Hospitals across U.S. laying off staff, pausing payments amid Medicaid funding delays: WSJ
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The Hill
2 hours ago
- The Hill
How Trump's megabill will impact health care
The massive tax cut legislation passed by the House and Senate this week will dramatically upend health care in America. The legislation, now on its way to President Trump, was never framed as a health bill, but it will mark the biggest changes to U.S. health policy since the Affordable Care Act (ACA) was passed in 2010. The bill's provisions will impact patients, doctors, hospitals, and insurers, as Republicans partially paid for it by cutting more than $1 trillion from federal health programs. The bulk of the cuts are coming from Medicaid. As a result, changes are coming that will affect how people qualify for and enroll in the program that covers more than 70 million low-income and disabled Americans, as well as how they can maintain coverage. 'No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud, and abuse,' American Hospital Association president Rick Pollack said in a statement. 'The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.' Almost 12 million lower-income Americans would lose their health insurance by 2034, according to the Congressional Budget Office (CBO), blunting the significant coverage gains made under the ACA. The cuts were deep enough to give some Republicans in both chambers pause, but in the end, only two GOP House members and three senators voted against the bill. It passed the Senate 51-50, and the House 218-214. Here's how the bill could impact Americans: By design, the group that would be hit the hardest are people whose income is between 100 percent and 138 percent of the federal poverty level (roughly between $32,150 and $42,760 for a family of four) who gained insurance when their states expanded Medicaid. The most significant change will be a first-ever requirement for adults under age 65 — including low-income parents of children older than 14 — to prove they work, volunteer or go to school at least 80 hours a month. States will need to develop and launch systems to verify individuals' work status at least every six months, beginning in December 2026. Health experts and advocates warn that a blizzard of red tape and administrative hurdles will strip people of needed health care, even those who would normally be eligible. GOP lawmakers say they are fine with those consequences, even those who have said they oppose cutting Medicaid benefits, because the requirements will only target the 'able-bodied' people who should be working but choose not to. Groups such as the disabled, pregnant women and people who are in prison or rehabilitation centers would be exempt from the requirements. Those people, Republicans say, are the truly needy. But someone who qualifies would need to prove they are exempt, which would require submitting the correct forms and documentation — in the correct order — at the time they apply for Medicaid and after they are already enrolled. Outside of work requirements, the legislation requires states to do an extra eligibility check on Medicaid enrollees starting in 2027. Checking every six months opens the possibility of a person losing coverage mid-year. The bill will also require people with incomes above the poverty line to pay out-of-pocket copays for most Medicaid services, like lab tests or doctor visits. States will be allowed to charge up to 5 percent of a person's income per year, though some Democratic-led states may opt for a smaller amount. Primary care, mental health and substance abuse services are exempted, and prescription drugs would only have a nominal copay. The bill could also limit the number of clinics available to patients who need abortions, even in states where it's legal. It targets Planned Parenthood without explicitly mentioning the organization by banning federal Medicaid funds from going to clinics that offer abortions. Nearly 200 Planned Parenthood health centers in 24 states across the country are at risk of closure, the organization said. More than 90 percent of those closures would occur in states where abortion is legal. The legislation will make it more difficult for people to sign up for and afford health plans on ACA exchanges. It will limit eligibility for premium subsidies to people living in the U.S. who are not eligible for any other federal insurance program. It will also bar most immigrants and lawful permanent residents from receiving the subsidies. The bill will require real-time verification of eligibility before a person can receive those subsidies to help afford premiums. Currently, anyone who purchases a subsidized plan can begin using it almost immediately. The state or federal government has 90 days to determine eligibility. But under the new bill, people won't have access to cheaper premiums until they are deemed eligible. In addition, people who sign up for ACA coverage during some special enrollment periods will not be eligible for subsidies. The bill will also end automatic reenrollment ahead of the 2028 sign-up period, meaning enrollees will need to update their income, immigration status and other information each year. According to health research group KFF, 10 million people were automatically reenrolled in ACA plans in 2025. The GOP bill could pose a major problem for rural hospitals, and subsequently the patients who rely on them. Changes to state-levied provider taxes would reduce spending by nearly $191 billion over a decade, according to the CBO estimate. An analysis of an earlier version introduced in the Senate by the National Rural Health Association and Manatt Health found the legislation generates $58 billion in Medicaid cuts over the next ten years for rural hospitals. The bill that passed includes a five-year, $50 billion rural health relief fund, but provider groups say it's a band-aid compared to the overall cost of the cuts. Hospitals would see a spike in uncompensated care and overcrowding of emergency rooms. 'Millions of Americans will see their health care coverage vanish through burdensome Medicaid work requirements and other eligibility changes throughout the bill. Hospitals across the country have been destabilized, affecting their ability to serve patients and their communities. We are in a crisis,' said Bruce Siegel, president and CEO of America's Essential Hospitals, a group that represents hospitals serving primarily low-income patients. 'Widespread coverage losses plus weakened hospitals is a recipe for disaster, and patients will pay the price.'
USA Today
3 hours ago
- USA Today
Trump doesn't know what it means to be a veteran. His budget bill punishes us.
President Donald Trump doesn't know what it's like to be a veteran. And, based on his policies, he doesn't care to learn from those of us who do. Imagine going to war to protect your country and coming home to find your country no longer protects you. Under President Donald Trump, this could be the new reality for the 15 million veterans who depend on VA health care. His "One Big Beautiful Bill" budget includes changes to the Department of Veterans Affairs, meaning Kentucky veterans like me might have to wait longer for the medical care, including mental health care, that was promised to us in exchange for service to our country. According to the Center on Budget and Policy Priorities: "Veterans could be particularly harmed by Medicaid and (food stamps) cuts given the complexity of their health care needs and their higher prevalence of food insecurity compared to non-veterans." His disrespect toward those who have served doesn't stop there. According to FactCheck: "The U.S. Department of Veterans Affairs changed the wording in its bylaws to comply with recent executive orders. In making the changes, words including 'national origin, politics, marital status' were removed from language prohibiting discrimination. But existing federal law already prohibits discrimination on those grounds, the VA says." 'Extremely disturbing and unethical' is right on the money One doctor called the change 'extremely disturbing and unethical.' While that's how you could describe a lot of Trump's decisions these days, this one targets our troops with a dangerous type of loyalty test – as if being willing to die for your country wasn't test enough. Kentucky vets already wait months to settle VA claims and get the benefits and care they've earned. Now, between Trump's mass VA layoffs, proposed budget cuts and this new change in bylaws, the gap between what Kentucky veterans get and what they deserve will get even wider. People willing to fight for this country should not have to wait months for benefits and be forced to drive hours just to see a doctor. And they shouldn't have to worry about getting turned away for wearing the wrong hat. Opinion: Hegseth stripping Harvey Milk's name off Navy ship is weak and insecure This is an insult to veterans It is an insult to subject these men and women to political intimidation tactics after they've put their lives on the line to defend democracy, religious freedom, freedom of speech – the most valuable principles of our nation. And I'll tell you, discrimination ain't one of them. Opinion: You think Republicans realize they've started hurting the wrong people? Taking care of veterans should be a place where Democrats and Republicans find common ground, but right now the GOP is applauding a man who uses troops as birthday party decorations while cutting the care they need to survive. Opinion alerts: Get columns from your favorite columnists + expert analysis on top issues, delivered straight to your device through the USA TODAY app. Don't have the app? Download it for free from your app store. Donald Trump doesn't know what it's like to be a veteran. And, based on his policies, he doesn't care to learn from those of us who do. We cannot let our troops come home to a country where their lawful political beliefs could get them punished. If someone is willing to defend American principles with their life, we'd better make damn sure those principles apply to them, too. Bud Andrews is a retired Army master sergeant who lives in Lawrenceburg, Kentucky. This column originally published in the Louisville Courier-Journal. You can read diverse opinions from our USA TODAY columnists and other writers on the Opinion front page, on X, formerly Twitter, @usatodayopinion and in our Opinion newsletter.
Boston Globe
7 hours ago
- Boston Globe
Medicaid, food aid recipients worry about safety net cuts in bill sent to Trump
Work requirements added for accessing more federal benefits To enroll and stay on Medicaid, many ages 19 through 64 would be required to work, go to school or perform at least 80 hours of community service a month. The Medicaid work requirement would apply to people in 40 states who are enrolled through expanded access that states agreed to put in place since 2014. Ten states, including Texas and Florida, did not expand the program. Advertisement For the Supplemental Nutrition Assistance Program, or SNAP, which already requires adults ages 18 to 55 to work, working would become mandatory for many until they turn 65. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up For both benefits, there would be exceptions, including for parents who are caregivers to children under age 14. Most people covered by Medicaid already meet the work requirement or qualify for an exception. The requirements are sparking worry for some enrollees Theresa Gibbs, who lost her job as a school bus driver, is enrolled in both Medicaid and SNAP. She likely would be exempt from the work mandate because she has three children under age 14. But Gibbs said she is applying for jobs anyway. 'I don't think people should just live off the state if they're perfectly capable to work,' said Gibbs, 34, of Jefferson City, Missouri. Advertisement But the changes worry others. Amanda Hinton, 39, of St. Martins, Missouri, receives Medicaid and SNAP benefits. She puts in enough hours at a part-time gas station job to likely meet the new requirements but is concerned should her fibromyalgia, which causes pain and fatigue, keep her from working for a time. 'I'm panicked. I mean I have some chronic health conditions that are not curable, and I rely on my medication to help me just get through the day,' she said. 'And without my Medicaid, I couldn't afford these.' Brittany Phillips, 32, of Greensboro, North Carolina, said being on Medicaid has helped her stay afloat both financially and health-wise while she works a temporary, remote medical services job paying about $600 weekly. 'I do believe that Medicaid should be available for everyone regardless of who they are -- regardless of capacity, faculty -- everyone should have Medicaid,' she said. It's not just the work requirement; it's also the paperwork The nonpartisan Congressional Budget Office estimates that 11.8 million fewer people could have health insurance by 2034 because of the changes, which also include booting off non-citizens who are not in the U.S. permanently and legally. And that doesn't include those who could lose coverage for other reasons. Advocates say that even people who are covered by exceptions to the work requirement could lose their Medicaid coverage. One major reason is a requirement that people's eligibility would be assessed at least every six months. 'Every additional paper someone has to submit separately from their application,' said Deborah Steinberg, a senior health policy analyst at the Legal Action Center, 'you lose people.' Julia Bennker, who runs an in-home daycare in Eau Claire, Wisconsin, relies on SNAP and Medicaid and has had paperwork issues under existing Medicaid requirements. She said that earlier this year, she didn't have health coverage for a month after she was told her forms were late — though she believes she submitted them on time. Advertisement That meant going a month without therapy and needing to reschedule another appointment with a prescriber. Some of the conditions that would trigger exceptions — mental illness or substance use disorder — are not currently tallied in Medicaid computer systems. 'It's not like you wave a magic wand and everyone who should be exempt is exempt,' said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. States will face pressure - and deadlines - to revamp their programs State health care and social services agencies will have to rework their computer systems to account for the various changes while also dealing with federal funding reductions. That's cause for concern for some health care advocates. The legislation requires all states to shoulder more of the administrative costs of SNAP starting in 2027 and, for the first time, could force some states to pay for a portion of food assistance benefits starting in 2028. States also must implement the Medicaid work requirement by 2027. 'It will be a very tight and difficult timeline for many of these states,' said Sophia Tripoli, senior health policy director at Families USA, a health care advocacy organization. 'There's a huge cost burden on states from the administrative side just to stand up these systems.' Julieanne Taylor, a lawyer at the Charlotte Center for Legal Advocacy in North Carolina, said her organization's clients already face delays in verifications for the food program. 'To add more to them, it's going to be a disaster,' she said. 'It's going to cause people to drop off because they're like, 'I don't want to have to do this every year or every six months.'' Advertisement Rural hospitals could face financial struggles The bill could also put rural hospitals at financial risk, experts say, because it seeks to cap the taxes that states impose on hospitals and other health care providers in a way that boosts Medicaid funding. The nonprofit KFF, which studies health care issues, estimates that Medicaid spending in rural areas would decrease by $155 billion over the next decade under the bill. 'While there are already a number of small and rural hospitals that are vulnerable,' said R. Kyle Kramer, CEO of Day Kimball Hospital in Putnam, Connecticut, 'it's going to lead to a lot of closures.' The bill includes a $50 billion fund to partially offset those reductions. Planned Parenthood would lose federal money Federal taxpayer money is already barred from paying for abortions in most cases. The bill would also ban federal funds going to Planned Parenthood, the nation's largest abortion provider, for other purposes like family planning programs and cancer screenings. The group says that one-third of its roughly 600 clinics across the U.S. could face closure as a result of the legislation, and that states where abortion is legal would be hardest hit. At least one other group says it also stands to lose funding because of the provision. Maine Family Planning has 19 sites and subcontracts with other health care organizations, including Planned Parenthood, to provide services at other locations across the rural state. Mulvihill reported from Cherry Hill, New Jersey. Susan Haigh in Hartford, Connecticut, and Gary D. Robertson in Raleigh, North Carolina, contributed to this report.
