal revenue by increasing payments to providers. Because the federal portion of Medicaid is based on a percentage rate, increasing payments to providers in turn increases the amount that federal officials pay the state. States then tax those same providers, such as hospitals, to bring the funding back to the state. Although this maneuver has been criticized, it has also now been used for decades. It's in place in every state except for Alaska, is legal and openly discussed. The Senate bill caps this manuever by cutting the tax rate by about half, from 6% to 3.5%, according to Machledt. In a 2024 analysis, the Congressional Research Service estimated that lowering the provider tax cap to 2.5% would effectively cut $241bn from Medicaid payments to states. Although the exact impacts of the Senate tax cap are not yet known, Machledt expects it would be in the billions, which states would then be under pressure to make up. 'We took great pains to close a $1.1bn shortfall caused by rising healthcare costs,' said the Colorado state treasurer, Dave Young, in a press call. 'To protect healthcare and education, we had to cut transportation projects, maternal health programs and even $1m in aid to food banks.' Because of taxing provisions in Colorado's state constitution, Young said: 'It will be nearly impossible to raise taxes or borrow money to make up the difference.' Similarly, the Senate bill goes after 'state-directed payments'. To understand state-directed payments, it's helpful to understand a big picture, and often hidden, aspect of American healthcare – health insurance pays providers different rates for the same service. Providers are almost universally paid the worst for treating patients who have Medicaid. Medicare pays roughly the cost of providing care, although many doctors and hospitals complain it is still too little. Commercial insurance pays doctors and hospitals most handsomely. To encourage more providers to accept Medicaid, lawmakers in some states have chosen to pay providers treating Medicaid patients additional funds. In West Virginia, a federally approved plan allows the state to pay providers more for certain populations. In North Carolina, state-directed payments allow the state to pay hospitals rates equal to the average commercial insurance rate, if they agree to medical debt forgiveness provisions. The first state-directed payment plan was approved in 2018, under the first Trump administration. These kinds of payments were criticized by the Government Accountability Office during the Biden administration. However, the Senate bill goes after these rates by tying them to Medicaid expansion – a central tenet of Obamacare – and gives stricter limits to the 41 states that expanded the program. Doing this will effectively be 'punishing them', Machledt said, referring to states that participated in this key provision of Obamacare, 'by limiting the way they can finance'. Advocates also warned of unintended knock-on effects from such enormous disruption. Medical debt financing companies are already readying new pitches to hospitals. Even people who don't lose their insurance and are not insured through Medicaid could see prices increase. When Medicaid is cut, hospital emergency rooms are still obliged to provide stabilizing care to patients, even if they can't pay. Hospitals must then make up that shortfall somewhere, and the only payers they can negotiate with are commercial: for example, the private health insurance most people in the US rely on. 'Folks who do not lose their health insurance will see increased costs,' said Leslie Frane, the executive vice-president of SEIU, a union that represents about 2 million members, including in healthcare. 'Your copays are going to go up, your deductibles are going to go up, your bills are going to go up.' Republicans hope to pass the bill by 4 July.
Yahoo
23-05-2025
- Business
- Yahoo
Trump's Tax Bill Would Decimate the Affordable Care Act
President Donald Trump and Republicans' 'big, beautiful,' tax bill already promises to leave millions of Americans without access to Medicaid and food assistance programs. The GOP is using Congress' massive budget reconciliation bill to slash taxes on the wealthy and enact a host of right-wing policy dreams, and among them is the fulfillment of their more than decade-long fixation on gutting the Affordable Care Act (ACA). Republicans plan to allow for the expiration of subsidies that help people afford individual health insurance plans, a move that would lead to a steep rise in prices for Americans who purchase coverage through the ACA marketplace. The version of the reconciliation bill passed Thursday by the House of Representatives would also prohibit passive re-enrollment for ACA plan users who receive financial assistance; increase penalties for incorrect reporting of income; place further restrictions on enrollment periods; and create new bureaucratic hurdles to obtaining premium tax credits, in ways that experts say will cause many to forgo or lose coverage. In addition to the bill's efforts to force millions off Medicaid and trim payments to health care providers for patients on the safety-net program, which provides health insurance to low-income and disabled Americans, the legislation would slash states' funding for Medicaid if they allow undocumented migrants or 'lawfully present' individuals (mostly children) to enroll in ACA plans. The sum total of Republicans' health care policies — including their changes to Medicaid and the ACA, and the expiration of expanded premium subsidies — are expected to result in roughly 14 million Americans losing their health insurance coverage. In a letter to House leadership, 18 state-level ACA marketplaces warned of the potential devastation. 'The Americans who depend on the marketplaces include working parents, small business owners, farmers, gig workers, early retirees, and lower and middle-class individuals of all ages, political views, and backgrounds who drive our local economies and make both our rural and urban communities thrive,' they wrote. 'These proposals, in total, will drastically diminish the progress on health coverage that the United States has made in the last decade via marketplaces. Only the sickest patients may remain in the marketplaces, skyrocketing costs for everyone.' 'Millions of Americans will lose their health coverage, local hospital systems will face unprecedented financial strain, state operational costs will spike in order to implement burdensome new federal rules, and all of this is likely to result in insurance carriers pulling out of local insurance markets. Some states may even be forced to walk away from state-based marketplaces entirely,' they warned. 'This bill's intent is to drown Americans in paperwork in order to make it harder to get on and stay on coverage,' Anthony Wright, Executive Director at Families USA, told Rolling Stone. 'Right now, if you are apply, if you are in the exchange — whether it's DC Health Link, or Covered California, or New York State of Health, or — and you are applying for coverage with a tax credit, right now most of those systems are based on electronic verification,' Wright says, explaining that state marketplaces have access to federal systems so they can — 'not automatically, but pretty seamlessly' — verify a person's eligibility. The current Republican bill would eliminate provisional eligibility for advanced premium tax credits, and deny the tax credits to consumers while they await a determination. It would also prohibit 'passive re-enrollment' for individuals who've purchased ACA plans with advanced premium tax credits. The new system would require plan-holders to re-submit their verification during the enrollment period. If not, they would be re-enrolled in a plan without a tax credit, which would in effect put them on the hook for the full price of their premium, which they likely cannot afford given their income status qualified them for a tax credit. According to the Commonwealth Fund, 93 percent of ACA marketplace enrollees use an advanced premium tax credit to pay for their plans. While some of the changes would result in direct coverage denials, the majority of lost coverage would likely be due to individuals opting out of the system due to the much higher premium costs they'd be expected to absorb, as well as the confusing, time-consuming, and nonsensical red tape Republicans are deliberately placing on them. 'They're actually taking us back to the Stone Age of what it means to sign up for coverage in terms of paperwork and bureaucracy,' says Wright, adding that there are electronic systems to make the process 'much easier, and we have been doing it for the last 15 years.' Larry Levitt, executive vice president at the health research organization KFF, tells Rolling Stone that the tax bill is 'not [a] repeal of the Affordable Care Act, but it, in many ways, has the same effect of dramatically increasing the number of people without health insurance.' After the House passed the reconciliation bill Thursday, Levitt wrote on X that 'it would represent the biggest rollback in federal support for health care ever.' More from Rolling Stone House Passes Bill That Would Gut Climate Tax Credits for Americans Here's Where to Find Birkenstocks On Sale Before Their Tariff Price Hike GOP Lawmaker Who Owns a Gun Shop Takes Credit for Silencer Tax Breaks Best of Rolling Stone The Useful Idiots New Guide to the Most Stoned Moments of the 2020 Presidential Campaign Anatomy of a Fake News Scandal The Radical Crusade of Mike Pence
