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Atlantic
10 hours ago
- Health
- Atlantic
How Medicaid Cuts Will Bleed Emergency Medicine
If you have a heart attack in the United States, you might assume that an ambulance will bring you to an ER and its staff will take care of you. But hospital closures over the past 20 years and physician shortages were undermining that assumption even before President Donald Trump signed his 'One Big Beautiful Bill' into law. Now that legislation—which will cut Medicaid spending by an estimated $1 trillion over 10 years, puts the entire emergency-medicine safety net at risk. The destabilizing effects will be felt not only by those who lose access to Medicaid, but also by those who have private health insurance. As an ER doctor in New York City, I am terrified about the coming cuts. A recent study from the Rand Corporation confirms that ERs across the entire country are dangerously overstretched and underfunded. About a fifth of emergency visits each year are never paid for, amounting to nearly $5.9 billion in care costs absorbed by hospitals. The uninsured and underinsured were already more likely to have to seek treatment in the ER when they fell ill. With the changes to Medicaid eligibility, their ranks are set to swell. Medicaid provides coverage to more than 71 million Americans; in addition, the Children's Health Insurance Program (which provides low-cost coverage for children of families that do not qualify for Medicaid) covers 7 million children. Trump's legislation is expected to deprive som 12 million people of Medicaid by 2034, and an additional 5 million will lose insurance because of changes to provisions of the Affordable Care Act. The cost of replacing this lost coverage for some 17 million Americans will be especially daunting for low-income families: On average, health-insurance premiums add up to nearly $9,000 a year, whereas a full-time minimum-wage job generates just $15,000. I went into frontline medicine to help people, not to bankrupt them—yet I am acutely aware that medical debt is a major factor in nearly three-fifths of bankruptcy cases in the United States. When someone who does not have insurance comes into the ER, I am forced to discuss with the patient what necessary care they may have to delay or forgo if they cannot afford it. These conversations will become only more frequent when millions of people are kicked off their health insurance. Jonathan Chait: The cynical Republican plan to cut Medicaid The 1986 Emergency Medical Treatment and Labor Act, one of the most important public-health measures ever enacted in the United States, mandates that every emergency department must provide treatment to anyone who comes through the door, regardless of their ability to pay or their insurance status. 'People have access to health care in America,' President George W. Bush once declared. 'After all, you just go to an emergency room.' But the treatment mandate is unfunded. Bush neglected to say that patients are still charged for that visit once they receive the care they need. When they can't pay, they get hounded by a collection agency. If they still can't pay, the hospital ends up eating the cost. The downstream effect is lower staffing and fewer services. The burden of uncompensated emergency care unquestionably contributes to hospital closures. Even before Trump's huge budget-reconciliation bill passed, many people living in rural communities were at risk of losing access to health care. Of 25 hospitals that closed last year, 10 were in rural America, the industry publication Becker's Hospital Review reported; according to a nonpartisan health-policy center, another 700 rural hospitals are financially distressed and at risk of closure. Nearly half of all children and one in five adults in small towns and country areas rely on Medicaid or CHIP; half of all births in these communities are financed by Medicaid. This makes rural hospitals highly dependent on the reimbursement that they receive from Medicaid for treating those patients. The more patients who lose coverage, the greater the threat to these institutions. A report from the National Rural Health Association and the research firm Manatt Health finds that, because of Trump's BBB, rural hospitals 'will lose 21 cents out of every dollar' they'd previously received in Medicaid funding. The inevitable result will be more service cuts and more hospital closures, which will endanger everyone in these areas—even people with insurance. The rational course would be for the government to put more resources into Medicaid, so that patients in need could access care in an optimal setting, instead of visiting the ER, where treatment is more expensive to provide and less comprehensive. Supporters of the BBB purport to have data showing that patients with Medicaid misuse the ER by seeking unnecessary treatment, and they argue that visit volume will go down once they are uninsured. My own experience is that although uninsured patients see me less, they typically show up much sicker—and need more resource-intensive care. One of my regular patients has both Crohn's disease and a debilitating psychiatric condition. He has no family support, usually lives in a shelter, and only sometimes has a job. After requiring an emergency intestinal surgery last year, he now comes into the ER every few days to have his ostomy bag changed, because the only clinic that takes Medicaid is in another borough. In an ideal world, he would have access to a clinic with wound-care nursing and social support. In this far-from-ideal world, taking away his Medicaid will not stop him from having chronic disease. This patient could try to skip visits, but he will have to come to the ER when he gets an infection or his illness flares again, and then he will also be stuck with a bill that will hurt his credit rating and set back his efforts to pull himself out of poverty. The hospital, too, will be worse off—forced to absorb the cost of his treatment when previously it did receive at least small payments for his visits. In short, any appearance of less demand on health-care resources is a mirage; the real outcome will be worse health for the patient and higher costs for his health-care providers. Imagine various such scenarios replicated all across the country, when millions of people lose Medicaid coverage. In a letter to Senate leadership last month, the American Medical Association's chief executive, James Madara, warned that the proposed law 'could lead to delays in treatment, increases in emergency room visits and hospitalizations, and other expensive forms of care.' His appeal went unheeded, as Congress passed the legislation on largely party-line votes. As Alison Haddock, the president of the American College of Emergency Physicians, put it: 'The very idea of emergency medicine as we now know it—lifesaving care available for anyone at any time—is under direct threat.' The threat is dire, but a stay is still possible. The majority of health-care cuts in the act will not go into effect until after the midterm elections in November 2026. Lawmakers have at least a theoretical opportunity to change course and save our emergency-medical system—if enough voters make them pay attention.
South China Morning Post
03-07-2025
- General
- South China Morning Post
How are Chinese aircraft carriers pushing limits and testing boundaries in the Pacific?
New details emerging about a rare Chinese military drill involving two aircraft carriers in the Western Pacific last month reveal that the vessels are training with greater intensity and complexity, according to experts. One analyst said that by testing themselves against each, the Liaoning and Shandong carriers could gain a level of experience that even the United States military could not gain in battle because it was usually engaged with far less powerful rivals. Since Monday, state broadcaster CCTV has released several clips of drills focused on reconnaissance and early warning, defensive and counterstrike operations, anti-surface assaults, air defence and day-and-night tactical flights by carrier-based aircraft. 02:21 Chinese aircraft carrier Shandong arrives in Hong Kong for 5-day visit Chinese aircraft carrier Shandong arrives in Hong Kong for 5-day visit In the latest drills, in June, the two vessels operated beyond the second island chain in the Western Pacific together for the first time, reaching waters near Japan's easternmost islands and as far as 965km (600 miles) northeast of Guam , the US' westernmost territory. The drills were different in operations and strategic messaging from China's first dual carrier exercise conducted in October, which mainly took place in the South China Sea, with additional manoeuvres in the Yellow and East China seas. Timothy Heath, a senior international defence researcher at the US-based Rand Corporation, said the key difference was 'greater complexity and intensity'. 'By contrast, last year's exercise was essentially a trial run as it was the first time two carriers operated together. They did not travel as far or for as long a time, and the drills were simpler,' Heath said.
Al Arabiya
20-06-2025
- Politics
- Al Arabiya
US military aircraft no longer visible at base in Qatar: Satellite images
Dozens of US military aircraft are no longer on the tarmac at a major US base in Qatar, satellite images show – a possible move to shield them from eventual Iranian air strikes, as Washington weighs whether to intervene in Tehran's conflict with Israel. Nearly 40 military aircraft – including transport planes like the Hercules C-130 and reconnaissance aircraft – were parked on the tarmac at the al-Udeid base on June 5, according to images published by Planet Labs PBC and analyzed by AFP. In an image taken on June 19, only three aircraft are visible. The US embassy in Qatar announced Thursday that access to the base would be limited 'out of an abundance of caution and in light of ongoing regional hostilities,' and urged personnel to 'exercise increased vigilance.' The White House says US President Donald Trump will decide sometime in the next two weeks whether to join ally Israel's strikes on Iran. Iran could then respond by striking US bases in the region. Mark Schwartz, a former lieutenant general in the US Army and a defense researcher at the Rand Corporation, said the personnel, aircraft and installations at al-Udeid would be 'extremely vulnerable' given its 'close proximity' to Iran. Schwartz, who served in the Middle East, told AFP that even shrapnel could render the aircraft 'non-mission capable.' 'You want to reduce risk to US forces, both personnel and equipment,' he said. The planes that have left the tarmac since early June could have been moved to hangars or to other bases in the region. A US defense official would not discuss the specific positioning of assets but told AFP: 'We remain committed to maintaining operational security while executing our mission with the highest level of readiness, lethality and professionalism.' US forces in the Middle East have been mobilized since Israel's first strikes on Iran nearly a week ago, with an additional aircraft carrier en route and significant aircraft movement. An AFP analysis of open source data tracking aircraft positioning showed that at least 27 military refueling planes – KC-46A Pegasus and KC-135 Stratotanker planes – traveled from the United States to Europe from June 15–18. Twenty-five of them were still in Europe as of late Wednesday, with only two returning to American soil, the data showed.
Malay Mail
20-06-2025
- Politics
- Malay Mail
Satellite images reveal empty tarmac at major US air base in Qatar
ISRAEL, June 20 — Dozens of US military aircraft are no longer on the tarmac at a major US base in Qatar, satellite images show — a possible move to shield them from eventual Iranian air strikes, as Washington weighs whether to intervene in Tehran's conflict with Israel. Nearly 40 military aircraft — including transport planes like the Hercules C-130 and reconnaissance aircraft — were parked on the tarmac at the Al Udeid base on June 5, according to images published by Planet Labs PBC and analyzed by AFP. In an image taken yesterday, only three aircraft are visible. The US embassy in Qatar announced yesterday that access to the base would be limited 'out of an abundance of caution and in light of ongoing regional hostilities,' and urged personnel to 'exercise increased vigilance.' The White House says US President Donald Trump will decide sometime in the next two weeks whether to join ally Israel's strikes on Iran. The Islamic republic could then respond by striking US bases in the region. Mark Schwartz, a former lieutenant general in the US Army and a defence researcher at the Rand Corporation, said the personnel, aircraft and installations at Al Udeid would be 'extremely vulnerable' given its 'close proximity' to Iran. Schwartz, who served in the Middle East, told AFP that even shrapnel could render the aircraft 'non-mission capable.' 'You want to reduce risk to US forces, both personnel and equipment,' he said. The planes that have left the tarmac since early June could have been moved to hangars or to other bases in the region. A US defence official would not discuss the specific positioning of assets but told AFP: 'We remain committed to maintaining operational security while executing our mission with the highest level of readiness, lethality and professionalism.' US forces in the Middle East have been mobilized since Israel's first strikes on Iran nearly a week ago, with an additional aircraft carrier en route and significant aircraft movement. An AFP analysis of open source data tracking aircraft positioning showed that at least 27 military refuelling planes — KC-46A Pegasus and KC-135 Stratotanker planes — travelled from the United States to Europe from June 15-18. Twenty-five of them were still in Europe as of late Wednesday, with only two returning to American soil, the data showed. — AFP
News18
07-06-2025
- Politics
- News18
'Operation Spider's Web' Spooks China As It Fears Taiwan Could Copy Ukraine's Drone Tactics
Last Updated: Chinese analysts warn of 'infiltration' threats after Ukraine's covert drone strikes deep inside Russia. Ukrainian forces' drone strikes on airbases deep within Russian territory, despite lacking long-range missiles or strategic bombers, are now a source of concern for China as it contemplates 'reunification" with Taiwan, according to a report by the South China Morning Post. The operation, dubbed Spider's Web, involved smuggling drones into Russia undetected, utilising unsuspecting drivers to transport them in modified containers close to key airbases. From these locations, drones were launched remotely to destroy high-value targets like surveillance aircraft and long-range bombers parked on the tarmac. The Russian bases targeted in the operation included Belaya airbase in Irkutsk, situated approximately 4,000 km from Ukraine's border, where strategic nuclear-capable bombers such as the Tu-95, Tu-160, and Tu-22 were targeted. Another base in Amur, near the Chinese border and roughly 8,000 km from Ukraine, was also attacked. According to a report by the South China Morning Post, the operation's success has alarmed Chinese military experts, particularly regarding a potential conflict in the Taiwan Strait. Chinese military aviation analyst and former air force member Fu Qianshao noted the implications extend beyond Russia. 'Such attacks could easily be carried out by secret services or in special military operations," Fu told the South China Morning Post. He cautioned that China must 'guard against enemy forces infiltrating military bases in such a way", highlighting vulnerabilities deep within its expansive territory. Like Russia, China possesses numerous military bases scattered thousands of kilometres inland, within what it considers its 'strategic rear area". Supporting this perspective, Timothy Heath, senior international defence researcher at the US-based Rand Corporation, stated that Operation Spider's Web demonstrated how drones can threaten even the most distant and well-protected military sites. 'Drones can be deployed close to a target and are difficult to defend against," Heath explained. 'It also showed that there are few truly safe spaces in war zones anymore". Get breaking news, in-depth analysis, and expert perspectives on everything from geopolitics to diplomacy and global trends. Stay informed with the latest world news only on News18. Download the News18 App to stay updated! First Published: June 07, 2025, 21:58 IST
