Tag Archives: Medicaid

More Insanity In The “Big Beautiful Bill”

When a piece of legislation is over 900 pages long, it shouldn’t surprise us to discover all kinds of “hidden” provisions that went unread and undiscovered even by the people elected to read and understand what they’re passing. (That includes Trump, of course–a man who evidently can’t read and quite clearly doesn’t understand anything beyond his own childish needs and impulses. Media sources have reported on his meeting with Republican legislators, during which he advised them not to touch Medicaid– totally unaware of what was in his “Beautiful” bill…)

Media outlets have varied widely in the adequacy of their coverage. Most have focused on the major elements of this abysmal legislation: the three trillion dollars plus it will add to the nation’s deficit, the largesse to plutocrats “paid for” by robbing millions of low and middle-income Americans of health care and food stamps, the gargantuan sums allocated to the creation of what can only be described as a Trump administration version of the Schutzstaffel, Hitler’s notorious SS.

Those elements are, admittedly, both the most prominent and most terrifying aspects of the bill, but the American Prospect recently highlighted ten lesser-known provisions that ranged from stupid to cruel.

File this one under “stupid.” The bill forces the states to shoulder more of the costs of the SNAP program. But when Lisa Murkowski negotiated a two-year exemption from cost-sharing for Alaska, the language of that provision exempted all states with an “erroneous payment rate” above 13.3 percent– language operating to exempt not just Alaska, but states with the ten highest error rates–and inadvertently incentivizing other states to increase waste and fraud in their programs.

The bill eliminates the $200 tax on gun silencers. Words fail.

Section 70309 allows municipalities to issue tax-exempt bonds to build spaceports. (I have no clue. Perhaps we’re closer to space travel that I thought?)

MAGA’s love of fossil fuels prompted a provision–inserted by Oklahoma’s Republican Senator Lankford– that eliminated taxes on oil drillers. The bill “includes an exemption for domestic oil and gas companies from the corporate alternative minimum tax, as long as they have intangible drilling and development costs.” Oil companies have lobbied consistently for this nice little loophole. (Climate change? Nah…just another scam like vaccinations…)

And speaking of the environment, the bill not only eviscerates President Biden’s climate program, it also provides vast subsidies to coal producers. As the article reports,

At least four million acres of federal land will be opened up to coal leasing, and the royalty rate will be cut from 12.5 percent to 8 percent. Incentivizing coal—the worst fossil fuel for the climate and also particulate pollution—in any way is bad, but Republicans are also literally subsidizing foreign steel companies in places like China, India, and Brazil, by making metallurgical coal eligible for “critical mineral” subsidies through 2030. This coal, which is used in blast furnaces to create steel, is mostly exported to poorer countries with fewer air pollution regulations. Sure enough, the coal doesn’t even have to be used domestically to get the subsidy.

Umn…how, exactly, does this make America great?

There’s much more: a $40 million appropriation to the National Endowment for the Humanities to build statues for a “Garden of Heroes” in Washington, D.C. (We don’t have money to feed children, but we do have money to build a “blood and soil” monument…); removal of limits on the ability of folks with pass-through income (think law partners or hedge fund managers), to take unlimited SALT deductions, giving rich people “yet another legal tax avoidance scheme, worth between $35 and $40 billion over the next decade.”

As policy analysts pore over the 900+ pages of this monstrosity, they will undoubtedly find more examples of pork for donors and lobbyists, funded by vicious cuts to programs for the needy. Meanwhile, the propaganda machine rolls on, with Republicans insisting that Medicaid recipients–the vast majority of whom are children, disabled and elderly–just need to get jobs. (As one FB response asked, “please send me a list of jobs that are available for Alzheimer patients.”) 92% of the rest already do have jobs.

Indiana’s two senators voted for this obscenity. Senator Jim Banks is a White Christian Nationalist and a fervent member of the MAGA cult; his vote was expected. Senator Todd Young, who might have been an effective lawmaker in a different party or time, and who clearly knows better, issued a statement that is gobsmacking in its dishonesty:

“The One Big Beautiful Bill Act will deliver the largest tax cut in history for working and middle-class Hoosiers, expand the child tax credit, spur new economic growth and job creation, and advance President Trump’s agenda.”

I don’t know how Senator Young sleeps at night….

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The Guy In The Mirror

Welcome to what seems like a very bad dream…

Congressional Republicans have passed a spending bill that contradicts every principle that party has endorsed over the years.  Furthermore, it’s a measure that will disproportionately hurt their own voters–and we know that they are aware of that fact, because they carefully timed some of the bill’s most egregious elements, like the draconian cuts to Medicaid, to take effect after the midterms.

Those GOP “defenders of liberty” who sport “don’t tread on me” t-shirts and insist that the government lacked even the authority to require masks during a pandemic are nevertheless cool with providing massive new funding for ICE, whose masked thugs display a terrifying similarity to Germany’s SS.

The Republicans in Congress passed this monstrosity because they are in thrall to an ignorant buffoon with tacky taste and the vocabulary, intellect and emotional control of a developmently-delayed five-year-old.

It has become increasingly clear that on the ground, the MAGA movement is the reappearance of the old Confederacy. The voters who continue to support Trump are motivated by fear–fear of losing their status as the “real Americans,” fear that those “others” will actually manage to attain civic equality. But what can we say about the Senators and Representatives those voters sent to Washington? Some–like Indiana’s Jim Banks–are as ignorant and bigoted as those who voted for them, but it’s obvious that many others actually know better, actually realize that their submission to Trump is cowardly, and that they are rewarding the votes of their constituents by robbing them of the little security they have.

What explains those Senators and Representatives–those presumably “traditional” Republicans who talked endlessly about fiscal discipline and limited government, but who obediently bend the knee to a would-be autocrat who routinely trashes those principles?

A recent article by Jonathan Last in the Bulwark took a stab at answering that question. 

A sizable portion of elected Republicans hold on to a residual image of themselves as avatars of a green-eyeshade, business-first party that no longer exists. They’re like a middle-aged man standing in front of a mirror, sucking in his gut and smiling, imagining that he still looks pretty close to his college days.

It’s a lie they tell themselves.

The article raised an interesting question: why didn’t the Republicans just choose to have it both ways–extend the tax cuts for their deep-pocketed donors, but keep Medicaid funded, and just push the debt even higher. After all, they were willing to add over three trillion to that debt–why not just add another 930 billion, and avoid sticking it to their own voters?

This, finally, is the root of the problem. Some Republicans still view themselves as the good guys in the movie. They need to imagine that they’re on the side of the angels. That they are something other than what they’ve become. It’s the guy in the mirror, again.

Trump has no illusions. That is his strength. Some congressional Republicans are reluctant to embrace their roles as kleptocrats and pillagers. That is their weakness. And it’s why they haven’t said, “Fuck it. Let’s just spend all the money.”

Last reminds us that when things go wrong in a cult, no one blames the cult leader. (He points to an example, a MAGA-supporting man in detention due to Trump’s hardline immigration policies, who nevertheless blames the Biden administration for his arrest.)

When millions of Trump voters lose their Medicaid, they aren’t going to blame Trump, either. They’ll blame Congress.

And what does Donald Trump care if a bunch of Republican losers get tossed out of Congress? He has no use for congressional Republicans. He is an aspiring autocrat who rules by fiat. Passing legislation is not anywhere near his list of priorities. Whether or not the House and Senate are controlled by Republicans is of little importance to him.

All of which is why Trump’s party is about to stab millions of Trump-loving Republican voters in the back instead of just throwing more money at the problem.

Trump knows who he is, what he wants, and how to get it. His party, on the other hand, is a bunch of delusional sad sacks. Which is why he will win and they will lose. Again.

At least we can take some satisfaction from the prospect of those “delusional sad-sacks” looking in their mirrors and seeing a greying and flabby reality looking back.

I wonder if any of them will regret providing the Kool-Aid to the cult members who elected them…

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Suicide By MAGA

Most of us have read about “suicide by cop”–a (hopefully rare) situation where someone desiring death purposely provokes a standoff with police. I don’t think MAGA cult members are that intentional, but I do think the result will be the same. The pandemic was a precursor: data shows that the MAGA science-deniers who refused to be vaccinated against COVID died in far greater numbers than more sane Americans.

Who coined that phrase “you ain’t seen nothin’ yet.”?

The Trump administration has already taken a meat-ax to medical research, derailing promising research into cures for cancer and Alzheimer’s and other deadly diseases. Those cuts will hurt all of us–Red and Blue alike. But as Paul Krugman recently pointed out, the administration’s radical changes in social spending, immigration policy and tariffs won’t simply hurt tens of millions of Americans — they will land disproportionately on Red, rural Americans.

The first thing you need to understand is that while rural Americans like to think of themselves as self-reliant, the fact is that poorer, more rural states are in effect heavily subsidized by richer states like Massachusetts and New Jersey.

This reality makes it inevitable that the standard conservative fiscal agenda — tax cuts for the rich, benefit cuts for the poor and middle class — hurts the heartland more than it hurts major metropolitan areas. But MAGA’s Reverse Robin Hoodism goes far beyond the standard conservative agenda, in ways that will be especially devastating to rural areas and small towns.

I’ve previously posted about Trump’s horrendous “Big Beautiful Bill” that will rob the poor to further enrich the wealthy. The bill contains savage cuts to Medicaid and food stamps, programs that will hurt all poor folks; but will disproportionately devastate Trump-supporting rural areas.

Krugman notes that Medicaid is a far more important program than most Americans realize.

Almost 40 percent of children are covered by Medicaid, with some of the highest percentages in deep red states like Alabama and Mississippi. Medicaid pays for 42 percent of births in America. And more to my point, Medicaid covers a higher fraction of the population in rural than in urban counties. So deep cuts in the program will hit Trump-supporting regions especially hard.

Ditto the impact of the drastic cuts to food stamps.

Many people–even those who are opposed to the “Big Beautiful Bill”– fail to recognize its very foreseeable impact on rural hospitals.  Hospitals in areas with low population density and a high percentage of patients who cannot pay for care struggle to stay open even now. Without Medicaid reimbursements at current levels, most will close. 

Most of us also fail to understand the role that Medicaid and Medicare spending play in supporting what Krugman calls “rural and left-behind local economies.”

For example, the economy of West Virginia no longer rests on coal mining, which employs very few people these days. It would be more accurate to say that the foundation of West Virginia’s economy is federal spending on Medicare and Medicaid. That is, in deep red West Virginia, Medicare and Medicaid are directly and indirectly a major source of income.

We are already seeing the impact of Trump’s immigration vendetta on the nation’s farmers.  Our agriculture relies heavily on hired workers, and some two thirds of those workers are immigrants–most of whom are undocumented. Farmers are already seeing the results of the threat: even workers who are legal residents or native-born citizens feel unsafe from the ICE goons who very clearly think all Brown people are illegal immigrants–so we see growing reports of workers decamping out of fear of arrest and deportation.

And then there’s the trade war.

In case you haven’t noticed, Trump hasn’t yet delivered a single one of the 90 trade deals he promised to negotiate by July 8. China has already retaliated, and others will follow. And U.S. agriculture is highly dependent on exports…

While many are now realizing that Trump’s policies will produce social and economic disaster, relatively few understand that the disaster will fall disproportionately on rural Trump voters. But of course it will. For the purveyor of Trump bibles and Trump meme coins, screwing the little guy has always been his personal style of grift. It remains to be seen if rural Trump supporters will awaken from their naivete.

Krugman is kinder than I am. I have given up any illusion that Trump voters are merely naive or uninformed. I’m pretty sure that MAGA voters are so wedded to their racism and grievance that they will support their own suicide if that’s what it takes to “own the libs.” 

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Listing The Obscenities

On Tuesday evening, I participated in a Zoom hosted by Indivisible of Central Indiana. It was focused on Trump’s “Big Beautiful Bill,” and if you can stand yet another enumeration of that insult to Americans, I’m posting my comments below.

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As Heather Cox Richardson has said, the Republicans’ “One Big, Beautiful Bill” is MAGA’s attempt to replace the government we’ve had since the 1930s with one that reflects the goals of Project 2025.

It is also an effort to rob the poor to further enrich the wealthy.

The Bill is 1000+ pages, but in this brief presentation I want to highlight the major elements—and alert you to the fact that, despite the fact that it is billed as a “budget,” it has numerous, damaging non-fiscal provisions which should be ruled non-germane in the Senate, but may not be.

Before getting to the truly horrifying fiscal mischief, let me share with you some of the most egregious non-fiscal provisions:

  • A measure to cripple the courts by prohibiting any funding from being used to carry out court orders holding executive branch officials in contempt. Passage of this measure would enable Trump and his officials to defy court orders at will.
  • The addition of billions to various parts of Trump’s deportation efforts, ramping up those efforts to the tune of an additional trillion dollars That includes $45 billion for construction of immigration jails (more than 13 times ICE’s current detention budget.) In addition, it would allow the indefinite detention of immigrant children and would charge families $3,500 to reunite with a child who arrived alone at the border. Asylum seekers will be charged an “application fee” of at least $1,000.
  • The administration would be given authority to label nonprofits as “terrorist-supporting organizations,” and terminate their tax status- an open invitation to suppress the free speech and activism of climate and civil liberties organizations, among others of which Trump and MAGA disapprove.
  • The bill would eliminate the National Weather Service, making local weather reports far less accurate.
  • One provision would allow the administration to sell off national parks.
  • A particularly ugly provision repeals the $200 excise tax on the sale of gun silencers, which have no lawful purpose other than concealing shootings.

Other bits of “fine print” more directly support the major goal of the bill, which is, as I’ve noted, to protect the extremely wealthy against efforts to get them to pay their fair share of taxes–basically, the bill exempts rich people from paying their dues to the country that made their accumulation of wealth possible. (For example, the bill would basically eliminate an Estate Tax that is already massively favorable to the top 1%.)

The “guts” of the bill are the fiscal provisions. Basically, the bill is an effort to fund the extension of Trump’s tax cuts for the rich by eliminating health care for the poor and middle class.

The Congressional Budget office estimates that as many as 16 million people would lose health insurance under the House-passed version of the bill. The annual cuts to Medicaid would average over 70 billion dollars a year—the same amount millionaires and billionaires would gain in tax cuts. The media has focused on those Medicaid cuts, but a number of analysts have explained that measures that have been minimized as “technical revisions” would essentially repeal Obamacare.

Not only would millions of individuals lose their health insurance, the consequences of these cuts would close many, if not most, rural hospitals and would have a dramatically negative impact on local economies, ironically mostly in Red states like Indiana. Economists have estimated that depressed local spending under the House bill would force the loss of 850,000 jobs. (Health care is the largest employer of any sector of the economy; it employs 18 million workers.)

Republicans who claim that they’re just adding “work requirements” to Medicaid are lying—the budget cuts 715 billion from Medicaid and 335 billion from Obamacare (the Affordable Care Act). And prior experience in the states has demonstrated that work requirements do nothing but erect paperwork barriers that throw eligible people off Medicaid; as we’ve learned from those previous efforts, Medicaid recipients who are able to work are already working—most Medicaid recipients are disabled, elderly or children.

There’s much more. The bill weakens the Child Tax Credit, by lowering the eligibility income threshold, so millions of children will suddenly become ineligible. It expands school vouchers–continuing the GOP effort to destroy public education and shift tax dollars to religious institutions, in violation of the First Amendment. It includes a variety of “Stealth Cuts’ to the Affordable Care Act that will increase out-of-pocket costs and make insurance more expensive for those people who are fortunate enough to retain it.

As if the assault on poor folks wasn’t mean-spirited enough, the bill also has deep cuts to SNAP. The House-passed version would cut nearly $300 billion from SNAP, the Supplemental Nutrition Assistance Program, according to Congressional Budget Office (CBO) estimates. That would be by far the largest cut to SNAP in history, and it would mean that millions of low-income families would lose some or all of the food assistance they need to afford groceries and feed their children.

SNAP has been the nation’s most effective anti-hunger program, and the bill cuts it by roughly 30 percent. These extreme cuts are actually deeper than the $230 billion in cuts the original budget resolution called for because the bill adds tens of billions of dollars in new spending for farm programs, and pays for those dollars by taking more food assistance away from people with low incomes.

And despite the GOP’s purported concerns about budget deficits, the bill blows up the budget deficit. According to the Congressional Budget Office, the bill will increase borrowing by a total of $2.4 trillion by 2034, because the $1.3 trillion in cuts to Medicaid, food stamps, and other programs don’t even come close to canceling out $3.7 trillion in tax cuts for the rich. Just the tax cuts going to the richest 5 percent outstrip the cuts to Medicaid and food stamps by 300 billion. If you add in interest costs, the total debt the bill creates exceeds $3 trillion.

This is just a horrible bill, and it needs to be defeated.

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Taxes And Spending

I am not an economist, nor do I play one on this blog. But let’s talk about economics and Trump’s “Big Beautiful Bill.” 

As Heather Cox Richardson recently reported, despite the GOP’s pious (and entirely bogus) expressed concerns about the deficit, the speed with which Congressional Republicans are trying to pass this monstrosity is rooted in their effort to avoid widespread recognition of what it actually does. The bill blows the budget deficit wide open by extending the 2017 tax cuts for the wealthy and connected, and it does so by sticking it to the needy, via draconian cuts to Medicaid.

The Congressional Budget Office has estimated that extending the tax cuts for the already-rich will cost at least $4.6 trillion over the next ten years. (And in an especially despicable twist, the tax cuts would go into effect immediately but the cuts to Medicaid wouldn’t hit until 2029, after both the midterms and the 2028 election.)

The prospect of that debt explosion led Moody’s on Friday to downgrade U.S. credit for the first time since 1917, following Fitch, which downgraded the U.S. rating in 2023, and Standard & Poor’s, which did so back in 2011. “If the 2017 Tax Cuts and Jobs Act is extended, which is our base case,” Moody’s explained, “it will add around $4 trillion to the federal fiscal primary (excluding interest payments) deficit over the next decade. As a result, we expect federal deficits to widen, reaching nearly 9% of GDP by 2035, up from 6.4% in 2024, driven mainly by increased interest payments on debt, rising entitlement spending and relatively low revenue generation.”

The difficulty in passing this monstrosity has been the insistence of hardline Republicans that the cuts to Medicaid and SNAP weren’t draconian enough.

It’s a standard Republican accusation that federal spending is out of control, but as Richardson notes, discretionary spending has actually fallen more than 40% in the past 50 years as a percentage of gross domestic product, from 11% to 6.3%. What has really caused rising deficits were the Bush and Trump tax cuts for the wealthiest Americans.

But rather than permit those tax cuts to expire— or even to roll them back— the Republicans continue to insist Americans are overtaxed. In fact, the U.S. is far below the average of the 37 other nations in the Organization for Economic Cooperation and Development, an intergovernmental forum of democracies with market economies, in its tax levies. According to a report by the Center for American Progress in 2023, if the U.S. taxed at the average OECD level, over ten years it would have an additional $26 trillion in revenue. If the U.S. taxed at the average of European Union nations, it would have an additional $36 trillion.

In a recent Substack, Paul Krugman described the Big Beautiful Bill as a “big tax giveaway to the wealthy combined with cruel cuts in programs that serve lower-income Americans,” writing that the measure’s cruelty is exceptional even by recent right-wing standards, and noting that it relies on

claims we know aren’t true and policies we know won’t work — what some of us call zombie ideas. And it’s hard to avoid the sense that the counterproductive viciousness is actually the point. Think of what we’re seeing as the attack of the sadistic zombies.

Krugman writes that this slashing of Medicaid will cause almost inconceivable hardship to the bottom 40 percent of Americans, especially to the poorest fifth. (Medicaid actually covers far more Americans than Medicare, including 39 percent of the nation’s children.)

Among the ways Republicans will slash Medicaid is by requiring that adult Medicaid recipients be gainfully employed — or, as Krugman points out, “more accurately, that they demonstrate to the satisfaction of government bureaucrats that they are gainfully employed, which is not at all the same thing.”

The belief that many Americans receiving government support are malingering, that they could and should be working but are choosing to be lazy, is a classic zombie idea. That is, like the claim that cutting taxes on the rich will unleash an economic miracle, it’s a doctrine that should be long dead. It has, after all, been proved wrong by experience again and again.

But right-wingers simply refuse to accept the reality that almost everyone on Medicaid is either a child, a senior, disabled or between jobs.

The evidence from state efforts to impose work requirements shows that–while such rules don’t get presumably “lazy” people to work–they do  take benefits away from people who are legally entitled to them through onerous paperwork and administrative barriers. 

If Republicans really cared about deficits, they’d tax the rich, not screw over the poor. They could begin by simply enforcing current tax rates, which our plutocrats evade to the tune of 150 billion dollars a year.

Your GOP at work…..

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