Trump Administration Unveils a Major Shift in Medicaid

States will be able to cap a portion of spending for the safety-net program, a change likely to diminish the number of people receiving health benefits through it.

Comments: 197

  1. "States will be able to cap a portion of spending for the safety-net program, a change likely to diminish the number of people covered by the health program." Can this be the Administration's way of fighting poverty by allowing more poor people to die for lack of medical care?

  2. @William Dufort Your comment certainly resembles a plausible end game for this Administration.

  3. @William Dufort Dead people cannot vote and that is what a certain party wants.

  4. @William Dufort Dead people in China means more American jobs, according to this administration, so that sounds about right. So pro-life.

  5. Expanding Medicaid eligibility was unquestionably one of the most important achievements of the ACA, along with getting rid of pre-existing condition clauses and mandating coverage of children on their parent's health insurance to age 26. People who criticize the short-comings of the ACA in their enthusiasm for achieving universal coverage often forget about Medicaid expansion. It is not surprising that the Republicans want to unravel this achievement. If you hope to achieve universal health insurance coverage going forward, it will be a much heavier lift if Medicaid is weakened.

  6. Well, well, well – Trump is proposing cuts to Medicaid to reduce the federal deficit if he wins a second term. Even if he were to beat the impeachment charges, this proposal will surely NOT be well received by the millions of senior Trump voters and could be what actually sinks him in the November election. Funny how in 2017 when the Republicans passed that $1.5 trillion tax cut, it was received as a great plan for this country but now that those chickens are coming home to roost by way of the federal budget deficit surpassing $1 trillion in 2019, now suddenly programs like Social Security, Medicare & Medicaid are being considered for the chopping block. Once again the Republicans have driven the deficit through the roof and the folks who will feel the most pinch from federal cuts will be those who need programs like Medicare, Medicaid and Social Security the most. So much for Trump’s promise in 2016 to “shield entitlements from cuts” and to “Save Medicare, Medicaid and Social Security without cuts. Have to do it. Get rid of the fraud. Get rid of the waste and abuse, but save it.”

  7. @Marge Keller Yup. If Republicans were confident about his reelection chances they would let this wait until next year.

  8. @Marge Keller At least Trump announced this BEFORE the election. Hopefully, this will cause a lot of seniors to vote against him. But Fox News will tell them otherwise.

  9. @Marge Keller Never underestimate the willingness of republicans (and Trump supporters even more) to vote against their own self interest. Seriously, this won't change a thing among the cult of Trump. When they're denied care, they simply won't make the connection. And blame Obama.

  10. I think it speaks volumes as to the state of our for-profit system that the traditional method of adjusting supply-demand (here, cutting funds available) doesn't result in a concurrent decrease in cost. Instead, we just drop people from the rolls.

  11. The title should read along the lines of "Trump policy denies healthcare to many while claiming everyone will have healthcare." In reality the poor will delay healthcare as long as possible because of lack of coverage and they will either die or wait until they are worse off and drive up costs of treatment.

  12. Only this administration would have the audacity to call a plan that would allow FEWER drugs for enrollees while still requiring a MINIMUM set of benefits the “the Healthy Adult Opportunity”. What Seema Verma, the administrator of the Centers for Medicare and Medicaid Services is proposing is anything but creating a “healthy adult opportunity.” This administration is clueless about what people need and require to simply survive.

  13. They know, they don’t care

  14. @Marge Keller Zejee beat me to it. They don't care.... do not care. No ethics, no morals... they only worship the almighty dollar that is sinking in value.

  15. @Marge Keller Just another Orwellian feel good title that means the opposite of what it states. Just more doublespeak.

  16. What is wrong with these people who want pro-birth but then no healthcare How can people not want all of us insured? I really don’t understand as a healthcare provider it makes me sadder and sadder every day I go to work

  17. The cruelty is the point. Force a young woman who cannot provide for a child to raise one. Give her a bill for a delivery that she cannot afford. Shackle her and that child into a life of poverty that they will not be able to escape from due to poor public education, further medical bills, and only access to low paying jobs. This is nothing but cruel, which is the point of it all.

  18. The people who are pro-birth, yet anti-healthcare view it as ‘tough love’; they want to create as much pain as possible so that women (not necessarily the men) will plan ahead and not get pregnant with babies they cannot afford to raise. Then there are those on the far right who want to outlaw any form of contraception, so that women cannot control their reproductive lives, and hence, their careers. That eliminates competition for the jobs that men want, and view as their birthright. Nevertheless, when women avoid sex due to relying on the rhythm method, these same women will be vilified because they deny access to their bodies.

  19. This may actually drive up the cost of medical coverage for the insured. Instead of going to the doctor for an illness the poor show up at the ER room. This is far more expensive and floods facilities with patients better served by an office visit.The cost gets passed on to consumers. It also posses a public health risk if something like the Corona virus hits an area. Cutting off a segment of the population from access to medical care is foolish.

  20. @Llewis It is definitely a public health risk since people will get various diseases and spread them to the general public if they have no health care. Such foolish and backward thinking.

  21. @Llewis Foolish, reckless and shortsighted.

  22. @Llewis Trump will gut all Social Programs when he wins re election; kiss Obamacare; Medicare;; Social Security; Medicaid Goodbye.

  23. Wonder how many Republicans are in nursing homes dependent on Medicaid?

  24. And the Republican plan to turn the U.S. into a Third World country continues.

  25. We’re already there

  26. @bijom The uneducated, non-military serving, electorate did that all on their own. You can't be a world superpower if your citizens don't believe in facts and reality.

  27. This plan is another blow in the ongoing efforts of Trump to pass bills and laws that hurt the middle and lower classes. But, these same people he's hurting vote for him. It's all part of the brainwashing of America.

  28. This proposal assumes the omniscience theory of big data: There is enough data, and enough knowledge of how to use it, to direct funds to only those poor people who are deemed to "deserve" these funds, according to one or another red-state legislature. Meanwhile, even well-thought out ideas for targeting care to the neediest do not really save money, as NYTimes reports from Camden, NJ: https://www.nytimes.com/2020/01/08/health/camden-coalition-chronic-illness.html Everyone needs expensive healthcare as some point in their lives. But there's no magic data bullet.

  29. @Aaron Lercher We can go to space fifty years ago and we cant do health care. We just have vulture capitalism and we cant believe that a poor person who is a minority or old has a right for quality medical care because you say so with your money. Look at the Sackler family, Johnson& Johnsons destroying communities because poor people dont have rights because they are not seen as even human. It isnt hard to be a country that loves there people, poor people are just not valued like rich white people. when it comes to wars yes they want us to fight but hot in charge because white superority is always in charge.

  30. The Trump administration is proposing a plan called “the Healthy Adult Opportunity” yet will allow fewer drugs for enrollees? Who exactly benefits from this “opportunity” and how?

  31. As a physician, Medicaid is truly a blessing for individuals and families without financial means. At issue is that many physicians, unless they work as an employee of a hospital, do not accept Medicaid as providers. So the low fee schedule creates a barrier for patients seeing physicians whom they deem as ‘providing better care’. Personally, I would love to accept Medicaid if they paid a reasonable amount - $19 for a 45 minute visit isn’t something I could long afford...so the few Medicaid patients whom I see for cash visits do so because they want to be able to “sit down and understand my situation and be able to take the next best steps” without another “5 minute visit with 30 seconds of decision making” that often ends with another prescription. On another note, in Vermont, prior to the ACA, there was a program that allowed subsidized commercial insurance with a very low ($150 per year) deductible, that allowed former Medicaid recipients to afford to return to work, and afford Insurance coverage. This was unfortunately discontinued under the ACA. I believe this type of “bridge” would be a wise expenditure for this group of patients. My two cents.

  32. Looks as though this has been mostly targeted to the red states that did not expand Medicaid. So be it. This is what they voted for. Unfortunate, but actions have consequences.

  33. Of course we will look for ways to save money, i.e. restrict social programs for the poor. Whether it’s Medicaid, SNAP, welfare payments, or soon social security, these programs need to be looked at very closely to make certain our federal dollars are well spent. When it comes to military spending, billions of dollars on drones, missiles, assasinations, incursions, training missions and bases, no questions asked. Our priorities are broken.

  34. @PGM Not to mention tax cuts for the very rich

  35. I wonder how many individuals in the Trump Base now think they are more better off with health care benefits and accessibility, and the fact that the country is now trillions more in national debt. I also wonder how much more better off are all of the Republicans who have benefitted from the reduction of taxes and the profits they have made on stock market transactions? The story of the “have nots” and the”haves”.

  36. Capping Medicaid will simply force hospitals to shift costs to people with private health insurance. Typically, Blue Cross and other private insurers, while getting discounts from list prices, subsidize losses from public payors. So employers will likely face increased health insurance premiums and employed workers may find they are hurt too. This move accomplishes nothing and makes the system even less rational.

  37. Abby what's missing here is a comparison to how other countries manage and give out assistance to their able-bodied poor. How does Norway or Finland, both frequently rated highly for general happiness, assist or not assist this population? I think one thing that is surprising is they are often more generous with their poor, but with better incentives for working than us.

  38. My understanding is that both Norway and Finland have single-payer systems and that there are no work requirements.

  39. This will end up in the courts, too. Medicaid is a defined benefit program with some specific requirements, including requirements for matching funds. States already have flexibility regarding eligibility, drug formulary, and services provided. What is more frightening than this fight going to the courts is the packing of the courts to predetermine the outcomes, regardless of the logic or legal precedents that are bulldozed to get there.

  40. The article does not explain if this change requires legislation or if it can be put in place purely by executive action.

  41. @Stephen Weber At this point is there a difference? We have found that we are no longer a nation of laws or have a co-equal government. We have been told by trump's legal "team" that the president can lie, cheat or steal his way to an election since his being re-elected is in the best interest of the nation. So, laws, schmaws! We don't need no stinking laws! We are now a dictatorship. If you had any doubts just watch the kangaroo, banana republic impeachment "trial" taking place in the senate. That's all you need to see.

  42. Article two: A president* can do whatever he wants. Kill the poor.

  43. @db2 * As long as he/she/they believe it is in the national interest.

  44. Mean, I’ll intended, and shortsighted. In fact this summarize much of the Trump Administration work. Economically speaking, healthcare expenses were one of the throngs that helped overcoming the Great Recession because it pushed money into a collapsing economy. Take this away and the next recession will be even worse. The GOP is out to ruin our lives

  45. They are bringing back the “Old Deal”, pre-FDR.

  46. Key word here is “block” as in block all Medicaid for poor folks.

  47. It grieves me as a Christian that this administration wants to be ever so biblical when it comes to sexual mores but completely against the Bible when it comes to caring for the vulnerable.

  48. @Timotheos What are you talking about? The thrice married prez and sexual predator cares about sexual mores?

  49. @Timotheos Trump is sexual predator, and has no religious/moral beliefs. The religious, by nature, are generally susceptible to manipulation and Trump is playing a very good game. He cares not one whit about you or your religion. If anything, it seems that Trump has not only trashed America, but has also reduced the majority of Christians to looking like a cult.

  50. Republicans are doing all they can to see that more hospitals go bankrupt across the country as people use emergency rooms. Some people who have private insurance have rates going up 24% a year and they will be asked to pay as costs shift to them. Make America Sick Again. How are people supposed to work when they are sick and not cared for?

  51. I wonder how much time Ms Verma has spent working directly with people needing Medicaid? I’d like to see her work for a month providing services at a community clinic. Perhaps then she would see what is desperately needed.

  52. Dream on. She is the epitome of hate and cruelty, and always has been, at least in her CMS career. Practically outdoing Trump in utter lack of compassion, tho I grant that she’s smarter than he is.

  53. @Pat This is the woman that wanted taxpayers to reimburse her $47,000 because her luggage was stolen from her rental car during a work trip. No empathy at all for those that need Medicaid.

  54. Mr. Bloomberg, change your Super Bowl ad to focus on healthcare, not guns. The need for affordable Healthcare is what all Americans agree upon and can be THE ISSUE that determines the outcome of the election. A Gun regulation ad during a Super Bowl is like running an anti-smoking ad at a smokers convention.

  55. @GW thumbs up!

  56. @GW Bloomberg knows everything, that was a stupid choice but he knows best. Maybe he might show a video of Stop& Frisk to go with Trump video's of children in cages at the border.

  57. @GW, I can't agree more. If Dems want to win they shouldn't waste their time on wedge issues such as guns, gay marriage or abortion, win the WH and Senate then discuss wedge issues.

  58. After this, it will be on to gutting Social Security. Enough talk of “Medicare for All”. The GOP is all in on Medicare for NONE.

  59. Medicaid does not fund states "based on whatever they want to spend." The matching funds are provided only for certain services specified in federal law. The second largest fee-for-service expense (after acute care) is for long term care (e.g. nursing homes). Almost 2/3 of Medicaid spending is for people who are elderly or have a disabiity. This is the population that is growing. So don't believe the rationale of this Administration. The basic goal is to shift the burden to states as the elderly population grows. Additional benefits of retaining the federal match is that the funding goes up during recession. Further, the federal matching funds are nationally redistributive, mostly moving money from the coasts and northern states to southern states where the federal matching rate is higher (e.g., 77% for Mississippi v. 50% for California, New York, Massachusetts). Federal Medicaid revenues represent the single largest source of federal funds for states. As the Kaiser Family Foundation observes: "The infusion of federal dollars into the state’s economy results in a multiplier effect, directly affecting not only the providers who received Medicaid payments for the services they provide to beneficiaries,... More recent analyses find positive effects of the Medicaid expansion on multiple economic outcomes." All data here are taken from https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/view/print/#footnote-397008-2

  60. Medicaid block grants already apply to Puerto Rico, which ends up receiving about 75% of its per capita share compared to the states.

  61. The GOP is determined to destroy the health care of this country. People will continue to be sickened and go to doctors and the hospitals it just won't be funded. Hospitals with unpaid bills will close, the first being those in the rural areas.

  62. But: If those in many rural areas voted for Trump, then they knew what they voted for in terms of policies like these. Small rural hospitals would always have been at risk—just more so now. What on earth didn’t they understand about the GOP plans and dynamics of who leads relevant cabinet agencies? So—exactly why are they suddenly concerned? They got what/who they wanted...no fair to the rest of us, and no sympathy is due to them, either! Especially if they support Trump again, and wreak havoc in their own backyards yet again as well.

  63. @Kathy last time Trump promised to deliver improved and cheaper healthcare for all. Obviously a lie but let's give people the benefit of the doubt. His first action as president pretty much was to repeal the ACA, but lo and behold, GOP senators found that their constituents didn't want to lose their coverage, and that failed. Trying to defund/decimate medicaid in the run up to the election seems like a rather strange tactic, as it will be fresh in the minds of voters come November and could be bad news for Trump's reelection, which is good news for the country!

  64. @jaxcat Iin my red state, which still hasn't expanded Medicaid, our small town and rural hospitals are closing at the rate of more than one a month. Last year we had 15 rural hospitals close, after several previous years of more hospital closures. We're at the point now that some of the 'small town" hospitals that close were actually from bigger small towns (about 40,000) that served as regional health care hubs for a hundred miles around. When a hospital's patient mix is so heavily poor and uninsured, they may struggle on for a while but eventually they can no longer keep their doors open. In some parts of rural America, a major accident or illness is a death sentence because medical care is so far away.

  65. As long as Republicans can cut taxes on rich people, anything is on the table, including taking medical care from people who can't afford it. The party of zero empathy. Either you're rich, or you go out with the trash.

  66. I'm glad you're calling it a safety net program instead of an entitlement like republicans want you to.

  67. @Tom J Huh? I see no Republicans calling Medicaid an entitlement, but if they did they would be incorrect. Social Security is an entitlement, because recipients are entitled to its benefits given that they paid into the system for decades before receiving them. Medicare is an entitlement, because recipients are entitled to its benefits given that they paid into the system for decades before receiving them. Medicaid is not an entitlement. It is a safety net program limited to low-income individuals but funded by everyone's taxes.

  68. As with every policy of this administration and its Republican henchmen, the cruelty is the point.

  69. Verifying eligibility to receive public assistance should be a high priority for all Americans, wherever on the political spectrum you are on. This article posits the “increased paperwork” has led to a reduction of the rolls of Medicaid recipients. Maybe because that paperwork proved they didn’t qualify. Most Medicaid patients I encounter only utilize the ER, because their copay is 0$, the ambulance ride is 0$, and all treatments cost 0$. Medicaid needs to be drastically limited and cut.

  70. @Rob In my area it takes months to find a doctor who will take medicaid and has an opening. Once you are a patient you can only rarely get in to see them for urgent issues. Most of these doctors are not particularly well informed of anything besides the most basic and common medical issues. Many of us who must use medicaid have complex medical problems. One doctor told me he didn't have time to deal with my issues so I should just go to the ER whenever I had a problem. I did. The ER doctors attempted to help but any specialist care required a referral from the primary. The only other primaries I could see were in the same clinic as that primary and none wanted to go through getting me the needed referrals through my medicaid HMO, which I was forced into as a cost saving measure by the state. Fortunately, I have a different primary insurance now but the many years I went without proper medical care for my life long disability left me with severe issues. I am just now starting to recover from the lack of treatment but going so long without what I needed likely left with with permenate deficits. I had been able to work part time and volunteer. I haven't been able to work or volunteer for years because of lack of treatment. As far as paperwork, it sets up people for failure. My workers consistently send the renewal work late, lose the paperwork I turn in, forget to include some of the paperwork and then try to cut my secondary medicaid off because of their mistakes.

  71. @Rob Where and when do you encounter all these Medicaid patients. I'm also curious about your knowledge of all the paperwork involved. Having dealt with Medicaid patients personally, I found most get inadequate care, lack choice of doctors, and needed resources. Medicaid needs help not cuts.

  72. @JJ I'm on Medical here in California, and nothing you describe is like that. It was relatively easy to find a doctor, who is excellent. You have to be your own advocate and take charge, don't just be a passive actor.

  73. The disgraceful acts, rampant immorality, and shamelessness of all of this aside, it is truly remarkable how effective republicans have been in advancing their goals. For purely evil/corrupt reasons to be sure, but remarkable nonetheless. The Supreme Court, tax cuts, blocking gun reform, cutting Medicaid, the list goes on and on. I long for the day any of our democratic representatives are even half this effective in advancing our policy goals. We have the moral high ground, but it feels like our side is always losing.

  74. @Exhausted unfortunately, it's about money. we are an oligarchy, and money is what determines who wins in this game. social justice and compassion have never been lucrative arenas.

  75. @Exhausted Well said. I too am frustrated at how the Democrats, who genuinely have the best interests of Americans as stake, are so often losing. Democrats would be wise to take a critical look at their party and acknowledge honestly where they need to change.

  76. @Exhausted Difficult to think about all of the poor GOP supporters who refuse to think but there own pockets.

  77. Lol. "Capping funding, their argument goes, would make Medicaid more efficient and ensure it can continue to help the sickest and most vulnerable Americans." Seriously? Republicans always talk about efficiency when they really mean cut the program.

  78. @Hugh MacDonald That's exactly what it is. A cut. But cutting Medicaid sounds bad, so they cap it instead and let inflation do the cutting anyway.

  79. Under Trump we are going back to the dark ages. Everything he touches has a negative bent for this country. We can start enumerating that, by looking at his environmental policy. Everything that this country has gained in regards to where we live, he has tried to nullify. How about the economy. It is a false economy when there is a yearly deficit of one trillion dollars. The country cannot keep up the deficits much longer. Then the Trump medical policy would just make working people sicker. My question would be, how is it that other countries are able to cover everyone under a medical umbrella and provide medical benefits to all their residents and the U.S. is going the other way? How can we fix this? Don't vote Republican,. At this time you cannot believe anything that is said by a Republican, they are owned by Trump and we know Trump's record on truthfulness.

  80. @Walt Sisikin I personally know some physicians, dentists and physical therapists who don't want to work with private, state or federal insurance programs because they don't want to feed profits, system abuse and who knows what else into the current system. The thinking of enough of our citizenry is absolutely primitive and mind bogging when it comes to social welfare and benefits. I have a coworker who is a cancer survivor and hates the idea of public health insurance, but also hates the private one too. Go figure. More and more I am convinced that we as a nation deserve what we get - local, state and national politicians, policies and welfare. I know sick and poor people who hate anything related to ACA because it pays enormous money to private providers. They also oppose public option for the same reason. Total insanity. We are living in the early stages of a Maltusian society. Add to this climate change and the near future looks frightening. The distant future ... not so much, as most of us will be dead, as Keynes commented long time ago. Enjoy

  81. @Walt Sisikin - How do other countries do it? We cut out the middle people -the insurance industry. Canada provides medical care to every citizen but Medicare doesn’t cover some things in some provinces like physio therapy or prescription drugs outside of hospital care. Different provinces and territories have different extras. There are private insurance plans that cover most of the “extras” with a 10 or 15 percent co-pay. But hospital care including ER and seeing family doctors or specialist doctors is paid for by taxes. That’s one of the reasons life expectancy in Canada is longer than for people in the US.

  82. It's not trump...he's not aware of anything happening within the agencies until he's in front of the cameras with an entourage behind him signing something. It's the efforts of his GOP and industry appointees doing this. Why do you think they're working so hard to keep him as president?Because he dosen't care about the end result. All he wants is publicity so he can pretend how hard he's working.

  83. Yet another reason not to live in a red state in the coming years. Trump's re-election will continue to create such disparities between red and blue states.

  84. @A Science Guy Not just red states. NY State's budget is $5B out of balance due to soaring Medicaid expenses. The governor has had to appoint a blue ribbon commission to come up with what will be painful cuts. Until the pharmaceutical drug prices are forced to come down -- and that will never happen -- there is little hope for a solution.

  85. @A Science Guy And unfortunately because of the Electoral College, votes in red states count WAY more than in blue ones, assuring his re-election. #timetoendtheelectoralcollege

  86. Obama's idea for ACA Medicaid expansion was that it would eventually lead to universal coverage of sorts. He made it very enticing for states to take that deal (he could not compel them to). Unfortunately, Republicans and Fox News exist, so it did not go as planned. Now 1/3 of the country is committed to having worse health outcomes. We don't look very first-world that way.

  87. @Roarke As a strong ACA supporter, just wanted to correct a few details in your comment. The Medicaid expansion as initially signed into law was actually compulsory. However, the Supreme Court held 7-2 (bipartisan decision) in NFIB v. Sebelius that the compulsory expansion was unconstitutional. Subsequently, the failure of 12 (if I recall correctly) states not to expand Medicaid has undoubtedly been political of course. But there's a very good argument to be made that the ACA's reliance on Medicaid expansion was a misstep both in terms of policy (for other reasons as well) and political calculus...not just related to right-wing instragience.

  88. The administration should make it a point to go after those providers and individuals who bilk the system. Focus on that instead of further undercutting the poor and disenfranchised.

  89. It will be interesting to see how much of President Trump base will be affected by this. Especially in states like Kentucky, Alabama, & Arkansas where he has a lot of support in.

  90. Doesn’t matter. They will blame it on Obama, Hillary, AOC, Pelosi, Soros, etc.

  91. Again those who voted for this man based on one idea or one issue will pay the price. As will we all. I wonder, as the quality of life in our republic sinks to new lows, will the TV glow of FOX and Friends keep these people warm? Will it keep them healthy? Will it allow them to keep their homes when illness prevents them from earning a living or receiving adequate care? When more and more of us have to care for elderly parents at home with our own hands, with worse healthcare, will the endless stream of propaganda ease their pain? If our leaders do not exhibit kindness and compassion today, one can easily guess the outcome when hardship comes knocking on at our door. We are on our own.

  92. They are looking for people to hurt to pay for tax cuts that benefited the wealthiest among us. They will be clever and not touch the benefit that makes up the largest share of the Medicaid dollar. The nursing home business is full of people who have had schemes drawn up by lawyers to shift their assets to their children, so that Medicaid will pay for their care. The nursing home lobby is the most powerful here in Ohio. I expect it is the same in much of the nation. Once again, the truly needy will be made to pay for the Republican base. Another convenient "welfare queen" false meme to campaign on.

  93. More trump campaigning, the trump policy of human life is expendable whenever and wherever there are profits to be made whether foreign, domestic or domestic budget, and trump fans support this.

  94. How about we get rid of some red state entitlement programs as well, like federal highway funds? Those should have been gone by the 70s when the major interstates were completed. All it is now is a redistribution of wealth from populous blue states to unpopulated red states.

  95. The left idolizes what they regard as "European socialism" and one of the few things that is different about them is that health care is run by the individual states, not the EU. Republicans are taking a meaningful step towards "European socialism". That's important since there is no way w can continue to afford the American version of socialism.

  96. @Ed - Insurance is cheapest with the largest possible pool of enrollees. By having individual states make up their own pools, they lose much of the benefit of having a larger pool of people. And the smaller states will suffer the most - you know, those small population states that are mostly red.

  97. @Ed .. The American version of socialism according to Republicans is unfettered, unlimited tax breaks for the wealthiest Americans and suck it up, pull up your boot straps for the neediest Americans.

  98. LOL. That’s creative rationalizing. So GOP efforts to cut federal spending will actually increase state spending and care. You’re confusing countries with states. France can carry a national debt; Missouri can’t.

  99. While we are at it, we could look at some of the money we give to corporations and cut that off too.

  100. Limited funds for the health of the citizenry, unlimited funds for tax cuts for the rich and the military industrial complex. Winning!

  101. What needs to be reined in is military spending! Second one could reduce costs by combining the ACA, Medicare and Medicaid into one broad insurance program.

  102. Many State budgets are short of money. I have often thought just reducing the amount spent on law enforcement and prisons could, like reducing defense spending, reduce the deficits.

  103. The ACA isn’t insurance, and I suggest taking a good look at where tax dollars actually go.

  104. Another wrong-headed effort by the wealthiest elite to hurt the working class and poor in America where health outcomes already lag behind every index of industrial nations. If this change is successful, an epidemic like the corona virus could completely overwhelm the states capacity to provide medical care for the poorest residents. This is another Trump administration effort to pass on to on the states the cost of medical care while it takes tax payer dollars to build the biggest war capability the world has ever seen. The states will have to curtail services or raise state and local taxes to pay for the services which we have all considered as basic and necessary to maintain our quality of life.

  105. All Medicaid needs is more money. I look forward to thoughtful suggestions from Democrats running for President and for Congress. Maybe the money can come from taxes on beverages, tobacco, and unhealthy foods.

  106. More than enough money can come from the GOP’s 2017 donor tax cut. Repeal it. Then start looking at reducing the biggest item in the budget, our bloated defense budget, which tops $750 billion this year alone. Most Trump voters thought he was going to reduce military spending by getting us out of the Middle East and out of peacekeeping missions. They thought all the money saved would be used in America. Instead he’s increased troop levels in the Middle East by 50,000 and ballooned the defense budget by 50 percent. Trump needs to pay off his defense contractor donors. He can just make up stories for his voters. Chances are they’ll believe him.

  107. @William McCain And I look for thoughtful suggestions from Republicans how we can pay for endless wars and bloated Pentagon budgets. But on one ever asks where the money will come from when it comes to killing machines.

  108. Plenty of money if we just return those tax cuts for the rich.

  109. Oh bother. Here we go again. We passed Medicaid expansion through popular ballot initiative. Any effort to enforce block grants will meet with similar retaliation. Everyone wants health care they don't need to think about. It's simply there. Having to refight the same political battle over and over again is tedious in the extreme. Solution: Medicare for all. You don't need to worry whether a citizen is single, married, working, employed, adult, or disabled. You can disband Medicaid entirely because everyone, absolutely everyone, is covered. The federal government pays all costs with no caps. Let the bean counters figure out who pays for it.

  110. I just don't understand how they can make such a drastic change without going through Congress. This, the work requirements for Medicaid, and the SNAP program changes in particular should have all gone through Congress. I hope they'll be sued by many interests.

  111. @Paul Thomas It's really quite simple to understand. trump is a dictator with an additional 253 or so elected officials propping him up!

  112. Recipe for social misery and social unrest: 1. give large tax breaks to the wealthy; 2. Cut medicaid, food stamps and any other governmental assistance to sustain the wellbeing of the poor. Incredibly sad, cruel and short sighted policy changes forced on the nation by an amoral and corrupt executive branch.

  113. @AA But good for Putin. There is nothing he would like more than to destabilize the US.

  114. @AA exactly.

  115. @AA Wait til his working poor base becomes "actually" poor. That will be the real test.

  116. Will losing their Medicaid coverage be enough to sway his cult members away from voting against their interests again? Probably not, so long as fear of the other is the #1 message of the Trump-GOP.

  117. Democratic candidates for President and Congress need to hammer this home and go on the offensive.

  118. "Healthy Adult Opportunity" should be Healthy Adult Holdup, known as HAH, gotcha. States can spend the allocated funds as they wish which will generally mean corruption central. Just another step to destruction of our country.

  119. Republican Branding: Huge tax cuts for billionaires; death to poor people. Yes, it is that simple and that cruel.

  120. Trump's war on the poor continues unabated.

  121. Are you paying attention Trumpsters? Are you happy? Is this going to help you or hurt you. If the latter, remember, the cuts that hurt you help pay for tax cuts for the wealthy. Smile!!!!

  122. Greatest Nation on Earth? Not by a longshot. Money for endless wars, corporate tax breaks, and yet...we don't care about our own citizens, who must fend for themselves. Rotten healthcare system that puts profits before patients. We are told to pop pills, with the root causes of our ailments 'irrelevant'. We have more people in our For Profit prison system, than Any Other Nation. 1/3 of all those in our For Profit prisons have some form of mental illness (gee, what a great way to take care of our mentally ill, eh?) We are killing our planet. Since 1970, the bird population in North America has declined by 29%.... that's almost One Third. You know, like the canary in a coalmine? But nah, nothing to worry about here. A large portion of American adults are working at minimum wage jobs, often piecing together 2-3 jobs to make ends meet. But hey, the 'economy' is doing great! We have crumbling infrastructure.... failing public schools....unaffordable colleges.... the NRA dictates to our government... Ugh. #Yang2020

  123. the red states keep voting for people who enact policies that hurt red states.

  124. The cruelty of these people is beyond belief.

  125. Well America, enough of you wanted a “businessman” elected to run things and here’s what you got, a man who will cut programs that help the poorest among you yet give tax breaks to the wealthiest, a Commerce Secretary who thinks disease in another country will be “good for America” and a Secretary of State who can’t handle questions from a reporter who’s just doing her job. Only “the best people”, eh?

  126. The total dismantling of Medicaid, Medicare and Social Security is coming unless we get these Grifters out. Happy now, Trumpers?

  127. It is time to solemnly and seriously talk about breaking this country up.

  128. Another reason to mobilize the masses and destroy the Republican party in November.

  129. First, they will attack and weaken medicate. Next up, Medicare. Believe it folks.

  130. Trump, the anti-Robin Hood, steals from the poor and gives to the rich. Medicaid Block Grants are needed to help pay for his tax cuts that furthered the fortunes of the wealthy.

  131. It seems that Donald Trump and the Republican ‘leadership’ spend their days trying to figure out what they can do to make life more miserable for as many Americans as possible - other than wealthy party donors, of course. Then Republicans do whatever is required to implement their plans. If it cannot be accomplished through fair elections and majority vote, why then, disenfranchise voters who would stand in their way and manipulate the system in any way possible, legal or not. If it cannot be accomplished through the legislative process, then circumvent the legislative process and rely on an expansive view of ‘executive powers’ and enable a demagogue who will govern by fiat - otherwise known as a ‘dictator.’ If the courts attempt to bolster the democratic process by subjecting the dictator’s actions to legal scrutiny, pack the courts with party hacks and extremists. A concerted campaign of disinformation and party control of the press always helps; and oligarchs like Rupert Murdoch are always glad to help. Fox News, the Sinclair Group, RT... we’re well on our way to state-controlled media. But after all, ‘the press is the enemy of the people.’ It says so right there in the Constitution, doesn’t it? Every true patriot knows that! We just need to ‘open up the libel laws’ and enforce non-disclosure agreements and gag orders on those ‘deep state’ operatives in the government who might blow the whistle. Is this a great country or what?

  132. Maybe this will wake up people in time for the November election, since the idea that Trump can do anything he wants to stay in office may not be terrifying enough. Medicaid first, then Medicare and SS> who thinks this isn’t the plan??

  133. @E Campbell - Last night I caught the last portion of a House Budget Committee meeting. Every Republican was arguing that we can no longer afford Medicare and SS, and those MUST be "reformed" (cut). I don't know why the media doesn't at least make a few mentions of what Republicans are calling for in their various committees, because everything they call for is intended to harm the most Americans possible.

  134. I'm sensing a trend here. Trump and his compliant Republican acolytes are doing everything possible to deprive Americans of access to affordable healthcare. Trump's so-called "Justice" Dept. is attempting to invalidate the entire ACA, which would remove protection for pre-existing conditions and throw millions of people off the healthcare rolls. Do Republicans truly believe their all-out war on American healthcare will be a winner for them in November? Apparently.

  135. This proposals gives the States the option to opt out of receiving money from the federal government, similar to the ACA Medicaid expansion. Logic would dictate that you wouldn’t take that option then again Republicans have never been logical in their opposition to healthcare.

  136. "States will be able to cap a portion of spending for the safety-net program, a change likely to diminish the number of people covered by the health program." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Why is it that "conservatives" care little about their fellow citizens? Do they need other people to suffer so that they can feel better about themselves? So much for their "christian values" and "compassionate conservatism"... MAGA, right?

  137. Well we know what needs to be done, vote every last GOP red state politician out of office. Trump is a killer of American democracy. he wants to do nothing good but roll back the country to the 1800's where slavery is legal, people die on the streets, and no health care for anyone So if the GOP refuse to wake up then VOTE them out especially those sleek mafia lawyers. who want us to be apart of Russia.

  138. The war on poor people continues....sigh....

  139. @Andrew Medicaid: a SOFT TARGET, fresh red meat for the deplorable horde, a sacrificial anode to pacify his believers into co-opting their values for a tall, rich and vicious head of state who illegally ascended to the presidency. Moral and ethical bankruptcy...third world style.

  140. Look at these wretched people beaming as they rescind the health care of millions. Sickening.

  141. Here is proof anew that conservatives (the Republican clubbers) simply do not care about real people.

  142. So the Red Party will finally get their death panels. We are becoming a right wing dictatorship.

  143. Class warfare. Here is the real quid-pro-quo. "Let me off the hook Mitch & I'll help you gut healthcare and social security." Nauseating.

  144. Trump continues to wage war on Americans - except the wealthy 1% of his supporters. And given the amount that trump golfs and texts without doing any work himself, why must taxpayer dollars continue to support him?

  145. The Democrats should slam dunk on this issue. Unfortunately, it will be a hard sell to get the type of accessibility to health care people have in other countries. We have War profits to tend to instead.

  146. People keep asking why Christians vote for this man. “Evangelical” Christians (yes, there are other kinds) love the current WH occupant because they are more interested in being in the in-club (“We get into heaven and you don’t!”) then they are interested in anything Jesus ever said. And they follow flashy mega-church con men walking around in $3000 suits and flying in private jets, so he’s a familiar character. Can you imagine: healing the sick, feeding the poor, loving thy neighbor? “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’” -Matthew 25:45

  147. The supposed "cost savings," "efficiency," or whatever you want to call it is little more than a cost shifting - from the federal government to state and local governments, and eventually to - you guessed it - consumers, many of whom will be unable to take on this additional financial burden. The proposed plan promises to index cost support increases, but as the actual cost of health care is rising faster than the proposed support increase, the gap in funding will have to be borne by state and local governments, and consumers. As state and local governments lack struggle to cover any funding gaps, the burden will increasingly shift to consumers, either in the form of cost increases or service cuts. The long term consequences of this shift will also likely include an increase in the number of uninsured and under insured. This will also increase the number of personal bankruptcies due to unpaid medial expenses and result in an increasing care burden for hospitals who must provide emergency care, regardless of ability to pay. This plan also makes no sense from an economic standpoint as it does little more than shift the burden for payment of health care expenses, not their cost. Worse, it may actually be an economic drag due to increased emergency costs, unpaid medical expenses, bankruptcies and lost productivity. The GOP also know this will never pass a Dem controlled House, making this little more than a faux attempt to bolster GOP fiscal credentials.

  148. Shame On Them

  149. Predicting the future health concerns of a particular state is impossible. This plan is stupid.

  150. Tax cuts for the rich. Early funerals for the unrich. Nice GOPeople. November 3 2020

  151. And this is a help to Americans....how?

  152. The playbook of the Republican Party since Reagan: 1) Pass an income tax restructuring by selling it as a plan to increase revenue while glossing over the fact corporations and the super-rich accrue the most benefits; 2) Boost spending in areas near and dear to their hearts, but especially the military; 3) Feign horror at the exploding budget deficit while ignoring the real reasons (see #1); 4) Use the exploding deficit as rational to reduce spending on programs such as Medicaid, etc.; and 5) Then engage in double-speak that cutting benefits is an opportunity designed to promote the program's objectives. It's time to realize the hypocrisy of these people knows no boundaries. Get it together Democrats and focus on the job at hand - winning the upcoming election.

  153. Democrats may have to just go along with the Republicans. Let them cut the federal taxes in half or 3/4ths and return money to the states. Let the feds just do military, law enforcement and a few other things that republicans allegedly care about. The liberal states can then provide the proper health care, education and social services to grow while other states can give it to their upper middle and wealthy classes and continue chugging along.

  154. @Susan Well-stated and exactly what is happening and has been happening.

  155. Once again the Trump team is taking away from the poor to give to the rich. It shows the lack of compassion for the most marginalized in our society. When Trump is re-elected he will surely be much more aggressive in taking from the poor and giving to the rich. Just another example of the damage he poses to our society.

  156. @James Joseph I agree with your comment. It also needs to be pointed out, though, that too many Americans keep voting for this. And so we have it. Although I do wonder what Trump's supporters are going to do when they find out that Medicaid is no longer covering their elderly parents' nursing home room and board.

  157. @Josa Unfortunately, they will continue to support him because they will believe whatever lie he tells them. He will somehow blame the Democrats.

  158. @James Joseph What Republicans are doing in the Senate today is quantum leaps worse: They are taking away the rule of law. Like Peter Pan and his shadow, you may not miss it 'til it's gone.

  159. I don’t know why any state would agree to this. At best, the burden of illness and care would be shifted from the federal government to the state and the state’s hospitals and citizens.

  160. How about a cap on War Department spending, now over $700 billion? Bernie will cut that into a tenth of the bloated irrelevance it is now.

  161. @Robert M. Koretsky : $700 billion for war spending, er, defense spending but on top of that is the Black Budget which is billions more. We don't hear about the Black Budget much, do we?

  162. Your employer based insurance premiums and Medicare premiums just went up. This proposal to block grant Medicaid includes the elimination of retroactive eligibility and presumptive eligibility which will result in an increase in uncompensated care. Those insured with employer based policies and Medicare will have to make up the difference. Your premiums will go up.

  163. As long as premiums only go up in those states that are taking block grants. If that is the case, let them go for it. Insurance watchdogs in the liberal states should be watching carefully.

  164. Well, now that we know that Trump can do no wrong toward getting re-elected - we heard this from his own attorney yesterday during the impeachment Q&A session, so it must be fact - it's equally obvious that he can do no wrong in his social policies, either. Remember, you are dealing with an administration that forcibly removed children from their parents at the border, and to this day has not been able to explain exactly what happened to all of those children, or where many of them ended up. This story is out of the news cycle for all but the children and parents who were separated. Imagine how you would feel if this happened to you? However, saying that to anyone who supports Trump does no good, because they would simply give you a bland look and reply, "Well, it would never happen to me, because I obey the laws of this country."

  165. The issue with Medicaid Block grants is that it gives the State's a fixed $ amount within which the State must allocate a certain fixed set of funds. Thus, the State must choose between the allocation of funds to, for example, a disabled, schizophrenic individual in a halfway house and mom living in the nursing home on Medicaid. A substantial portion of Medicaid benefits are to nursing homes. Likely what will happen will be that the Medicaid reimbursement rates payable on behalf of nursing home residents will decrease. Even with the Medicaid reimbursement rates what they are now, staff training, turnover, and supervision are chronic issues. If you think nursing home care is bad now, wait until the reimbursement rates get lower.

  166. Not getting care is more likely a function of lack of accessibility...and to a lesser extent availability. Just because one has coverage doesn’t mean one is able to get seen for treatment. This is a social justice problem not an individual problem

  167. This is of course standard Republican efforts. It surprises me that they want to give Democrats such a hot issue after what happened in 2018 in the mid term elections. Tax breaks are too hard for people to figure out, but cutting healthcare is an issue many can get motivated by.

  168. @WHM... This spiritually stingy rhetorical manipulation is going to be too confusing for many underinsured Americans... which is going to make something like Medicare For All Who Want It sound so much simpler... understandable... and appealing.

  169. For the love of....I live in a Medicaid unexpanded state. Rural hospitals already go out of business because they can't balance the books of the reimbursements with the huge amount of uninsured and underinsured patients. Meanwhile you can't get treated for your substance use disorder without some type of insurance (there are technically options on paper but none in the actual world where people live). So I am just SO GLAD to hear that I will now be able to tell EVEN MORE people their country would prefer to watch them slowly wither away and die rather than pay more in taxes. Thanks guys.

  170. How can we have tax cuts if we continue to help the poor and needy?

  171. Imagine what this group of extremists will do to our nation's safety net programs when the current occupant of the Oval Office is given another 4-year lease on that office. We will become a country led by oligarchs whose aim will be, as it is now, self-enrichment. They care nothing about anybody else...well, except the evangelical extreme right who put them in power.

  172. Must be another tax cut coming

  173. Trump voters have to come terms with what they created. This football, machoesque “us against them” mentality will eventually catch up with them. However, it could be awhile and people will have to suffer. But until the Rustbelt, conservative voters realize that Moscow Mitch, Cornyn, Lindsey Graham etc. only care about getting re-elected things will continue to get worse. The democrats are trying mightily in D.C. to help the less fortunate but if the voters don’t do their part in the places where the electoral college numbers matter, nothing will change. Unfortunately, things will have to get much worse before things change. It really is up to those Pennsylvania, Florida, Texas voters.

  174. @Weiler And the republican aka trump machine with unlimited campaign funds is going full-bore in those "key Electoral College states" to sell trump and republican candidates and divide or suppress Democrats.

  175. Yes, our “right to life” party in action. You MUST be born. And should you have the misfortune of being born into poverty or fall on hard times (health crisis for instance...) - You’re on your own. Beg for scraps. It’s infuriating, the hypocrisy.

  176. This administration seems to want poor people sick and starving.

  177. Republican policy: Tax cut for the rich and limit medicare for the poor. VOTE ALL THE NAME WITH(D) TO FOLLOW IN NOVEMBER 2020 FROM LOCAL TO FEDERAL.

  178. @Lle Limit Medicaid is for the poor. Medicare is for the elderly. Of course, Medicaid pays for many (most?) stays in nursing homes among the elderly. So it's an attack not only on young+poor but on old+poor.

  179. Seema Verma’s “Arbeit macht Frei” healthcare financing proposals and policies in Indiana fit in perfectly with Trump and the Republicans plans to defund Medicaid through shifting the responsibility to the States who will defund care for the poor. Thus doctors will not see the poor as often compared to the rich and powerful because they don’t want to lose money. The poor will suffer. Come on Trump and Republicans - you didn’t invent healthcare.

  180. How can the republican party be so cruel to the least fortunate citizens of America? What would Jesus do?

  181. Changes like this will disproportionately hit poor white people in states like West Virginia, Kentucky, Missouri and Arkansas, all bastions of pro-Tump sentiment. Maybe someday these people will cast votes consistent with their economic interests. Until then, it looks like they will be out of luck.

  182. Pretty much everything the Bible says absolutely do not do but hey, Christians are getting their tax breaks so what does Jesus know anyway!

  183. The Republicans only represent billionaires. They try to pretend they care about Christians and rural constituencies, but then they promote wicked morally corrupt leaders that enact policies which hurts everyone but billionaires.

  184. But the farmers and ranchers that get welfare because they don't properly manage their land, will get billions and call it "incentives", because welfare is for poor people, trying to buy groceries and their meds.

  185. So Trump can have people’s life terminated prematurely by his Medicaid policy. Yet he is antiabortion (pro life). The American people support him thru their elected Congressional choices. This country, the US, no longer deserves to exist. It is the epitome of evil. Emigrate while you can. Our days are numbered.

  186. @Klaus Perry I've lived overseas in the past, but that window is now closed at my age, as it is for many. Hopefully, I'll get by, but I'm also a former US Marine, and an armed liberal (for purely defensive purposes), so there's that. Best solution, of course, is that voters wake up and come to understand the destruction that Trump and Republicans are doing to our country, but I'm not holding my breath on that.

  187. It is so obvious that Trump and his cabal are intent on systematically transferring wealth from average Americans AND future Americans to make the ultra-wealthy of today even wealthier. This is both immoral and societally unstainable.

  188. Well, he's found a way to trim .001% off of the trillion $ deficit his tax cut has caused.

  189. @jhanzel : And soon he'll cut NPR because snowflake Pompeo had a meltdown with a professional, honest reporter. That will trim another .001% or less off the deficit. That'll show those Dems!

  190. People will literally die, but look at these ghouls grinning away. Why anyone who isn't really wealthy votes for Republicans is a mystery to me? They clearly don't care about the welfare of millions of people.

  191. Every now and again, it’s important to remember that almost everyone who works for this administration* is an utter ghoul. For example, here’s Secretary of Commerce Wilbur Ross, upright and awake for a change, talking about the economic upside of the unfortunate possibility of a worldwide pandemic. "I think it will help to accelerate the return of jobs to North America.” “Ah,” says Maria Bartiromo in reply, “that’s a good point.” No, in fact, it’s not. It’s an astonishingly wrong-headed take that is barely human. I’ve long believed that the basic business philosophy of the American corporate class is fraud. (And Ross has his own problems there, too.) Now, I’m coming to believe that sociopathy is part of the business plan, too.

  192. Innocent people dying for lack of medical care has never bothered the GOP. Remember this when it tries to destroy Medicare.

  193. What would Jesus do? Give tax breaks to the rich and shrink safety nets for the poor? How can Republicans call themselves Christian who violates basic Christian tenets?

  194. Block grants are preferred by conservatives because it eliminates equitable distribution of assistance in favor of selective distribution of assistance. For the Mormon Church which generously offers assistance to community members who have suffered severe losses but whose bishops can cut off those who abuse that generosity, block grants do not interfere. For racist holder overs from the segregation era it’s a way to deny assistance to inferior races. For old fashioned reactionary Social Darwinists it’s a way to drive the unfit out of their communities by denying them assistance.

  195. Seniors are on Medicaid and they vote, in this election cycle why bother, you want change America , everyone stay home this election .

  196. @Independent voter Seniors are on MEDICARE, not MEDICAID.

  197. Yes, another policy that reflects the teachings of Jesus, embraced by Trump and his evangelical supporters.