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Axios
07-07-2025
- Business
- Axios
Trump bill's health effects won't be felt until after midterms
President Trump's tax and spending bill sets in motion nearly $1 trillion in cuts to Medicaid and other health policy changes that could loom over the midterm elections. But the real effects likely won't be felt until well after the ballots are cast. Why it matters: Despite negative polls and headlines, bill supporters could be insulated from political blame by a slow drip of policy changes that will play out over the next decade — a contrast to when the GOP tried to repeal Obamacare in 2017. "Republicans backloaded a lot of the Medicaid and ACA cuts," said Larry Levitt, executive vice president at KFF. "There will be few tangible effects in health care from this bill before the midterms." That creates a messaging challenge for Democrats, he added. "There's not going to be a day where everyone wakes up and all of a sudden ... more people are uninsured." What's inside: Medicaid work requirements, which account for many of the nearly 12 million people projected to lose coverage under the bill, generally won't kick in until 2027, and some states could get extensions. Though beneficiaries will get warnings ahead of time, able-bodied recipients ages 19 to 64 wouldn't actually be dropped from program rolls for failure to meet or properly report the required 80 hours a month until after November 2026. The bill also increases the frequency of Medicaid eligibility checks to every six months, starting on Dec. 31, 2026. People in the Medicaid expansion population who retain coverage under the new system could have to pay up to $35 in cost-sharing per service starting in October 2028. The phasedown of Medicaid provider taxes and state-directed payments, which states use to help fund their share of program costs and which hospitals in particular have come to rely on for funding, only begins in 2028. The legislation's $930 billion cut to federal Medicaid funding will likely force states to make corresponding cuts to their programs or pick up a greater share of obligations, but those wouldn't take effect right away, either. Yes, but: People covered through the Affordable Care Act exchanges will see changes more swiftly. The bill does not extend the Biden-era enhanced premium subsidies, which are set to expire on Jan. 1, 2026. The GOP-led Congress still can do so, but has shown little appetite so far. Obamacare premiums would increase by more than 75% on average for enrollees next year without the enhanced subsidies. That would give Democrats "a very potent talking point going into the midterms," Levitt noted. Medicaid funding of Planned Parenthood will also be cut off for next year under the bill — a change the family planning organization said could result in the closure of nearly 200 clinics. Restrictions on which lawfully residing immigrants can access Medicaid will go into effect on Oct. 1, 2026, just before the primaries. Reality check: Hospitals and clinics have to plan ahead and already are making contingencies for the Medicaid cuts and coverage losses. That could translate into facility closures or the elimination of some services. Case in point: Community Hospital in McCook, Nebraska, announced last week that it's closing as a result of uncertainty over the upcoming Medicaid cuts, per Nebraska Public Media. What to watch: Patient advocates and provider groups will likely press Congress to further delay the provisions, or stop them from taking effect. Sen. Josh Hawley (R-Mo.), who argued against the steep health insurance cuts before voting for the package, said he would"do everything in his power" to reverse the future Medicaid cuts. "The fact that this all plays out over a period of time creates an opportunity for opponents to try to delay and overturn," Levitt said. Democrats, meanwhile, plan to launch the first fusillade of ads about the cuts in swing states this week, and want to turn the August recess into a referendum on the bill at town halls and through mobilization efforts. "House Democrats will spend every day of the next 16 months making sure moms, dads, seniors, and veterans know that Republicans took away their health care, raised their energy bills, and hiked their grocery costs," Democratic Whip Katherine Clark of Massachusetts said in a statement. The bottom line: If nothing changes, it will take nine years for the effects of the bill to fully play out.
Washington Post
25-06-2025
- Health
- Washington Post
Transcript: The Price of Care
MS. WINFIELD CUNNINGHAM: Hello, and welcome to Washington Post Live. I'm Paige Winfield Cunningham, a health care reporter here at The Post, and today we have two segments on health care costs and what's cooking in health care policy these days. Later, we'll hear from Jeanne Lambrew and Larry Levitt, where we'll take a deep dive into the One Big Beautiful Bill Act.
Yahoo
04-06-2025
- Business
- Yahoo
The GOP's 'big, beautiful bill' would leave 10.9 million more uninsured, CBO says
The Republican party's "big, beautiful bill" would leave 10.9 million fewer people in the US with health coverage while cutting more than $1 trillion in spending from federal insurance programs over a decade, the nonpartisan Congressional Budget Office reported on Wednesday. Most of the coverage losses would be due to changes in Medicaid, the health program for low-income, elderly, and disabled children and adults, including new work requirements that are expected to knock millions from its rolls. The rest would be due to reforms to the Affordable Care Act that could make buying insurance through its marketplaces more difficult while also limiting benefits for immigrants. By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Healthcare experts have described the cuts as unlike any in history and warned that they would undo much of the progress the US has made in reducing the number of people without insurance since the Affordable Care Act passed in 2010. 'This would be the biggest rollback in federal support for healthcare ever,' Larry Levitt, executive vice president for health policy at the think tank KFF said on X. The new numbers are similar to previous estimates from Capitol Hill, but they were updated to reflect the final version of the legislation passed by the House of Representatives last month and to show how different portions of the bill would interact with each other. According to the CBO, the GOP's legislation would reduce Medicaid enrollment by about 7.8 million. Much of the drop would be due to new rules requiring that able-bodied, childless adults spend at least 80 hours a month at work, in community service, or in an education program. The change is expected to shave $344 billion from the program, out of about $780 billion in total cuts. The White House has tried to cast doubt on the CBO's numbers, suggesting with little evidence that its staff may be politically biased. Other Republicans have argued that the office's estimates are simply overblown and that the work rules are a 'common sense' reform that won't reduce coverage for individuals who truly need it. 'You're telling me that you're going to require the able-bodied, these young men, for example, to only work or volunteer in their community for 20 hours a week. And that's too cumbersome for them?" House Speaker Mike Johnson said on this Sunday's "Meet the Press." "I'm not buying it. The American people are not buying it." But other healthcare experts have argued that work requirements are likely to block many Americans from coverage they are legally eligible for simply by piling on paperwork and red tape. They point to Arkansas' brief attempt to impose work rules during the first Trump administration, which led to about 18,000 residents losing coverage even though 'nearly everyone who was targeted by the policy already met the requirements,' as one study found. Many of the bill's changes to the Affordable Care Act are more technical, but together they would narrow the opportunities for individuals to sign up and stay enrolled. They include shortening the open enrollment period and ending the ability of lower-income adults to buy coverage throughout the year. Customers will also no longer be able to automatically reenroll in their health plan from year to year, thanks to new requirements that they annually verify their income and residency. Conservatives have argued that the changes are necessary to prevent fraudulent enrollments on the insurance exchanges, but more left-leaning experts have argued that the bill is simply trying to cut spending by throwing up unnecessary roadblocks. 'What they've done in both the marketplaces and Medicaid is that they've made it much harder to get and maintain your coverage,' said Sara Collins, vice president for healthcare coverage and access at the Commonwealth Fund. Republicans have emphasized that some of their reforms are intended to cut coverage to illegal immigrants. For instance, the bill would ban states from using their own money to extend Medicaid coverage to undocumented residents, which the CBO estimates will lead to about 1.4 million more people uninsured. The majority of coverage losses would fall on American citizens and legal residents, however, with 9.5 million more uninsured. Separately from the GOP bill, the number of Americans without insurance is expected to increase significantly after next year when expanded Obamacare subsidies passed under the Biden Administration are set to expire, significantly increasing premiums. The CBO has forecast that about 4.2 million fewer people will have coverage as a result. Between those losses, the One Big Beautiful Bill Act, and regulatory changes the Trump administration has proposed, the office has projected that about 16 million fewer Americans will be insured over the coming decade. Matthew Fiedler, a healthcare expert at the Brookings Institution, estimates that the US uninsured rate will increase to about 12 percent from around 7.7 percent today — undoing about half the decline since the Affordable Care Act was passed in 2010. 'We're on track for a fairly unprecedented increase in the uninsured rate,' he said. Jordan Weissmann is a Senior Reporter at Yahoo Finance. Sign up for the Mind Your Money newsletter
Yahoo
22-05-2025
- Business
- Yahoo
There's a reason Republicans want to hide what's in their megabill
Early Wednesday, when most Americans were snuggled in their beds, Republicans in the House of Representatives were working hard to take away the health care of millions of Americans, blow a $3 trillion hole in the budget deficit and make the wealthiest people in America richer and the poorest Americans poorer. If this sounds like hyperbole, it's not. The GOP-controlled House Rules Committee convened at 1 a.m. Wednesday morning to discuss a bill that hasn't been fully drafted and the provisions of which were still part of intense negotiations. Indeed, the real work on the legislation was happening behind closed doors as House Speaker Mike Johnson, R-La., tried to cobble together enough votes to pass something, anything, so he could meet his self-imposed deadline for a floor vote by Memorial Day. Late Wednesday, GOP leaders released yet more significant changes to the bill, and on Thursday morning the full House passed the bill by a single vote. What we do know about the legislation the GOP is calling the 'One Big Beautiful Bill Act' is genuinely terrifying. According to an analysis published Tuesday by the Congressional Budget Office, the numbers in the GOP's draft legislation are brutal. The bill would increase the federal deficit by $3.8 trillion — a rise that is spooking bond markets already worried about the president's tariff increases. The bill would slash $267 billion in federal spending for SNAP, which more than 42 million low-income people rely on to put food on the table for their families. And it would cut nearly $700 billion from federal funding for Medicaid. The CBO estimated Tuesday that the Medicaid cuts could cause roughly 8 million people to lose their health insurance coverage, and that number could rise to 15 million thanks to other provisions in the legislation. The amendments revealed Wednesday, writes Larry Levitt, executive vice president for health policy at KFF, surely 'would lead to more people losing health insurance.' But Republicans scrambled to vote Thursday before the CBO could update its totals. All this is being done to extend the Trump tax cuts, which disproportionately benefit wealthy people. The impact of the GOP's bill is extraordinary in both its cruelty and its extreme inequality. According to the CBO's estimate, household resources for the poorest people would decrease by 4% over the next eight years, while the richest people's household resources would increase by 4%. If enacted, the bill would constitute the largest transfer of wealth from the needy to the wealthy in American history. It's no wonder, then, that Republicans were rushing this bill through while most Americans slept. If you were robbing the poor on behalf of the rich, you, too, would do it in the dead of night. This obfuscation has become par for the course as this legislation has wound its way through Congress. As Bulwark's Jonathon Cohn pointed out last week, the House Energy and Commerce Committee, which is responsible for overseeing Medicaid, hasn't held a single hearing to examine the implications of these changes to the American health care system. Instead, it merely held a markup hearing to move the legislation closer to a vote on the House floor. What makes this situation even worse is that Republicans, from the president on down, are consistently lying about what the bill would do. Earlier this week, White House press secretary Karoline Leavitt claimed that this bill, which would blow a $3 trillion hole in the federal budget, wouldn't increase the deficit. Leavitt even claimed that there are '$1.6 trillion worth of savings in this bill' and that this number represents 'the largest savings for any legislation that has ever passed Capitol Hill in our nation's history.' (Leavitt provided no source for this figure, and it appears she simply referred to the spending cuts in the bill while ignoring the trillions in lost revenue that will come from the tax cuts.) It is as stunning a lie as perhaps any other uttered by members of the Trump administration (and that is saying something). Even one House Republican, Thomas Massie of Kentucky, is publicly calling the White House and his colleagues liars for promoting this fiction. On Tuesday, President Donald Trump traveled to Capitol Hill to lobby Republicans and told reporters that Republicans are 'not doing any cutting of anything meaningful. The only thing we're cutting is waste, fraud and abuse.' This, too, is a bald-faced lie. House Republicans have consistently claimed that the bill's work requirements for Medicaid recipients are meant to get the 'able-bodied' into the workplace. Such people, according to the No. 2 Republican in the House, Steve Scalise of Louisiana, are 'living in their mom's basement playing video games.' In fact, nearly two-thirds of those on Medicaid are already working. Almost all other recipients aren't working because of caregiving, school, illness or disability. In states where work requirements have been imposed on Medicaid recipients, the result is a drop in coverage, which almost certainly is the reason Republicans are including them in their big, beautiful bill. The fewer people on Medicaid, the greater the cost savings, and the more money there is for tax breaks. Indeed, what is happening on Capitol Hill can hardly be described as legislating. Making laws means hearing from experts, considering data and weighing pros and cons. The GOP's 'Big, Beautiful Bill' is none of those things. It's highway robbery, and Republicans desperately don't want the American people to know that they are the ones holding them up. This article was originally published on
Yahoo
21-04-2025
- Health
- Yahoo
Supreme Court hears challenge to Obamacare no-cost preventive health benefits
Preventive care health benefits provided at no cost to tens of millions of Americans since 2010 under a popular provision of the Affordable Care Act are in the balance Monday at the U.S. Supreme Court as the justices consider whether the government task force behind the mandate to insurers is unconstitutional. Among the services the U.S. Preventive Services Task Force designates for no-cost coverage under the federal health law are statins to lower cholesterol; colonoscopies for 45- to 49-year-olds; preexposure prophylaxis (PrEP) medicine to reduce the spread of HIV; medications to lower the risk of breast cancer for women; and lung cancer screenings for smokers. The case was brought by a group of employers and individuals who oppose some of the task force's recommendations for covered services on religious groups, specifically the PrEP medication to prevent HIV. They allege the group's structure violates the Constitution and lower federal courts agreed. MORE: Supreme Court to hear arguments over injunctions on Trump bid to end birthright citizenship If the justices uphold the decisions, the task force and its recommendations since 2010 could be invalidated -- and along with them the guarantee of no-cost preventive services coverage many people enjoy. "The case is not the kind of existential threat that we have seen in previous Supreme Court cases involving the ACA, but it's certainly something that could affect a lot of people," said Larry Levitt, executive vice president at KFF, a nonpartisan health policy group. At the heart of the dispute is whether the structure of the 16-member task force is illegal under the Constitution's Appointments Clause. The provision requires "principle officers" of the U.S. government, such as Cabinet secretaries and ambassadors, to be confirmed by the Senate. It stipulates that "inferior officers" who are appointed by Senate-confirmed officials are permissible, provided they are supervised and reviewed. The plaintiffs allege that members of the task force, who are appointed and supervised by the Health and Human Services secretary, are not properly appointed and have too much power. While they can be removed at will, their recommendations for covered health services cannot be reviewed or overridden by anyone. 'Americans have the constitutionally protected freedom to live and work according to their religious beliefs, and governments exist to defend that freedom," said Daniel Grabowski, an attorney with Alliance Defending Freedom, a conservative legal advocacy group supporting the plaintiffs. "We urge the Supreme Court to restore this accountability within the federal government and to the American people.' The Fifth Circuit U.S. Court of Appeals ruled the task force unconstitutional and that its recommendations since 2010 be invalidated. The Trump administration is defending the constitutionality of the task force and the health secretary's power to oversee the body's recommendations. More than 150 million Americans rely on early screenings and interventions for chronic conditions under no-cost preventive services, according to American medical organizations. Public health groups say a decision striking down the task force could deeply affect the long-term health of Americans and disease prevention efforts. Insurers worry that it could inject instability into the insurance market, while hospital groups fear they may have to shoulder more of the burden from people who are sicker. MORE: Supreme Court tepid on Trump while defending power to check president: ANALYSIS "The ACA's preventive services requirement has been a game-changer, providing access to evidence-based preventive care and early detection of serious medical conditions," said Wayne Turner, a senior attorney at the National Health Law Program, a nonprofit group that advocates for low-income communities. "The ACA's coverage and cost-sharing protections are especially important for low-income persons, who will be harmed most if the Supreme Court refuses to allow the ACA provision to stand." Oral arguments in the case -- Kennedy v. Braidwood Management -- will be heard at the Supreme Court on Monday. A decision in the case is expected by the end of June. Supreme Court hears challenge to Obamacare no-cost preventive health benefits originally appeared on
