Yesterday (twenty eighth) I launched the first half of Charles Gaba commentary. In case you forgot what it was, you will discover it right here: Twenty-one Million Individuals to Lose Healthcare – Indignant Bear for reread. Charles does a radical job of discussing what Repubs are planning on doing to a sizeable variety of residents.
To the appropriate, I’ve included the Pie Chart (from the primary submit) which reveals the 21 million residents, the Republicans are going to tear healthcare away from in order to assist subsidize tax breaks for the higher 5% of taxpayers largely focusing on the higher 1%. Click on on iy to enlarge. A list of these funds is within the first commentary. Hyperlink above or right here.
Lets transfer on to half 2.
Republicans have determined which 21 million Individuals ought to lose their healthcare Half 2
Charles Gaba
There are 42 Home Republicans who received their seats final November by 15 factors or much less (see beneath). These are essentially the most susceptible Republicans. In the meantime, Democrats have been outperforming their districts by a mean of over ten factors in particular elections to this point this 12 months.
Mix these information factors with the rising backlash and as you’ll be able to think about, some Home Republicans in swing districts (and not-normally-considered swing districts) are understandably nervous about ripping healthcare protection away from as much as 60% of their constituents (that’s not a typo . . . take a look at CA-22).
The optics look even worse for Republicans when Democrats have been efficiently calling consideration to the enormous numbers of kids, the aged and the disabled who depend on Medicaid, as famous by my good friend & colleague Andrew Sprung (Andrew Sprung is an effective one to learn as he affords up nice element).
Right here is the core protection in a letter from Households USA, co-signed by greater than 300 advocacy teams, to Senate Majority Chief John Thune, asking him to reject the home finances decision:
Medicaid is a lifeline for communities throughout the nation. It gives inexpensive medical health insurance to nearly 80 million Individuals—1 in 5 folks dwelling in america—and serves as a monetary spine of the well being care system, together with for the clinics and hospitals on which all of us rely. Medicaid delivers important care to 37 million kids, 14 million folks dwelling in rural areas and greater than 8 million folks with disabilities. It helps 7 million seniors and 12 million Medicare enrollees. It additionally covers greater than 40 p.c of all births and is the one largest payer to neighborhood clinics, for long-term care, and for psychological well being and substance use dysfunction companies within the nation.
So, what’s a Republican Home member to do? They have to have their huge tax cuts for millionaires & billionaires, in spite of everything; that’s not even up for debate of their minds!
Properly, as Sprung goes on to notice, the very advocacy for these susceptible teams of Individuals has additionally supplied the “solution” to Republicans’ drawback of their eyes:
Republicans are on the market proclaiming that “able-bodied” adults don’t deserve protection, that the 90% federal match fee for the growth that made it financially viable for states sucks assets from “traditional” Medicaid beneficiaries (it doesn’t), that defunding the growth is simply slicing “waste, fraud, and abuse” — that’s, that low-income adults with out inexpensive entry to employer insurance coverage are successfully human waste. The copious advantages to growth beneficiaries themselves and to state healthcare methods and funds stemming from the growth must be defended immediately.
Certain sufficient, simply a few days in the past, Punchbowl Information reported that:
A dozen Home Republicans are warning GOP leaders that they received’t again a reconciliation package deal that features huge cuts to Medicaid, in line with a letter first obtained by Punchbowl Information.
(Sidenote: Punchbowl doesn’t seem to know simply how “massive” the cuts to Medicaid these dozen Home Republicans are OK with can be, as I’ll clarify beneath).
.“We help focused reforms to enhance program integrity, cut back improper funds, and modernize supply methods to repair flaws in this system that divert assets away from kids, seniors, people with disabilities, and pregnant girls — those that this system was supposed to assist.
“However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”
…“There’s reasonable actions we can support like work requirements for able bodied adults without children and auditing the Medicaid list,” Bacon advised us. “But there will not be the votes to cut Medicaid for those who need it or to the hospitals that we need to preserve.”
Kim mentioned in an announcement {that a} reconciliation package deal “that does not protect vital Medicaid services for the most vulnerable citizens in my community will not receive my vote,” including she’s made that clear to constituents and GOP management.
…Van Drew later advised reporters that Johnson promised to not lower Medicaid for people who’re “qualified” to obtain the profit. LaLota advised us that the speaker vowed to take a “compassionate approach.”
In different phrases, of the 8 concepts Home Republicans had been taking part in round with again in January, it sounds an terrible lot like they’re gonna boil it down to 2: Decreasing the FMAP matching fee and imposing work reporting necessities for the ACA growth inhabitants . . . whereas presumably “showing mercy” on the non-expansion inhabitants.
As Jason Sattler aka LOLGOP notes (and as I alluded to above). The way in which Punchbowl frames this makes it sound like these dozen Republicans are to be praised. Praising them for “only” tearing away healthcare protection from as much as 21 million folks who’re “undeserving” of it for some motive or one other.
This is similar sort of “logic” which the Trump Regime has been utilizing in attempting to justify denying due course of to individuals who they (falsely most often) have accused of being “gang members” and which Republicans writ giant have been utilizing to justify kidnapping & imprisoning folks in a international gulag as a result of they “aren’t U.S. citizens.” As if solely U.S. residents are “entitled” to be handled as . . . properly, as human beings. (And naturally they’ve been kidnapping some U.S. residents as properly, I ought to observe).
Briefly, the speaking level that Congressional Republicans have settled on is to go after ACA Medicaid growth particularly.
Jonathan Cohn of The Bulwark concurs:
Then Johnson went on Fox and, after the compulsory promise “to protect Medicare, Social Security, Medicaid for people who are legally beneficiaries of those programs,” mentioned the next:
We have now to root out fraud, waste, and abuse. We have now to remove folks on, for instance, on Medicaid who aren’t really eligible to be there — able-bodied staff, for instance, younger males who’re—who ought to by no means be on this system in any respect.
When you’ve folks on this system which might be draining the assets, it takes it away from the folks which might be really needing it essentially the most and are supposed to obtain it. You’re speaking about younger, single moms, down on their fortunes at a second — the folks with actual disabilities, the aged. And we’ve obtained to guard and protect that program. So we’re going to protect the integrity of it.
Which will sound like a protection of Medicaid and the individuals who want it, and absolutely that’s how Johnson hopes the general public will interpret it. However that can also be the language Medicaid critics have been utilizing to explain an enormous, controversial downsizing of this system — one that will undermine what was arguably Obamacare’s single greatest achievement.
So, what would really occur if “all” they find yourself doing was decreasing the p.c of Medicaid prices. These prices paid by the federal authorities for the growth inhabitants from 90% right down to regardless of the non-expansion FMAP fee is for every state?
Twelve states at the moment have “trigger” legal guidelines in place that will mechanically finish growth or require modifications if the federal match fee had been to drop, however protection can be in danger in different states given the substantial lack of federal funding. Not all set off legal guidelines would instantly finish the Medicaid growth, however enrollees in states with set off legal guidelines are at better threat of shedding protection. States are actively debating their Medicaid growth set off legal guidelines, with some states working to take away and others working to ascertain the automated termination of Medicaid growth protection if federal help declines.
Right here’s the 12 states (beneath) with set off legal guidelines. Barring laws by the person states, between 3.8*- 4.4 million Individuals can be kicked off of Medicaid from these states proper out of the gate…as much as 13.6% of their complete populations. It’s value noting that certainly one of these is North Carolina, which simply applied Medicaid growth somewhat over a 12 months in the past.
Replace*: I forgot that about 18% of these enrolled in Medicaid through ACA growth had been really already legally eligible to enroll earlier than the ACA was handed, and presumably nonetheless can be if ACA growth ended of their state; the opposite ~82% are solely or newly eligible particularly through ACA growth. I’ve up to date the desk beneath to replicate this (beneath).
The second quick consequence can be that the ten remaining non-expansion states (AL, KS, MS, FL, GA, SC, TN, TX, WI & WY), the place over 1.4 million low-income adults have been caught within the “Medicaid gap” for over a decade now would completely by no means increase their applications.
OK, however what in regards to the 16.6 million Medicaid growth enrollees within the different 19 states which did increase Medicaid?
Properly, in line with this evaluation by KFF, right here’s how a lot each growth state (together with the 12 w/set off legal guidelines) must give you on their very own so as to fill within the $626 BILLION in misplaced federal funding in the event that they wished to maintain their present growth populations coated:
These estimates are for a ten 12 months interval, besides, not many states have a number of hundred million {dollars} in additional money mendacity round every year (or a number of billion per year within the case of the bigger states). A number of of the deeper blue states would possibly discover some strategy to cowl the misplaced funds, however it might solely be a fraction of what’s wanted, and my guess is most received’t even hassle to attempt.
Replace: Nationally, of the ~21 million enrolled in Medicaid through ACA growth, round 3.6 million had been already eligible and would theoretically be capable to keep on their state’s non-ACA Medicaid program, bringing the variety of Individuals shedding protection within the occasion of each state dropping growth right down to maybe 17.6 million.
However, this could nonetheless trigger an elevated pressure on the budgets of these states which might seemingly result in decreased companies for his or her remaining Medicaid populations.
The “beauty” of this from a sociopathic MAGA Republican standpoint is {that a}) not one of the Republicans representing the ten non-expansion states must sweat it, since they by no means expanded their applications within the first place; and b) since technically there’s nothing within the laws which really reduces Medicaid eligibility for any particular inhabitants, they get to (attempt to) shift the blame to the states for not developing with the additional funds essential to preserve this system working.
This submit is getting fairly prolonged, so I’ll (Charles Gaba) handle the “work reporting requirement” scheme (in addition to the looming expiration of the ACA’s IRA subsidies) individually, however within the meantime, right here’s what focusing on the ACA Medicaid growth portion of the inhabitants appears like nationally
