Tag: medicaid cuts
Nearly Half Of Working-Age American Adults Have No Decent Health Coverage

Nearly Half Of Working-Age American Adults Have No Decent Health Coverage

This past June, GoozNews forecast the uninsured rate would soar to 11 percent this year due to changes contained in the One Big Ugly Bill passed by the Republican-controlled Congress and signed into law by Donald Trump in July 2025. That would be a 37 percent increase from early 2025.

While official numbers won’t be released by the Census Bureau until next year, a new survey from the Commonwealth Fund confirms that back-of-the-envelope estimate. Not only did a poll of 9,360 adults conducted this past summer find this year’s uninsured rate rose over three percentage points from last year’s eight percent, but the share of working-age adults with inadequate coverage still stands at 35 percent, bring the total with no or inadequate coverage to 46 percent.

What constitutes “inadequate” coverage? It’s people who can’t afford their insurance premiums, deductibles and high out-of-pocket costs when accessing care. It’s people facing gaps in their coverage, which must be paid out-of-pocket. The survey found 31 percent of adults insured throughout the year are paying off medical bills or debt.

“Our survey shows that most Americans are struggling to get the health care they need, and things are getting worse,” said Dr. Joseph R. Betancourt, president of the Commonwealth Fund.

Americans have repeatedly told pollsters that health care affordability ranks as either their first or second most important issue this year. Despite this being an election year, not a single mainstream media outlet — print, broadcast or online — covered yesterday’s release of the Commonwealth Fund survey.

Cause and effect

It’s no mystery why both unaffordable coverage and the uninsured rate are rapidly rising. They are, respectively, cause and effect.

The Republican Congress refused to renew the expanded Obamacare subsidies for low-income workers that were passed during Covid. That non-act sent premiums on the exchanges soaring and forced millions of people without employer-based coverage to drop their individual and family plans.

The One Big Ugly Bill’s new work rules for Medicaid recipients and the requirement that state agencies conduct twice-a-year recertifications won’t go into effect until January. But expiration of the recertification waiver passed during the Covid pandemic has already forced 25 million people from the program, not because they weren’t still eligible, but because they failed or didn’t have the documents needed to fill out the necessary paperwork. After the new Medicaid rules go into effect in January, another four to five million poor people are expected to lose coverage.

The resulting massive increase in the uninsured rate has sent uncompensated care costs at the nation’s hospitals and physician practices soaring. That in turn has led to rapid price increases as providers look to the still insured to pick up those additional costs.

Insurers are glad to pass those costs along since it raises their profits. Whether they are selling their own plans or acting as third-party administrators for self-insured employers, insurers generally reap about five percent of top line revenue as profit. The larger the top line, the larger the bottom line.

The annual KFF survey of employers, also released this week, confirmed those soaring top-line costs. It reveals how employers are responding this year by shifting more of the total cost onto their employees. The average cost of a family plan rose five percent to $28,303. But the average amount workers pay in premiums rose nine percent to $7,471 while the average cost for the employer share rose only 3.4 percent.

But to be fair, these numbers jump around a lot year over year (see the chart below). Over the past decade, rising health care costs have imposed a greater burden on employers. They saw their share of the average family plan rise 62 percent over the past decade compared to their workers’ share rising “just” 42 percent (or twice the rate of inflation on average).

But employers have an out that their employees don’t have. They can grab a larger share of total income (which they have), and they can limit workers’ wage increases (which they have).

As every health care economist will tell you, in the end, health care benefits are a form of wages. Workers wind up paying one way or the other. It is no mystery why health care costs have become many families’ most pressing economic concern.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from GoozNews


As Republicans Devastate Healthcare, Industry Keeps Financing GOP

As Republicans Devastate Healthcare, Industry Keeps Financing GOP

Does the medical industrial complex endorse health care’s status quo? Do its major players think a divided and therefore paralyzed Congress will prevent the multiple crises that will hit in full force early next year? Judging by their campaign contributions during the run-up to the mid-term elections, which is now less than two weeks away, the answers are yes and yes.

Every major sector of the industry has reasons to be upset by the actions taken by the Trump regime and the Republican-run Congress over the past 20 months. Hospitals’ and physician practices’ uncompensated care costs are surging as millions of people lose health insurance due to Medicaid’s new work rules and the GOP’s failure to renew Covid-era Obamacare subsidies.

Things are about to get a lot worse. The biggest hits begin next year when the full Medicaid cuts kick in and millions more people lose coverage.

The sector’s workforce is being hammered by the regime’s anti-immigration policies. An estimated 17 percent of all health care workers are immigrants, with the highest concentrations in critical areas like home health, nursing homes and hospital support staffs. Out-of-control ICE raids are not just chasing valued workers away, its agents’ well-publicized violence has sharply curtailed the overseas pipeline for new recruits.

Physician autonomy is under full-scale assault. The nation’s doctors are suffering from unprecedented levels of burnout and frustration, exacerbated by the insurance industry’s escalating use of prior authorization. Their professional status faces an existential threat from artificial intelligence. This year’s Medicare pay increase lagged behind inflation despite a one-time bump of 2.5 percent, which goes away next year.

Let’s move on to the two areas where, rhetorically at least, there is bipartisan support for curtailing profit-seeking overreach. Government-funded research — the pharmaceutical industry’s seed corn — has been slashed. Innovation has taken flight on an easterly wind to China. On drug pricing, while the Trump regime hasn’t done anything more than what was required under the price negotiations passed during the Biden years, it backs international reference pricing, which would sharply lower Big Pharma’s revenue.

Even the insurance industry, whose biggest fan, Dr. Mehmet Oz, now sits atop the Centers for Medicare and Medicaid Services (CMS), is facing tough times. The government gave Medicare Advantage plans just a five percent bump for 2027, which was several percentage points below medical inflation. While they are being overpaid to the tune of about $80 billion a year and deserve cuts, insurers responded by raising co-pays and deductibles in next year’s plans, even as they abandoned many markets in what had been their fastest growing and most profitable segment.

Whither donations?

The nation’s pollsters and pundits are unanimous in predicting Democrats will win control of the House. They increasingly see Trump’s rock bottom popularity tipping the Senate their way, too. You would think this would be a good year for the health care sector’s major actors to punish those that have harmed their economic interests by refusing to back GOP incumbents, especially given the fact that as many as 260 candidates for House and Senate seats have declared they will not take campaign contributions from corporate political action committees (PACs). That includes most of the Senate seats in swing states that will determining who controls the upper body next year.

Health care’s major players rarely suffer when Democrats are in power, and have been major beneficiaries of each of the party’s insurance expansions (Medicare, Medicaid, the Children’s Health Insurance Program, Obamacare). Some insurers also prospered by taking on management of state Medicaid programs (they cover about three-quarters of beneficiaries in red and blue states alike).

Hospitals and doctors have dodged significant payment reforms, not just single-payer Medicare for All, but more gradualist approaches to reining in costs like single-pricing, budget-based reimbursement, and rigorous antitrust enforcement. The centrist wing of the Democratic party, like the GOP, is generally protective of the drug industry, whose headquarters and major research facilities are located in blue states.

Regular readers know I’m supportive of dramatic reforms that would move the system toward achieving what former CMS administrator Donald Berwick called the triple aim: a healthier population achieved at a lower cost with a better patient experience. His successors at the Institute for Healthcare Improvement later added workforce well-being and health equity to the mix.

Anything the Democratic Party enacts should they win Congress this year and the presidency in 2028 will move the system closer to those goals. Everything the GOP and its leader imposed over the past two years moved the system away from those goals. They hobbled Obamacare; eviscerated public health; endorsed anti-vaccine know-nothingism; assaulted Medicaid; and embraced ideological manipulation of the nation’s research enterprise.

Should the GOP retain unchecked power for the next two years, surely all the big players in health care understand that they will face daily threats to their stated public purpose.

Yet, the most recent filings by the political action committees of the American Hospital Association, AHIP (America’s Health Insurance Plans), the Pharmaceutical Research and Manufacturers Association and the American Medical Association reveal the industry is continuing to provide financial support for Republican incumbents. They are still funding the party that’s kicking them in the teeth.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from GoozNews

Will Surging Tide Of Uninsured And Spiking Hospital Costs Trigger A Recession?

Will Surging Tide Of Uninsured And Spiking Hospital Costs Trigger A Recession?

All of the health care sector’s major economic indicators are headed in the wrong direction.

Major hospital chains last week began reporting a substantial rise in their uncompensated care costs after millions of people dropped health insurance. The Republican Party’s refusal to retain the Biden administration’s expansion of Affordable Care Act subsidies has already forced at least three million people into the ranks of the uninsured.

Meanwhile, the Centers for Medicare and Medicaid Services under Dr. Mehmet Oz announced Friday it will grant hospitals a 2.3 percent increase for their 2027 in-patient Medicare rates. That’s well below the general inflation rate (3.5 percent over the past 12 months) and a half percentage point behind the Bureau of Labor Statistics' measure of inflation in overall medical services (2.9 percent).

If you’re sitting in the chief financial officer’s seat at one of the nation’s hospitals, the next 12 months look bleak. Private insurers have already announced they will seek double-digit rate increases for individual and family plans sold on the exchanges later this year. Those rates are usually finalized in late October, just ahead of the start of open enrollment, which this year falls on the day before the mid-term election. Rate-shock will likely force millions more people to drop coverage.

Then there’s the One Big Ugly Bill’s imposition of work requirements in Medicaid, which will go into full effect next January (some states have already begun winnowing their roles). That’s expected to lead to nearly 12 million poor people losing coverage over the next few years, mostly due to eligible enrollees’ failure to leap over the bureaucratic hurdles established by the law.

The coming huge increase in the ranks of the uninsured — the first since passage of the Affordable Care Act in 2010 — is certain to raise the uninsured rate well into double digits. It reached an historic low of eight percent during the Biden years. The accompanying sharp rise in uncompensated care delivered by hospital emergency rooms and other providers will inevitably lead to major spikes in premium costs for employer-provided health plans, which covers an estimated 160 million workers and their family members.

A recent survey of major insurers’ actuaries found the cost of employer-based health insurance prices is expected to rise nine percent on average next year. That increase — more than two percentage points greater than this year and nearly twice the rate of economic growth — will sharply increase both employer premiums and their employees’ co-premiums, co-pays and deductibles.

Given the price pressure in other household necessities, many more workers will opt for high-deductible plans to hold down their out-of-pocket expenses. Some will decide to drop out of their employers’ plans. That’s a viable if risky option for the young and healthy, who use far less health care on average than older workers. But it’s a disaster for older, sicker employees and their families, who will see their premiums rise even faster than anticipated because the young and healthy have left the pool.

Labor costs are rising

Major health care institutions are no doubt formulating plans now for how to deal with their deteriorating financial position. Given that labor costs generally account for about half of all hospital spending, hiring freezes and job cuts will probably be on the agenda.

We’ll know more on Friday this week when the July jobs report comes out. There is a high likelihood that the central role that health care has played in U.S. job creation over the past decade, and especially in the past year, is coming to an end. Should that happen due to the sudden shock to the system from the soaring uninsured rate, it could prove devastating for the rest of the U.S. economy, where job growth has slowed dramatically this year due to the Trump regime’s tariffs, the war against Iran, and government job cuts.

The overall jobs numbers tell an interesting tale if we look at the past year and compare that to the past decade. Over the last ten years, the entire health care sector added 3.1 million new jobs. That was one in every five new jobs in the economy (roughly commensurate with a health care sector that makes up 18 percent of GDP). Hospitals alone accounted for 758,000 of those new jobs or just a shade under 25 percent of the total new health care jobs.

But in the past year, the overall economy added just 506,000 new jobs as manufacturing declined (so much for Trump’s claim he is bringing back goods-making industries). Overall service job growth couldn’t keep pace. Indeed, just one sector kept the unemployment rate from leaping into recessionary territory.

What sector was that? Health care, which added 437,000 new jobs over the past year, accounting for fully 86 percent of the new jobs total. Hospitals accounted for 118,000 or 27 percent of those new jobs.

The only way hospitals have been able to keep adding jobs is by using their market power to raise prices on the privately insured. According to the most recent Kaufman Hall National Hospital Flash Report (May), hospital expenses are up seven percent from a year ago while average patient days are down two percent.

The higher expenses are being driven mostly by the need to raise pay for physicians, nurses and support staff to keep pace with inflation, which is rising at one-and-a-half to two times the rate the Federal Reserve Bank considers optimal. Yet even with those price increases (which are angering everyone), hospital margins and profitability are shrinking compared to a year ago.

Given those numbers, there’s no way that hospitals or health care will be able to maintain its recent role as the U.S. economy’s main job generator. Given the Trump regime’s mismanagement of the rest of the economy, one can’t rule out the possibility that the emerging health care financing crisis will trigger a recession.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from Gooz News

Senate GOP Ads Broadcast Lies On Immigrants, Medicaid And Trump Budget

Senate GOP Ads Broadcast Lies On Immigrants, Medicaid And Trump Budget

The National Republican Senatorial Committee (NRSC) is running ads in multiple states that spread disinformation about Medicaid and undocumented immigrants.

The ads target Democratic Senate candidates in Ohio, Alaska, Iowa, Georgia, New Hampshire, North Carolina, and Michigan for not supporting the One Big Beautiful Bill Act (OBBB), which the NRSC claims stopped undocumented immigrants from receiving Medicaid benefits.

This claim is false. Federal law already barred undocumented people from accessing Medicaid, Medicare, CHIP, and Affordable Care Act (Obamacare) coverage. Instances of undocumented people being erroneously enrolled in these programs are extremely rare.

Republicans have made this claim about OBBB repeatedly since the legislation was introduced. Health policy experts, including the Kaiser Family Foundation and Georgetown University’s McCourt School of Public Policy, have repeatedly debunked it.

The law does, however, make profound changes to Medicaid. OBBB will cut about $1 trillion from the health insurance program over the next decade, resulting in up to 12 million Americans losing their coverage. The bulk of those cuts will fund tax breaks that disproportionately benefit the wealthy.

Sens. Jon Husted (OH) and Dan Sullivan (AK) both voted for OBBB, as did Reps. Ashley Hinson (IA) and Mike Collins (GA), who are both running for Senate this year. Former New Hampshire Sen. John Sununu and former Michigan Rep. Mike Rogers, who are also running for Senate, have both publicly praised the law.

Michael Whatley, the Republican Senate candidate in North Carolina, said he would have voted for OBBB “in a heartbeat.”

A tracking poll by the Kaiser Family Foundation found that OBBB is deeply unpopular with voters. Sixty-four percent of respondents have an unfavorable view of the law. Among independents, 71 percent oppose it.

President Donald Trump has proposed additional tax cuts and further cuts to government programs if Republicans retain control of the House and Senate after the 2026 elections.

Reprinted with permission from American Journal News

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