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Merrill Goozner

Republicans Push Poor And Unaffordable Health Coverage As Costs Keep Rising

The median cost of employer-based health insurance this year leaped ahead at nearly twice the rate of the consumer price index, according to the annual Kaiser Family Foundation employer survey released yesterday. Sadly, workers are bearing a larger share of the increased burden through rapidly rising co-premiums.

The press coverage this morning of the closely followed survey emphasized the combined top-line increase of 5.5 percent for a family plan, which now stands at a staggering $26,993 a year or about the price of a new compact car. The cost of an employer-based individual plan rose at the slightly lower rate of 4.6 percent to $9,325 a year.

But a deeper dive into the numbers provides a better understanding of why people are so upset about rising health care costs. Employee co-premiums for a family plan (the amount deducted from paychecks) rose 7.6 percent on average to $6,850. The employer share went up only 4.8 percent. The net effect was a downward shift in the share paid by employers and a corresponding upward shift in the share paid by their employees, which was a half percentage point more or 25.4 percent of the total.

This increased burden on workers comes after an eight-year period when the employer share of premiums rose fairly steadily (with a few years off early in the pandemic). Companies offset some of those increases by funneling more of their workers into plans that raised their out-of-pocket expenses for deductibles and co-pays.

Depending on the plan type (HMO, PPO, high-deductible), the average deductible from employer-based family plans now ranges from $3,118 to $5,095 a year. Fully a third of workers and their families enrolled in high-deductible plans for 2025, up from 28 percent the previous year and the most ever.

Put the two together, and the median family (half pay more, half pay less) now pays anywhere from $9,968 to $11,945 a year for health care or close to $1,000 a month. Given the median household income in 2024 stood at $83,730, that translates into anywhere from 12 percent to 14 percent of a typical family’s income.

Things are about to get a lot worse. Next year’s premiums and co-premiums for employer-based plans, which cover an estimated 154 million people, are set to rise six percent to seven percent, according to a new survey by Mercer, a health care benefits consulting firm. If the split between employers and their employees remains the same, that will exceed wage increases by two to three percentage points. Wage increases have been trending down for the past three years, falling to just 4.1 percent this past August, the last month reported by the Bureau of Labor Statistics before the government shutdown.

Source: Atlanta Federal Reserve

No wonder health care costs now ranks as the second most important issue for inflation-weary Americans, just behind the deteriorating state of the overall economy. More than four in five of 1,300 adults surveyed in mid-October by the Associated Press and the NORC Center for Public Affairs said health care issues were extremely or very important to them personally. That was nine percentage points more than crime and 23 percentage points ahead of immigration — the next two biggest concerns.

The impact of ACA/Medicaid cuts on employer plans

The outlook for employer-based plans will also get a lot worse if Democrats fail to restore the Medicaid cuts and the enhanced subsidies for Affordable Care Act plans (which provides affordable insurance for tens of millions of low-wage workers, gig workers and sole proprietors). An estimated 7.3 million people who purchased subsidized exchange plans will drop ACA coverage, with more than half becoming uninsured, according to a Commonwealth Fund brief.

Many will look for cheaper, non-ACA compliant plans that don’t quality for listing on the exchanges because they provide skimpier benefits, are not required to provide free preventive care, can discriminate based on prior medical conditions, and often carry extremely high deductibles and co-pays. This summer, the Trump administration announced it wouldn’t enforce the rule approved by the Biden administration in mid-2024 that limited such plans to three months duration.

“Those who sell non-ACA plans … will absolutely see the coming open enrollment as an opportunity to push their plans as more affordable alternatives, without sharing full information with consumers about the limits of those plans,” said JoAnn Volk, a professor at Georgetown University’s Center on Health Insurance Reforms.

What happens when people who previously had Obamacare buy skimpy plans or become uninsured? They postpone care until their conditions require emergency room treatment — the most expensive place to obtain health care. When struck by serious illnesses like cancer, heart attacks and strokes, they often fail to pay their uncovered bills, or resort to Go Fund Me campaigns to pay off their high deductibles. Some will negotiate long-payoff periods and live the rest of their lives burdened by medical debt. Some will declare bankruptcy.

Hospitals and physicians, in turn, will raise their prices to cover the cost of uncompensated care, which will cause private insurance rates to rise even more. Rising prices, rising insurance premiums, and rising uninsured rates is an accurate description of what existed in the U.S. before passage of the ACA.

These health care economic fundamentals are of little interest to the modern-day Republican Party, which invariably includes some variation of bare-bones insurance as one of their answers to the affordability crisis. Early in the shutdown, they floated ideas like instituting new income caps on Obamacare subsidies, establishing minimum co-pays, and cutting off subsidies for new enrollees, none of which they would agree to negotiate until the government is reopened.

Then, last week, Politico reported they are also willing to beef up tax credits for investing in health savings accounts, which could be used to buy skimpy plans. Lower-income workers generally avoid HSAs since they can’t afford the voluntary deductions needed to fund them.

I can’t predict when or how the shutdown crisis will end. But I am pretty confident that I know what will happen to health care costs in the next few years given Republican control of Washington. They’re going up, up, and up.

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

Now Republicans Are Using Hunger As A Weapon In Shutdown Fight

Starving a poor, defenseless population worked in Gaza. Why not try it in the U.S.?

That seems to be the Trump regime’s emerging tactic for ratcheting up pressure on the Democratic Party to abandon its attempt to restore the Medicare cuts and Obamacare subsidies as the price for reopening the government.

In mid-October, the Department of Agriculture told every state agency administering the Supplemental Nutrition Assistance Program that they should stop sending in monthly files with the names of beneficiaries. Those files are used to send electronic food-stamp cards worth an average of $187 a month to more than 41 million people across the U.S. That’s one in out of every eight Americans.

During previous government shutdowns, Congress took steps to assure food assistance continued to flow. Earlier this year, the Republican-controlled Congress and the Trump administration agreed to an additional $300 million for the Special Supplemental Nutritional Program for Women, Infants and Children. WIC provides extra nutrition assistance to about 6 million low-income, expectant mothers and young children.

But the SNAP program is far larger, costing the federal government about $8 billion a month. State officials are beginning to ring alarm bells about the looming SNAP shutdown. “If SNAP funds are not delivered by the federal government, the State of Illinois does not have the budgetary ability to backfill these critical resources,” the state’s Department of Human Services said in a statement late last week.

Illinois Gov. J.B. Pritzker, the most vocal governor resisting the Trump administration, asked: “Why is it that they can find the money during a shutdown to pay their masked federal agents wreaking havoc in our communities but not help people in need put food on the table? … The very least they could do is preserve SNAP access for low-income families struggling to feed their kids.”

Connecticut officials warned the federal government electronic processing system could also be shut down, which would cut off access to any food assistance dollars that remain on cards from previous months. The Associated Press reported last week that state officials in Minnesota told all counties and Native American tribes not to approve new SNAP applications, and planned to tell recipients tomorrow that monthly benefits will end in November, barring any changes.

Any prolonged shutdown in federal food assistance will have devastating health consequences. Food insecurity and housing insecurity are major contributors to ill-health in the U.S. One in eight Americans depend on food stamps and even $100 billion a year is not enough to meet the need, witness the charity-dependent food banks that exist in every major city in the country and many ex-urban and rural areas. The U.S. spends even less on subsidizing housing than it does on subsidizing food.

Yet both programs have been targeted for cuts by the Republican-run Congress. The One Big Ugly Bill signed into law last July imposed work requirements in the food stamp program for adults aged 55 to 64 and parents with children 14 and over.

Food isn’t the only area where the Trump regime is moving to administer maximum pain in its efforts to reopen the government without negotiating compromises. Last week, shortly after flip-flopping on cutting off Medicare payments to physicians, it announced it would cease offering special assistance to rural hospitals and for telehealth, programs whose funding expired at the end of September. StatNews reports “ground ambulance transport services and Federally Qualified Health Centers could also be affected by the pause in some payments.”

Most of these cuts will have their deepest impact on states run by Republicans. But that doesn’t seem to matter to the Trump administration, which could care less about the collateral damage in its war against anything and everything that smacks of social decency.

Reprinted with permission from Gooz News

New Report Sharpens Doubt About Medicare Advantage As Open Enrollment Begins

Open enrollment for the over-65 crowd began yesterday with most analysts predicting there will be a sharp dip in the number of seniors who choose privatized Medicare Advantage plans for 2026.

That’s good news for people worried about the program’s fiscal health and the looming expiration of its trust fund, now slated for 2033. The Center for Medicare and Medicaid Services paid MA plans an estimated $84 billion more than it would have had the 54 percent of all beneficiaries choosing MA plans in 2025 — the most ever — remained in traditional Medicare, according to the Medicare Payment Advisory Commission.

Why do experts predict many people will opt out next year? In part, it’s because the three major insurers selling MA plans — UnitedHealth, Humana, and CVS Health’s Aetna — have eliminated hundreds of counties, and in some cases, entire states from their plans.

Despite the enormous profits they earn from MA, insurers complain rising prices and greater utilization are driving up their expenses (true) while the federal government is curtailing reimbursement (false). The Center for Medicare and Medicaid Services final MA payment rule, unveiled last April, showed private health plans will get an effective rate increase of nine pecent in 2026, which is several percentage points above inflation-adjusted economic growth rate.

Disappearing plans is not the only reason why people are abandoning MA. Consumer preference is playing a huge role.

Private insurers are increasingly using prior authorization to curb utilization. Prior authorization is where physicians are required to obtain insurer approval before making specialist referrals, prescribing certain drugs, tests and procedures, and, in some cases, ordering preventive care. This delay and deny strategy (the first allows insurers to earn money on the float; the second simply cuts expenses) is drawing enormous pushback from physicians and patients, so much so that the industry was forced to announce this past summer it would take steps to ease the approval process — by 2027.

The Centers for Medicare and Medicaid Services has also been revamping its “star” rating system, which is one of the few tools elderly consumers have for comparing the quality and outcomes of different plans. Insurers sometimes game the system by combining multiple counties from widely dispersed geographic areas into a single plan for star-rating purposes, which gives a false picture to beneficiaries who happen to live in poor-performing counties included in the plan. Insurers must have 94 percent of its MA members in plans rated 4-star or 5-star before getting a five percent bonus payment.

The revamp is having an impact. For instance, in 2024 Humana had 94 percent of its MA plan members in 4- or 5-star rated plans. The changes instituted by CMS (an agency which so far has escaped the scientific quackery and staff cutbacks Robert F. Kennedy Jr. and Martin Makary have imposed on the Centers for Disease Control and Prevention and the Food and Drug Administration, respectively) reduced its 4- and 5-star share to 25 percent this year, according to a story yesterday in Modern Healthcare. Earlier this week, the U.S. District Court in North Texas rejected Humana’s suit challenging the reduction.

Has Medicare Advantage improved quality?

There is still a substantive debate about whether MA has improved quality for its beneficiaries.

The original idea behind Medicare Advantage, which took off in the early 2000s, was that privatization of Medicare would lead to lower costs since the private sector was, allegedly, more efficient. Proponents of MA also argued that replacing fee-for-service reimbursement as deployed by the government in traditional Medicare with privately managed care would lead to higher quality, greater patient satisfaction and, most importantly, better outcomes.

The first argument is demonstrably false. As numerous MedPAC reports have shown, MA hasn’t saved the government a dime. In fact, over the years it has cost the government hundreds of billions of dollars more.

But have we at least gotten better results from all the extra taxpayer money shoveled out to the insurance industry through privatization? Dozens of studies have been conducted over the years testing that question. Proponents of MA, led by the Better Medicare Alliance, an industry front group, cherry pick the literature to claim MA enrollees have fewer hospital readmissions, fewer preventable hospitalizations and reduce the use of high-risk medications among seniors. Privatization opponents like the Center for Medicare Advocacy are equally adamant that quality in MA is at best no different than traditional Medicare, and in some cases worse.

A September 2022 Kaiser Family Foundation report examined 62 studies published since 2016 that compared MA and traditional Medicare based on measures of beneficiary experience, affordability, service utilization, and quality. The report found MA “outperformed traditional Medicare on some measures, such as use of preventive services, having a usual source of care, and lower hospital readmission rates. However, traditional Medicare outperformed [MA] on other measures, such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies.”

Today, the Commonwealth Fund offered a first-of-its-kind comparison study of Medicare performance in all 50 states and the District of Columbia. While comparing traditional Medicare to Medicare Advantage wasn’t its focus, and its authors caution against using its findings to highlight quality differences between the two approaches to paying for care, the scorecard’s findings did suggest (based on my analysis) that MA delivers outcomes on key quality measures that are at best equal to traditional Medicare, and sometimes worse.

The overall study looked at 31 measures of access, quality, affordability and population health, derived from the records of both traditional Medicare and Medicare Advantage plans. Two of the main quality indicators highlighted in the report were the statewide number of preventable hospitalizations per 1,000 beneficiaries, and what share of seniors on Medicare were prescribed drugs known to be risky or inappropriate for people in their age group.

For the overall score, the study’s authors ranked each state and the District of Columbia for the 31 measures, and then created a composite score. The results were predictable: Vermont, Utah, Minnesota, Rhode Island, Colorado, New Hampshire, Maine and Hawaii were, in order, the eight top-ranked states; starting from the bottom, Louisiana, Mississippi, Kentucky, Oklahoma, Arkansas, Texas, West Virginia and Alabama brought up the rear.

Those results show that the social determinants of health — statewide wealth and income, food and housing security, low unemployment and the like — drive overall health and therefore health care spending in Medicare. That’s not surprising. How well people fare during their working years will usually determine how well they fare in retirement, which in turn determines how much they will cost Medicare and, ultimately, how long they will live.

“Spending doesn’t always align with outcomes,” said Dr. Joseph Betancourt, president of the Commonwealth Fund. “The states that tend to do well in Medicare performance also tend to do well in our other surveys of broader populations.”

But in looking at the two quality indicators highlighted by the study, a different pattern emerges. I ranked the share of each state’s population in Medicare Advantage plans in 2024 (compiled by the Kaiser Family foundation) and compared that to the state’s performance on two quality indicators: preventable hospitalizations and inappropriate drug prescriptions. In the charts below, the numbers in red and purple (the worse five) are states with below average scores (which are higher numbers); the numbers in black are states that did better (lower numbers) than the national average.

These are important measures for evaluating Medicare Advantage performance since preventing unnecessary hospitalizations is precisely what MA managed care is supposed to achieve and inappropriate prescribing is precisely what MA prior authorization is supposed to prevent. The study also measured what share of MA plans in a state used prior authorization, which is shown in the second column in the chart.

The bottom line: States with above-average enrollment in MA plans tend to have higher-than-average rates of preventable hospitalizations. There is no discernible pattern in the rates of inappropriate prescribing between states with above or below average enrollment in MA plans.

For instance, Michigan ranked in 25th or right in the middle of the pack in the overall rankings. It had the highest Medicare Advantage penetration (61.6 percent). Yet its managed care plans, nearly half of which used prior authorization, did not prevent the state from being ranked fifth worst in preventable hospitalizations and three percentage points above the national average in inappropriate prescribing. Ditto for Alabama, which had the second highest MA market penetration, yet ranked among the five worst when it came to preventing unnecessary hospitalizations and inappropriate prescribing.

On the other end of the spectrum, rural states like Vermont and Wyoming had very low MA market penetration and scant use of prior authorization. Yet they scored above average performance on both quality indicators.

Having read numerous studies over the years that compare Medicare Advantage to traditional Medicare, I think it’s fair to say at this point that all the extra money that’s been poured into Medicare Advantage has not delivered to beneficiaries higher quality care or better outcomes. It is, in fact, a waste of money.

I’ll leave the last word to Gretchen Jacobson, the Commonwealth Fund vice president for expanding coverage and access. When it comes to Medicare, the federal government should “set standards for private plans and participating providers” and “incentivize providers to apply best practices and reduce wasteful care.”

Reprinted with permission from Gooz News

Democrats Must Address Looming Cost Spike In Private Health Insurance

Here’s the good news. The Democratic Party’s demand that Congress extend the Affordable Care Act premium subsidies in exchange for helping end the government shutdown is fracturing the GOP monolith.

In recent social media posts, Rep. Majorie Taylor Greene (R-GA) articulated what every legislator on the GOP side of the aisle knows but won’t admit. Out-of-pocket costs for ACA plans will skyrocket next year if the enhanced subsidies passed by the Biden administration during the pandemic are allowed to expire.

“This is a major crisis in America,” she said this week on NewsNation, a conservative cable news network. “We’re looking at a massive spike in health premiums. It’s going to crush people. They’re going to have to drop their health insurance. That will put a lot of people in danger of becoming bankrupt with health care bills, with hospital bills,” she said.

Even Donald Trump, ever the prevaricator, has begun toying publicly with opening negotiations with Democrats after Greene made her comments.

But she went further. It is not just the 24 million people on ACA plans who will get hit hard with average premiums more than doubling to more than $1900 a month (before subsidies) without the enhanced premium subsidies. “People with regular or private plans, their premiums are looking to go up a median of 18 percent. That’s brutal,” she said.

Always fast and loose with her facts, Greene’s claim that private health plan premiums will rise 18% is more than double what employer benefits consultants are predicting. But there’s no doubt huge spikes in employer premiums and employee co-premiums are coming. Both will likely to see near double-digit increases.

That’s the issue I want to address in today’s post because it represents a messaging minefield for Democrats, even if they win an extension of the ACA plan subsidies.

Where’s the rest of us?

During September, there was an interesting debate within the Democratic Party about what to demand from the GOP majority before giving them the votes needed to keep the government running beyond September 30th. Progressives wanted to focus on limiting the Trump regime’s flagrant violations of the law and constitution. Centrists, led by Senate Minority Leader Chuck Schumer (D-NY) and House Minority Leader Hakeem Jeffries (D-NY), preferred putting health care — usually a winning issue for Democrats — front and center. The centrist majority won the day.

The political wisdom of the leaders’ decision now seems vindicated. As Jonathan Cohn wrote yesterday in The Bulwark (his post was headlined “The Democrats Are Winning the Shutdown Fight”):

“A big premium spike can be a political nightmare for the party in charge, as anybody who lived through the Obamacare rollout can attest. That’s the whole reason Republicans seem so uncertain about their current position—and why now even MAGA stalwarts like Greene are suggesting Republicans sign on to an extension. If nothing else, that would seem to give Democrats leverage to demand even more…
“Democrats actually do care passionately about making health care more affordable. If the subsidy boost lapses, the higher costs will mean real hardship for many millions, and 4 million more Americans with no insurance at all. Extending the subsidy boost would prevent most or all of that from happening. And insofar as Republicans are bound to support some kind of extension eventually—precisely because the blowback to the spike could be so strong—forcing a deal now, in this high-profile debate, would allow Democrats to claim (legitimately) it was their doing.”

Nowhere in his lengthy article did Cohn discuss the employer-based insurance market, which covers 164 million working Americans and their families. If the Democrats say nothing about their looming health care cost increases, it will be a huge mistake.

Should Democrats win on the ACA issue, it will no doubt be great news for the 24 million Americans whose health insurance comes through plans sold on the exchanges. Just seven percent or about 1.7 million purchasers pay the full cost of their plans. The rest receive subsidies based on income that limit their out-of-pocket premiums. The lowest wage workers pay nothing at all.

For most, the total cost of the plan is irrelevant. The federal government picks up most if not all of any increase in the total cost of the plan.

But that won’t be true for the far larger employer-based insurance market — the half of all Americans whose health plans come through an employer, group or union. Their plans receive no direct subsidy. The employer share — on average about 75 percent of a family plan — is tax deductible as is any employee premium, usually deducted from paychecks. But the employee share paid through co-pays and deductibles is not unless their medical expenses exceed 7.5 percent of adjusted gross income; they itemize deductions; and their total deductions exceed the standard deduction. Even then, the deduction is only the amount over 7.5 percent of AGI.

Both employers and employees will bear the full upfront cost of the expected large increases in premiums on tap for next year. A month ago, Mercer, a leading benefits consulting firm, projected average employer premiums could rise nine percent next year based on preliminary results from its annual survey of nearly 2,000 employers. It predicted actual increases would be closer to 6.5 percent because of steps employers will take to hold those costs in check. That’s still twice the overall inflation rate.

Smaller employers will be hit hardest of all. A recent issue brief from the Kaiser Family Foundation found the median proposed premium increase for 318 small group insurers who offer ACA-compliant plans was 11 percent.

What’s behind rising costs?

Mercer health research director Beth Umland cited the usual suspects for the biggest increase in health care costs since 2010: The high cost of cancer treatments and weight-loss drugs; higher-than-usual price increases enabled by provider consolidation; higher health care worker wages driven by rising inflation in the general economy; and the “buildout of AI-based platforms that help providers optimize billing.”

The KFF brief echoed that analysis. It cited higher prescription drug costs and utilization, rising labor expenses, and overall economic inflation. “Some insurers also note declining enrollment and worsening risk pool morbidity as factors leading to higher projected costs next year,” the brief said.

The daily news in the health care trade press is filled with stories of insurers and providers battling over who should be forced to absorb some of those rising costs. Insurers are increasingly resorting to the “just say no” form of prior authorization and receiving pushback from both providers and patients. Modern Healthcare (where I used to be editor) reported this morning that insurers Aetna and Cigna are imposing their own version of the two-midnight rule (don’t ask) by forcing hospitals to accept out-patient rates for emergency room visits deemed routine care, no matter how long they stay in the hospital.

There’s going to be a lot more of those ER visits next year should the ACA subsidies not be extended, since an estimated four million people are expected to drop coverage. That will force many folks to use hospital ERs instead of primary care physician practices for their routine care. And, given that those dropping coverage will be fairly low income, most will postpone or fail to pay those ER bills, which leads to higher prices for everyone else who uses hospital services. Hospitals invariably raise prices to make up for uncompensated care.

And how will employers mitigate some of those rising costs (thus whittling the expected nine percent increase down to 6.5 percent), according to Mercer? “The survey found that 59 percent of employers will make cost-cutting changes to their plans in 2026 — up from 48 percent making changes in 2025 and 44 percent in 2024,” Umland wrote. “Generally, these involve raising deductibles and other cost-sharing provisions, which can lead to higher out-of-pocket costs for plan members when they seek care.”

In other words, workers will see their out-of-pocket co-pays and deductibles rise sharply in addition to a 6.5% average increase in their co-premiums, which are taken directly out of their paychecks. Workers with chronic health care needs could see their annual medical expenses rise at three times the overall inflation rate — perhaps even into double digits.

Only a tiny share of those increased costs will be mitigated by a Democratic win on ACA subsidies. Nor will a win do anything to help the millions of people who will be thrown off Medicaid, whose uncompensated expenses when they also show up in ERs for routine care will also be reflected in higher private employer/employee insurance bills.

For a majority of Americans, any Democratic Party claim that they “saved” health care by their strong stance during the shutdown negotiations will ring hollow in the face of their still rising out-of-pocket expenses.

Reprinted with permission from Gooz News

Lawless Order: Chicago On The Verge Of Federal Occupation

I awoke this morning in a city on the verge of occupation.

On Monday afternoon, U.S. District Court Judge April Perry, a Biden appointee, refused to do what a Trump-appointed judge did in Oregon: Issue a temporary restraining order preventing the federalized National Guard from occupying a peaceful city. This would be a direct violation of the Posse Comitatus Act of 1878 and a move Gov. J.B. Pritzker, Mayor Brandon Johnson, Police Chief Larry Snelling and state Attorney General Kwame Raoul say is unwanted, unnecessary and unconstitutional.

Judge Perry gave the lawbreaking regime in Washington two days to respond. This gives Trump and his minions the time they need to bring in 700 troops from the Texas and Illinois national guards, a move they’ve been looking to justify for months through constant provocations. Their campaign has led to the arrest of hundreds of local residents, a significant share of whom are U.S. citizens. Over the weekend, it included several politicians attempting to protect their constituents by reminding them of their rights.

The military-style campaign, carried out by masked and otherwise unidentified agents from multiple federal law enforcement agencies, included the unprecedented and now infamous assault on an apartment building in the historic South Shore neighborhood, which lies adjacent to Jackson Park, home of the soon-to-open Obama Presidential Center. About 300 federal agents stormed the five-story building and its fewer than 100 residents in the middle of the night by rappelling onto the rooftop from helicopters, throwing flash-bang grenades, kicking down doors, ransacking apartments and detaining adults and children with zip-ties. Many were U.S. citizens or in the U.S. legally.

“They just treated us like we were nothing,” one local resident told ABC7 Chicago. She was handcuffed, had a gun pointed in her face and held until 3 a.m. before being released. The raid, carried out without warrants, resulted in 37 arrests.

At least some of those detained were children, including four U.S. citizens, according to news accounts. One neighbor told television reporters she saw agents zip-tie the kids. “They was terrified. The kids was crying. People was screaming. They looked very distraught. I was out there crying when I seen the little girl come around the corner, because they was bringing the kids down, too, had them zip-tied to each other.” At least one agent laughed when local residents protested the children’s mistreatment. “He said, ‘Fuck them kids,’” she said.

“Imagine an armed stranger forcibly removing you from your bed, zip-tying your hands, separating you from your family, and detaining you in a dark van for hours,” Pritzker said in the aftermath of the raid. “This didn’t happen in a country with an authoritarian regime — it happened here in Chicago,” he said.

Judge Perry refused to act because she needed time to read the voluminous court filings, according to today’s Chicago Tribune. Though “very troubled” by the Trump regime’s actions, she gave the Department of Justice until midnight Wednesday to respond.

Invasion imminent

The newspaper reports those troops will be moving into the city as soon as today since Gov. Pritzker and local officials have no options beyond the courts for enforcing the law. While a case could be made for using local law enforcement to police the illegal actions of individual federal agents, that would be exactly the type of provocation Trump regime is looking for to escalate its assault on the city.

The militarized presence is not limited to the few neighborhoods making the news. When my wife and I returned to Chicago late Sunday after two weeks away, we were greeted by at least one military helicopter flying low over our mostly white neighborhood along Chicago’s North Side lakefront. A friend reports the federal government also sent military helicopters flying over his mixed, middle-income neighborhood over the weekend. They used searchlights to pan streets, lawns and alleys, no doubt scaring the bejesus out of the local rat population.

The regime’s actions make clear this has nothing to do with immigration enforcement. Their goal is to terrorize the local population, whom, through its votes and elected leaders, have chosen to stand in opposition to the illegal and immoral actions of the Trump regime.

The Trumpists are simultaneously consciously attempting to destroy the local economy. It illegally cancelled an already-approved $2 billion contract for mass transit expansion. The president’s constant lies about the state of crime in this city (“a hellhole” and “the murder capital of the world”) is a deliberate attempt to smear the reputation of the Midwest’s top tourist attraction, especially for foreign visitors.

Early estimates showed foreign tourism was down sharply this summer after returning to pre-Covid levels last year. The drop in Canadian tourists — the single largest group — was an estimated 25 percent, which isn’t surprising given they’ve taken to booing the Star Spangled Banner during sporting events in Canada.

According to the state’s complaint filed yesterday in Judge Perry’s court, the Trump’s regime assault on Chicago is creating “economic harm, depressing business activities and tourism that not only hurt Illinoisans but also hurt Illinois’s tax revenue.” The economies of thriving Hispanic neighborhoods have been especially harmed by the constant presence of ICE agents. Street traffic has been reduced to Covid-lockdown levels since everyone with brown skin is at risk of being detained and possibly arrested for failing to present proper credentials during ICE’s indiscriminate sweeps.

The core of the lawsuit charges the federal government with overstepping its authority and violating the constitution. The “deployment of federalized military forces to protect federal personal and property from ‘violent demonstrations’ that ‘are occurring or are likely to occur’ represents the exact type of intrusion on State power that is at the heart of the Tenth Amendment,” the complaint says. “The deployment of federalized National Guard, including from another state, infringes on Illinois’s sovereignty and right to self-governance. It will cause only more unrest.”

I suspect we will learn first hand the truth of that latter statement in the next few days as more Chicagoans are subjected to the presence of heavily armed soldiers patrolling their previously peaceful streets.

Reprinted with permission from Gooz News

The 'Obamacare Scare' That Forced Government Shutdown

There are many ways to debase a debate and guarantee a government shutdown.

The White House showed its way on Tuesday when Trump posted on social media a deepfake video portraying House Minority Leader Hakeem Jeffries wearing a sombrero while Senate Minority Leader Chuck Schumer says Democrats “have no voters anymore, because of our woke, trans bullshit” and “if we give all these illegal aliens health care, we might be able to get them on our side so they can vote for us.”

The Wall Street Journal editorial page weighed in with a deepfake economic spin to what other media outlets are calling a “vulgar” (Politico), “racist” (The Independent), and “falsely accusing” (New York Times) video. The Murdoch clan-owned Journal claimed that people who took advantage of the enhanced premium subsidies to buy health insurance (the Democrats’ sole demand for giving Republicans the votes they need to avoid a shutdown) did so to avoid paying for “affordable” health care coverage provided by their employees.

“Workers aren’t supposed to receive ObamaCare subsidies if they have access to ‘affordable’ coverage through their employers, but this rule is barely enforced,” the editorial complained. “Many workers could get employer coverage if the enhanced subsidies lapse at the end of the year, which would save taxpayers hundreds of billions of dollars. Don’t believe the Democrats’ ObamaCare scare.”

Its evidence? The paper cited a recent Bureau of Labor Statistics report showing that take up of employer-offered plans is plunging, especially among low-wage workers. Nearly three-quarters of employers now offer health coverage, up from 71 percent in 2019, according to the BLS. Yet just 65 percent took advantage that offer in 2025, down from 73 percent in 2019.

Among workers in the bottom 25 percent of wage earners, take up was just 49 percent this year compared to 61 percent a half decade ago. And in the lowest 10% percent of income, take up was just 34 percent compared to 57 percent in 2019.

Why? “Perhaps because they can now get ObamaCare plans at no cost,” the opinion page speculated.

Let’s take a closer look at what the Wall Street Journal editorial page deems is “affordable” health care coverage that employers offer to their low-wage workers. The average cost of an annual health insurance plan in 2025 was $25,572 for family coverage and $8,951 for individual coverage, according to the Kaiser Family Foundation. The average employee contribution to family coverage was 25% of the total or $6,296, according to KFF. For individual coverage, workers paid 16% of the total or $1,368.

Now let’s take a look at what low-wage households earn. In 2024 (BLS data on household income lags behind publication of monthly and annual wage data) families earning at or below $41,400 a year landed in the bottom 25% of all households. Those in the bottom 10% earned at or below $19,900 a year.

That level of income doesn’t make their employer plans affordable. It makes them prohibitive.

A family at the 25th percentile would be paying for an average family plan fully 15 percent of its annual income for coverage. Better-off families that itemize their deductions (lower wage workers almost never itemize) would be able to take half of that as a tax deduction. A better way to characterize Obamacare subsidies is as one way to help to level the playing field of our inequitable tax code.

Meanwhile, a family in the bottom 10 percent of households would be paying a prohibitive 32 percent of its income for health insurance through their employers. No wonder take up of employer-offered plans among low-wage workers is so low, and was so even before arrival of the Affordable Care Act. When you’re poor, paying your rent, food and transportation bills have a higher priority than buying protection against the possibility you’ll be thrown into bankruptcy should someone in your family might get sick in the coming year.

That’s not something an editorial writer who is paid not to understand the economics of health care will ever understand.

Reprinted with permission from Gooz News.

Kennedy's MAHA Movement Reveals Itself As Corporate Front

Robert F. Kennedy Jr.’s Make America Healthy Again commission on children’s health reached its ignominious conclusion Tuesday by issuing a final report that failed to mention the biggest threats to childhood ill-health in the U.S.

The final 73-page report, which was accompanied by a 20-page strategy memo, made no mention of:

Gun violence, the number one killer of American children under 18;
Smoking, a lifelong habit most take up when teenagers; or
Global warming, the greatest long-term threat facing the youngest generation.

Mentioning these issues would have required the report call attention to the biggest roadblocks standing in the way of addressing each of these issues. They are, respectively, the Gun Lobby, Big Tobacco and Big Oil & Gas.

Those industries are fervent supporters of the U.S.’s authoritarian headman, Donald Trump. His only consistent political position — one that he requires all his lackeys adhere to — is steadfast support for the nation’s richest and most powerful corporations and individuals, especially those that have given him huge campaign contributions.

Even when it came to addressing the issues that Kennedy claims to care most about, his need to please Trump by giving special interests a pass denuded the final report of any meaningful measures. Those issues include the prevalence of ultra-processed food; chemical food additives; environmental toxins; and excessive use of psychotropic drugs and vaccines. Other than vaccines (last week, his denigration of vaccines led even a few Republican physician-Senators to question his honesty), those are issues that most Americans and unbiased researchers would also like to see addressed.

Yet the final report failed to outline any concrete steps that the Health and Human Services Department, the Agriculture Department or the Environmental Protection Agency plan to take. “A lot of this is nice (but) it’s a report about intentions, not about actions,” New York University professor of nutrition emeritus Marion Nestle told the PBS NewsHour. “How on earth are they going to do these things (when) the word regulation is only mentioned once?”

Many of the deregulatory and budget cutting actions taken by the Trump regime since taking office work directly against the goals outlined in the report. For instance, the Environmental Protection Agency’s research department has been gutted, all but eliminating the agency’s ability to scientifically determine which environmental toxins are causing significant harm to children’s health.

The budget for the Supplemental Nutrition Assistance Program (colloquially food stamps) has been cut sharply, which will reduce food assistance to almost three million children. Rather than taking steps at the federal level to limit the ability of low-income beneficiaries to purchase sugar-laden beverages or salt-heavy snack foods (instead, they plan to offer technical assistance to states that want to do that), the Trump regime is making more children go hungry. Common sense suggests allowing three million kids to go hungry will destroy the health of far more children than allowing parents of kids on food stamps to continue buying soda pop.

The strategy report called on the Department of Education to “help states” reinstitute the presidential fitness test. The DoE is currently being dismantled by the Trump regime.

Also, it claimed HHS’ Administration for Children and Families will “promote greater physical activity” in after-school and summer programs. Meanwhile, Trump’s budget cutters slashed $7 billion to support those programs in June, only to restore a mere $1 billion a month later after widespread protests from educators in both red and blue states.

Perhaps the most curious oversight in yesterday’s strategy report was its turnaround on the chemicals, dyes and other additives in ultra-processed foods (UPFs), a major bête noire for Kennedy and a long-time concern of mainstream nutritionists. The main report’s 7-page section on UPFs contained 75 footnotes. Yet the strategy memo contained just a single action item of little significance: “USDA, HHS, and FDA will continue efforts to develop a U.S. government-wide definition for ‘Ultra-processed Food’ to support potential future research and policy activity.”

“What this says to me is that the first report was written by MAHA,” Jerold Mande, an adjunct professor of nutrition at the Harvard T.H. Chan School of Public Health and a former senior policy official for nutrition in the Bush, Clinton, and Obama administrations, told Time magazine. “The second one, the White House let industry lobbyists write it.”

Reprinted with permission from Gooznews

Labor Day weekend shootings across Chicago

Where Does Chicago's Murder Rate Actually Rank?

The New York Times released a story on Wednesday afternoon about crime rates in various cities. Its headline? “Crime Festers in Republican States While Their Troops Patrol Washington.” It pointed out that cities like Kansas City, St. Louis, and Springfield, Missouri; Birmingham, Alabama; Cleveland, Dayton and Toledo, Ohio; Tulsa, Oklahoma; Memphis and Nashville, Tennessee; Houston, Texas; Little Rock, Arkansas; Salt Lake City, Utah; and Shreveport, Louisiana have crime rates comparable to Washington’s, where federal troops have been patrolling for the past few weeks.

Why isn’t the Times taking a close look at Chicago, which faces a federal invasion? The truth is that my home city is on pace to have its lowest murder and violent crime rate in four decades. Where does it rank in terms of cities when it comes to murders? It turns out Chicago doesn’t even make the top 20. How about cities in Republican run-states? Eleven out of the top 15 have Republican governors.

This list comes from Newsweek magazine (data reflects murders per 100,000 population; cities in bold have Republican governors):

Birmingham, Alabama (58.8)
St. Louis, Missouri (54.1)
Memphis, Tennessee (40.6)
Baltimore, Maryland (34.8)
Detroit, Michigan (31.2)
Cleveland, Ohio (30)
Dayton, Ohio (29.7)
Kansas City, Missouri (27.6)
Shreveport, Louisiana (26.8)
Washington, D.C. (25.5)
Richmond, Virginia (24.2)
South Fulton, Georgia (22.2)
Cincinnati, Ohio (21.8)
Louisville, Kentucky (21.7)
Indianapolis, Indiana (20)
Oakland, California (18.6)
Albuquerque, New Mexico (18.4)
Montgomery, Alabama (18.1)
Minneapolis, Minnesota (18)
Lancaster, California (17.7)
Little Rock, Arkansas (17.6)
Hartford, Connecticut (17.6)
Chicago, Illinois (17.5)

Of course, facts do not matter to the Trump regime. When the president posted on Truth Social that Chicago is the “murder capital of the world,” it wasn’t even close to the truth.

Reprinted with permission from Gooz News.

Who Will Take Care Of Grandma When Trump Expels Immigrant Workers?

As we prepared to honor working people on this Labor Day, I could not think of a more relevant topic to discuss on this week’s podcast that the impact that President Trump's war against immigrants is having on the nation’s health care workforce.

Healthcare is heavily dependent on immigrant workers. Nearly 30 percent of our physicians hail from abroad. Around 17 percent of nurses are foreign born. More than one quarter of direct care workers — those who labor as nursing and other aides in hospitals, nursing homes, assisted living facilities and home care — are immigrants.

There are undocumented immigrant workers in each of these categories, especially direct care. Leading Age, the trade association for the long-term care industry, says immigrants make up 30 percent of home care aides, 20 percent of nursing assistants, 20 percent of registered nurses, and 15 percent of licensed practical nurses in our nursing homes.

No one knows exactly how many of these workers are in the U.S. without legal documentation. But there are nine million undocumented workers in the United States. A substantial share are engaged in providing health care. Many of them have been here for years, just like the nine Filipino nurses who were deported from my home city of Chicago in the early days of Trump's second term as president.

There are currently about 65 million senior citizens in the U.S. That number is expected to grow to 72 million by 2030. Who will care for those needing special care if Trump and his henchman Stephen Miller succeed in their mass deportation plans?

To discuss this issue, I invited onto this special Labor Day GoozNews podcast a leading researcher in the field — Dr. Patricia Santos of Emory University. Dr. Santos' research focuses on understanding the structural barriers to care in under-served populations and communities. She recently co-authored a commentary in the New England Journal of Medicine on the dangers posed by the immigration crackdown.

She offers an important perspective on what the Trump regime’s inhumane policies on immigration might mean for patients, the institutions that care for them, and the immigrants themselves in the weeks and months ahead.

Reprinted with permission from Gooznews

How RFK Jr's New Anti-Vax Guidelines Will Kill Innocent Americans

A few months ago, the film and culture critic Neal Gabler wrote on his Substack about the many state-sanctioned killings authorized by the Trump regime:

“Donald Trump kills. He kills government, he kills the rule of law, he kills checks and balances, he kills the Constitution, he kills science, common sense, common decency, morality, compassion, community, order, responsibility, accountability, seriousness, decorum, politesse, and just about every other value and institution and tradition on which he can get his dirty grifter’s hands.”

Gabler forgot to add that he also kills the health of the American people. Yesterday, the Food and Drug Administration, an agency once considered the gold standard among global health regulators, approved mRNA Covid vaccines for this fall with a label recommending they be limited to seniors and adults and children over five with at least one chronic medical condition. All healthy adults and children — at least half the population — are not on that list.

There were no scientific justifications for these limitations — none in the FDA pronouncement and none in the scientific literature.

Next up will be the recommendation from the Centers for Disease Control and Prevention’s new and degraded vaccine advisory panel. It could refuse to offer any endorsement for this year’s vaccine. The eight-member panel, installed by Health and Human Services Secretary Robert F. Kennedy Jr. after firing its 17 predecessors, includes numerous vaccine skeptics. (Shortly after this article was posted, Kennedy dismissed CDC chief Susan Monarez after she “ran afoul” of Kennedy “by objecting to his changes to the panel of experts who advise the agency on vaccine policy,” according to the New York Times.)

Should the CDC refuse to endorse vaccination, it will trigger state laws that prevent pharmacies from administering vaccines not recommended by the CDC. Pharmacies are the site for 90 percent of Covid vaccinations, including almost all delivered to seniors and other vulnerable populations, according to another story today in the New York Times. States that have such laws include California, Florida and Massachusetts.

Spreading disease

No matter what the CDC does, Covid vaccine rates, already low, are certain to fall farther after today’s announcement. Vaccine rates have fallen to under 25 percent among all adults and less than 13 percent for children under 18, according to the CDC.

That is certain to increase the incidence of the disease, even if those already infected have very mild cases or fail to show symptoms. The usually mild Covid cases that healthy adults and children under 65 experience was the FDA’s rationale for refusing to endorse their need for vaccination.

However, sick people of any age spread the virus through tiny aerosolized particles that can linger in the air and infect people nearby for hours, especially in crowded or poorly ventilated indoor spaces. Sick people infect vulnerable people. That’s why vaccination rates need to be high.

This is especially true for American schools, especially when located in older buildings. Most are poorly ventilated. During the pandemic, infected children were a major vector for spreading the disease to adults in their households. With adult and senior vaccination rates falling, we’re likely to death rates from Covid rising again this fall, especially among vulnerable populations.

We’re also likely to see rising caseloads of Long Covid, which strikes many people who only experienced a mild case of the disease. See this recent GoozNews post on the rising incidence of Long Covid and its impact on health and the economy.

This decision is one more affirmation that the Trump regime, to use Gabler’s formulation, “kills science, common sense, common decency, morality, compassion (and) community.” Encouraging healthy adults and children to go unvaccinated poses a direct threat to the health and well-being of their older, sicker family members, friends and the general public as they go about their daily business.

It is the perfect expression of the Trump regime’s reigning philosophy. The only thing that matters for the MAGA-ites and the president is how it affects me. It is an indecent, immoral and uncompassionate philosophy. It is a threat to the community. It is the hallmark of our times under authoritarian rule.

Reprinted with permission from GoozNews

Why Trump's Scheme To Cut And Privatize Veterans' Health Care Will Fail

You would think protecting veterans’ access to health care would be sacrosanct in the current political environment.

So how can we explain the Trump regime wielding a budget axe at the Veterans Health Administration? The agency – the largest health care system in America – is in the process of eliminating 30,000 jobs for physicians, nurses and other personnel. That’s nearly one of every 12 employees at the VHA, which is responsible for delivering health care to over nine million veterans.

In recent weeks, Veterans Affairs Secretary Doug Collins, a former Georgia Congressman and military chaplain, cancelled every union contract with the VHA’s physicians, nurses and other employees. This came after the Baptist minister-turned-politician sent letters to VHA workers encouraging them to either retire or look elsewhere for work. Morale at the agency is plummeting.

These were only the first steps in the Trump regime’s plan to dramatically downsize the VHA during his second term in office. The 2026 budget he sent to Capitol Hill called for spending more than a third of the VHA’s $115 billion budget on outside physicians and other private providers. That’s a nearly 50 percent increase over previous outsourcing, a move that some progressive Democrats in Congress are calling the stealth privatization of the VHA.

“They want every employee to be pushed out so they can decimate the VA’s workforce,” Rep. Delia Ramirez (D-IL) said during a July House Veterans Affairs committee meeting. It “wants them to leave” as part of its plan to privatize services.

The Trump regime’s escalation of VHA privatization extends a decade-long trend. It began in 2014 after a Phoenix VHA administrator was accused of under-reporting appointment wait-times in the reports sent to Washington. (No other health care system reports wait-times. If they did, the VHA would probably look good by comparison.)

Ensuing demands that veterans be allowed to access private-sector providers led to passage of the 2014 Choice Act, signed into law by President Barack Obama. The law launched pilot projects in rural and under-served areas that, while allowing for outsourcing, limited it to situations where the local VHA facility was more than a 30-minute drive from the veteran’s home, or, the facility could not schedule an appointment within 20 days for primary or mental health care or within 28 days for specialty care.

The program became system-wide with passage of the 2018 Mission Act, which also had bipartisan support. Though touted as a major benefit for the 25 percent of veterans who live in rural areas, the bill broadened the criteria to include instances where veterans and their VHA physicians thought it was in “their best medical interest.” But they needed a second opinion to that effect. Earlier this year, VA Secretary Collins removed the second opinion requirement.

No choices

But is “choice” helping rural veterans? Earlier this month, The American Prospect reported on a comprehensive survey by the Veterans Healthcare Policy Institute that questioned private providers’ ability to serve the needs of the 2.8 million rural veterans enrolled in the VHA. The “analysis reveals a system that cannot provide even basic medical and mental health services to non-veteran patients,” Suzanne Gordon, co-founder of VHPI wrote. “Hundreds of hospitals in America’s rural counties and under-served areas have curtailed critical services or closed entirely. And thousands of counties across America are experiencing significant health provider shortages.”

Things are likely to get a lot worse over the next several years as millions of rural residents on Medicaid or Affordable Care Act insurance plans lose coverage due to the cutbacks recently signed into law. “President Trump, VA Secretary Collins, and Republicans in Congress want to send more veteran patients into an already troubled private-sector system, while depleting that system of the resources necessary to absorb this extra load,” Gordon wrote. “The idea that this will work well is shaped more by ideology than reality.”

If helping rural veterans is the goal, a far more fruitful approach would be shifting VHA resources into the areas where most veterans now live. The system rapidly expanded during the quarter century after World War II to serve the needs of veterans who, for the most part, hailed from urban areas. The system’s 170 hospitals are located mostly in large and medium-sized metropolitan areas.

The VHA also staffs almost 1,200 outpatient facilities. Unfortunately, most rural areas remain poorly served by these clinics. Many rural counties have none. This should come as no surprise. Residents of these areas often have to drive an hour or more to access pharmacies, grocery stores and other retail outlets. Accessing medical services, whether public or private, often involves even longer drives.

Moreover, rural hospitals, which would be a logical place for providing additional services for veterans, are also dying. There simply aren’t enough patients in sparsely populated areas to support comprehensive medical services. The idea that the private sector can meet the special needs of veterans, who suffer disproportionately from chronic diseases, whether related to their service (Agent Orange and burn pit exposure; PTSD and other mental conditions) or not, is absurd.

Here’s an idea. Why not use the VHA budget to establish clinical capacity in these regions? Indeed, they could open their doors to the entire local population, turning the VHA in rural America into the equivalent of a federally qualified health center. This could provide the agency with an additional source of revenue to the extent other payers (Medicare, Medicaid, private insurance) offered coverage to people living in these sparsely populated areas.

Best care

But, you’re probably asking, wouldn’t this take money away from the urban medical centers that are the backbone of the VHA system? These large complexes are currently underutilized, spatially mismatched to where current and future generations of veterans live, and often in need of renovation – a set of circumstance documented by numerous commissions and reports. (See here and here, for instance.)

To help solve these problems, one idea I found intriguing while doing research for this article (it comes from the right-leaning Manhattan Institute) would be to allow the VHA’s urban hospital systems to provide services to people covered by public programs like Medicare and Medicaid and the privately insured.

The VHA model for delivering care is everything a wannabe reformer like myself dreams about (as Phil Longman documented in his 2012 book, Best Care Anywhere: Why VA Healthcare Would Work Better for Everyone.). Its physicians are salaried; they are mission-driven (they work for less than their private sector counterparts); they are trained to follow clinical practice guidelines; and, as a general rule, they deliver high quality care (studies have repeatedly documented how VHA outcomes equal or surpass those of comparable facilities). The VHA also provides comprehensive coordinated care for people who require it (including addressing housing and food insecurity and other social issues) and pays the lowest price for drugs.

Unfortunately, its facilities are disproportionately located in regions that no longer house many veterans. Manhattan Institute senior fellow Chris Pope summed up the problem in his recent proposal, “Making Use of VA Hospital Overcapacity: Expand Access to Reduce Costs”:

“The VA operates essentially the same hospitals in the same locations as it did in the 1970s, despite a great shift of the veteran population to the Sunbelt. In 1970, far fewer civilian veterans lived in Arizona (0.2 million) than in New York (2.4 million). By 2020, the number in Arizona had surged (to 0.5 million), while that in New York had plummeted (to 0.6 million). While the VA still operates twice as many hospitals in New York as in Arizona, facilities in the Grand Canyon State have been strained. The VA has substantial excess capacity across the country as a whole; but in a few areas, clinicians have been overworked while patients face long waiting times.

His proposal?

“VA hospitals should be permitted to treat and bill Americans covered by other insurance plans (privately financed, Medicare Advantage, or Medicaid managed care), regardless of their eligibility for VA-financed care. Congress has repeatedly demonstrated that it is unwilling to cut funding for existing VA hospitals, as this may threaten their continued operations. Policymakers should therefore attempt to make better use of these facilities, so that their fixed costs can be spread over more patients.”

Since many veterans who receive free care at VHA facilities are also enrolled in taxpayer-financed private plans like Medicare Advantage and Medicaid managed care, it would also save the government money. “This proposal would provide increased revenues to allow the continued maintenance of VA institutions, without increasing federal expenditures per patient as the veteran population continues to decline,” he wrote. “It would also end the double payment for veterans receiving care through the VA who are also enrolled in Medicare Advantage or Medicaid managed care.”

This seems like an idea well worth exploring — one that has the potential to generate bipartisan support on Capitol Hill.

'Lingering Effects': The Long-Term Cost Of Long COVID

Well over 100 million U.S. adults have contracted Covid since the beginning of the pandemic with an estimated 13% of patients suffering from its long-term effects. The most common symptoms among this very large group are chronic fatigue, breathing difficulties and “brain fog” — the loss concentration and memory.

Little attention has been paid to the impact this suffering is having on health care spending, which is once again growing at a faster clip than the rest of the economy. An early study conducted by David Cutler at Harvard conservatively estimated Long Covid treatment had cost $528 billion through the end of 2022. More than two years later, that spending would be far higher.

Even less attention has been paid to its impact on the broader economy. That same study estimated Long Covid reduced earnings by nearly a trillion dollars among its sufferers, which would make the disease a significant contributor to the relatively slow economic growth we’ve seen over the past two years.

A new study released today in JAMA seeks to quantify the financial impact on working-age adults from Long Covid. It found people reporting long-term effects from the disease experienced greater unemployment, reduced work hours and were more likely to experience activity impairment at work compared to those whose disease resolved quickly without long-term effects.

“The substantial employment and economic burdens … underscore the need for targeted policy interventions and greater workplace support structures to ensure that the sizable U.S. workforce that may have Long COVID is able to contribute to economic activity and to avoid personal economic hardship,” the study authors concluded.

The study, conducted at eight academic medical centers, followed 3,663 people who contracted COVID during the first two years of the pandemic for at least six months after they recovered. More than a quarter (27.1 percent) of the participants reported having symptoms of Long Covid with nearly half of them reporting a waxing and waning of their symptoms.

The lingering effects of the disease proved devastating to their work lives. Those with either resolved or current Long Covid were nearly three times more likely to be unemployed compared to those who suffered no after-effects from the disease. More than 40 percent of Long Covid sufferers (current or resolved) had reduced work hours compared to just 14% of those without it.

And as far as productivity was concerned, those with Long COVID were 44 percent more likely than those without it to ask for shorter hours or less demanding work. As a consequence, the Long COVID group was five times more likely to face economic stress in their daily lives compared to those without it.

The bottom line: The media, following the lead of the federal government, has largely moved on from reporting on the ongoing effects of the pandemic. That ignores ongoing physical and economic impact it is having on well over 13 million Americans.

Reprinted with permission from Gooz News.

How Trump Promoted A Multi-Billion Dollar Medicare Fraud

One of the largest Medicare fraud schemes in program history began to unravel several years ago when accountable care organizations created under the Affordable Care Act began noticing most of their savings, which they share with taxpayers, were vanishing due to the exorbitant cost of a single product — wound care bandages made mostly from dried placenta cells.

By April 2024, the National Association of Accountable Care Organizations (NAACOS) had enough data to notify the Centers for Medicare and Medicaid Services (CMS) about the outlandish sums being paid to physicians using “skin substitute” bandages for wound care instead of traditional bandages. The physicians, who purchased the skin substitutes at a steep discount from manufacturers, were billing ACOs at the list price and pocketing the difference.

Some patients were racking up millions of dollars for the skin substitutes used to cover their diabetic sores and other hard-to-heal wounds. According to a letter NAACOS sent to a Medicare payment contractor in June 2024, “the skin substitutes have been provided to patients who are poor candidates for specialty wound care, including hospice patients receiving significant wound care in the last three days of life, patients with inability to off-load pressure or transport without force, and patients who are unable to maintain adequate nutrition.”

This lucrative scheme for physicians was providing even larger profits for their manufacturers, almost all of which are privately-owned. Using loopholes in the law, they began charging an average of more than $6,000 per square inch for skin substitute bandages. Some products reaching over $21,000, according to a New York Times investigation in April.

Five years ago, the highest priced skin substitute bandages on the market was only $1,045 per square inch. Medicare spending on skin substitute bandages soared from about $250 million in 2019 to more than $10 billion in 2024, according to CMS.

The Biden rule

After NAACOS alerted CMS to the alleged fraud, the Biden administration began crafting a new rule that would sharply lower the maximum price paid the firms selling the expensive bandages. It also limited payments to physicians who used skin substitute bandages purchased from firms that had generated medical evidence showing they improved wound care better than much cheaper standard bandages. Many firms in the field produce no such studies since the bandages do not require FDA approval beyond meeting sterility standards. The rule was slated to go into effect this past February.

That when the Trump regime sprang into action. The rule was delayed until April 13 as part of its blanket regulatory freeze. Then, in March, Trump issued a post on his Truth Social site claiming: “‘Crooked Joe’ rammed through a policy that would create more suffering and death for diabetic patients on Medicare” — an echo of the industry’s false claims.

How did Trump know anything about an issue that at that point still had not appeared on the mainstream media’s radar screen? Last fall, when the Biden rule was in the works, San Antonio-based Extremity Care, one of the largest firms in the skin substitute field, donated $2 million to MAGA Inc., the super PAC supporting Trump’s election campaign. In February, according to post this week by journalist Judd Legum on the substack Popular Information, Extremity Care donated another $5 million to MAGA Inc.

In April, the day after publication of the Times exposé, Dr. Mehmet Oz's CMS postponed enactment of the new rule until 2026. This allowed companies to continue selling at high prices for at least another eight months.

Then, three weeks ago, the Trump regime reversed field and included a price limit for skin substitutes in the physician payment rule for 2026. The proposal sets a maximum price of $806 per square inch. “We’re making it easier for seniors to access preventive services, incentivizing health care providers to deliver real results and cracking down on abuse that drives up costs,” Oz said in a statement.

What Texans do when they’re not gerrymandering

However, nothing the Trump regime says should be taken at face value. As Legum reported, the new rule does not limit limit coverage to products that are scientifically proven to be effective. Moreover, the $806 price is higher than what many reputable firms in the industry charge.

The two biggest abusers of the loopholes in the law are based in Texas: Extreme Care and Ft. Worth-based Legacy Medical Products. Both are privately held and neither has tested their products against traditional bandages to determine if they generate superior outcomes.

And they’re not done fighting. They’ve formed the Mass Coalition to fight the new rule. They’ve also paid $320,000 a year to Brian Ballard, a Trump fundraiser who is widely regarded as the lobbyist with the most influence with the Trump administration, according to Legum. Susie Wiles, who is Trump's chief of staff, worked for Ballard. Many of the early commenters on the proposed rule are using identical cut-and-paste letters to protest the proposal, the kind of ginned up outrage that inside-the-Beltway lobbyists are expert at generating.

ACO-employed clinicians are worried that even this limited rule will be deep-sixed by the transactional Trump regime. In its July story announcing the rule’s reintroduction, the Times quoted Alex Binder, the vice president of the Parker Advanced Care Institute, a nonprofit medical practice belong to an ACO that treats older patients with chronic or terminal illnesses in New Jersey.

“There has been pushback in the past,” Binder said. “Will there be pushback again?”

Reprinted with permission from Gooz News.

Kennedy Distorting FDA Advisory System With Crackpots And Bias

The Food and Drug Administration last week convened an expert panel to warn women about the dangers of using anti-depressants during pregnancy. It wasn’t billed that way. It was billed as a listening session for FDA officials to hear “world renowned experts” on the issue.

This wasn’t an advisory committee. It was a presentation committee, where each of the panelists made five- to seven-minute presentations with no one from the public allowed to speak or ask questions.

The 10-person roster, seven of whom were men, was larded with critics who have spent their careers attacking the science behind anti-depressants and questioning their use, both in pregnancy and in general psychiatry. They included David Healy, the British physician who has written books attacking the use of seritonin reuptake inhibitors (SSRIs) in particular (the subject of the hearing), and has served as a paid consultant for trial lawyers suing the companies that make Prozac, Zoloft and Paxil.

The hearing’s presiding officer was Tracy Beth Høeg, who was a sports medicine physician and professor of management (not medicine) at the Massachusetts Institute of Technology prior to joining the FDA in March as senior advisor to Commissioner Marty Makary. The Danish-American dual citizen rose to prominence in conservative circles during Covid as a vaccine and lockdown skeptic.

At the outset of the hearing, Høeg asked each of the ten panelists making presentations to declare their conflicts of interest. None did. One said he had no conflicts. The rest ignored the request and never addressed the issue, even though three of the panelists (including Healy) had jointly issued a paper in 2019 disclosing they worked as consultants in anti-SSRI litigation. That paper suggested SSRI use during pregnancy leads to genetic “malformations,” a claim refuted by other studies.

Lizzy Lawrence of Stat News reported: “9 out of 10 panelists have either been paid witnesses in litigation involving antidepressants, run media platforms rooted in SSRI skepticism, or have published research pointing to the drugs’ potential risks in developing babies. Many share the views of health secretary Robert F. Kennedy Jr., who has called SSRIs harder to quit than heroin and has falsely linked them to mass shootings.”

The use of SSRIs during pregnancy or at any time remains controversial. The clinical trials that led to their FDA approval showed they barely beat placebo when treating mild to moderate depression, their most frequent use. Still, many people who take the pills swear by them.

Only an estimated 5% of pregnant women take the drugs, with many stopping treatment as soon as they become pregnant in order to avoid their well-publicized but rare risks, which include pre-eclampsia (organ damage due to elevated blood pressure), pre-term birth and postpartum hemorrhage. On the other hand, untreated depressed pregnant women face heightened but still rare risk of suicide, substance abuse, pre-term birth, pre-eclampsia, and low birth weight.

The Society of Maternal-Fetal Medicine, which represents more than 6,000 OB-GYNs (and takes money from the pharmaceutical industry for its medical education programs), issued the following statement after the hearing:

“As with all medications during pregnancy, the potential risks of antidepressants should be weighed against the benefits to maternal and fetal health. The available data consistently show that SSRI use during pregnancy is not associated with congenital anomalies, fetal growth problems, or long-term developmental problems. Evidence also shows that depression during pregnancy is the strongest predictor of postpartum depression, and discontinuing antidepressants is associated with a relapse of major depression.”

That’s exactly what happened to Jessica Grose, an opinion writer for the New York Times. In a moving essay in her weekly newsletter, she described her own relapse into major depression after stopping her medications when pregnant with her first child. She eventually restarted her meds, stabilized her condition, and bore the first of two healthy, full-term children. Here’s what she was hoping to learn from the hearing:

“I was hoping for an in-depth, nuanced discussion of the benefits versus the risks of these well-studied drugs. I wanted someone to talk about how mental health care is inaccessible for so many pregnant women, and why those who would benefit from talk therapy alone may not be able to get it. I wanted to hear them discuss how ashamed many pregnant women feel if they are struggling with their mental health, because there is so much pressure to be joyful and glowing. But that’s not what happened. Most of the panelists were clearly biased against antidepressant use.”

That’s a completely accurate assessment of the two hours of presentations, which I watched yesterday for the first time. The meeting was completely at odds with normal FDA procedures for running advisory committees.

This is not the first “listening session” the FDA has held since Makary took over (I reported on the one on hormone replacement therapy here). Nor will it be the last. The FDA has only held seven regular advisory committee meetings since Trump took office and Makary assumed the reins at FDA. That compares with 20 between February and July, 2024.

Rather than giving FDA regulators informed and contrasting presentations about controversial drugs, medical devices or vaccines awaiting decisions, the agency’s head is increasingly forcing professional staff to fly blind.

How sad. Makary and his boss, Robert F. Kennedy Jr., came into office declaring they’d adhere to full transparency in their dealings with the public. They also promised to eliminate conflicts of interest from the committees advising the Health and Human Service Department’s various sub-agencies. What we’re getting instead is a complete lack of transparency and committee members that may not have ties to industry but are ideologically biased with financial ties to other parties with a stake in the agency’s decisions.

This will have two pernicious effects should it continue. First, it will limit the information flow to FDA staff, which will make their drug, device and vaccine approval decisions, especially when it’s a close call, increasingly prone to error. Second, it will isolate the professional staff from the external academic, NGO and patient advocacy world, which will make them more vulnerable to political pressure by political appointees with their own agendas.

Merrill Goozner is a former editor of Modern Healthcare, where he wrote a weekly column. He is also a former reporter for The Chicago Tribune and professor of business journalism at New York University.

Reprinted with permission from Gooznews Substack. Please visit and consider subscribing.

Reprinted with permission from Gooz News.

How Trump Is Hustling Consumers To Protect Pharma's Excess Profits

Pegging drug prices to rates paid abroad, a great idea as proposed during the first Trump administration, is getting a second life — this time as a tool for preserving Big Pharma’s earnings power.

The president on Thursday sent letters to the CEOs of every major drug company demanding they sell their products in the U.S. at what he called “most favored nation” (MFN) prices. The original rule, proposed in late 2020, set those prices at the average prices paid by more than a dozen advanced industrial economies. The letter only calls for equalization of prices without specifying what those prices should be.

Trump gave the companies 60 days to comply. The move came about 85 days after he signed an executive order demanding drug companies lower their prices or face the consequences.

International indexing, or reference pricing as it is sometimes called, would be meaningful if it left foreign prices alone. But reading between the lines of Trump’s latest dictat, the real goal is to get the reference group — mostly Europeans — to raise their prices.

This would effectively:

Raise the collective MFN price for U.S. consumers above what it would be had foreign prices stayed low; and
Undermine policies used by foreign countries to set prices based on drugs’ realistic medical value.

From the drug industry’s perspective, this is the best of all possible worlds: They get to maintain more of their current sales and profitability levels while being freed from the shackles of other countries using medical value to negotiate reasonable prices.

Industry executives were quick to notice the change. During an earnings call on Friday morning, Regeneron CEO Leonard Schliefer, one of the letter’s recipients, agreed with the president that foreigners need to pay more for drugs before U.S. consumers can pay less. “Europeans are not paying their fair share of innovation, and some way that needs to change,” he said.

However, he expressed concern about the letter’s demand that industry engage in a “collaborative effort towards achieving global pricing parity” as “the most effective path for companies.” In other words, Trump wants drug companies to demand or impose higher prices.

It has “to be done at a trade and policy level, because it can’t be done at an individual company level,” Schliefer countered. “The solution is simply not to lower cost prices in the U.S. without some equilibrating in Europe, because then there’ll be no innovation.”

Trump echoed the industry’s rhetoric. He claimed in his letter that foreigners are “getting a free ride on American innovation.” The reality is that foreigners are paying what are closer to appropriate prices, while the U.S. pays too much.

The drug industry remains highly profitable under the current pricing structure. They are not losing money in Europe, Canada or Japan. The higher prices paid in the U.S. mostly go to support the industry’s massive direct-to-physician marketing budgets, direct-to-consumer advertising and the high-priced lawyers who engage in patent manipulation to prevent generic competition. These behaviors are enabled by U.S. policy, and are either banned or discouraged abroad.

Drug companies could choose to reduce those marketing budgets should U.S. prices fall to the international pricing levels now in existence. Unfortunately, past experience shows individual companies in the industry cuts R&D just as much as they cut other budgets when revenue falls.

At the end of his letter, Trump threatened to implement international reference pricing if the drug companies failed to win higher prices in those countries. Given the small chance that the companies will succeed in those negotiations, much less move unilaterally to raise prices (which will result in many countries simply saying no thanks), what we’ll see after 60 days will be either a watered down proposed rule or another threatening letter.

The most likely outcome over the long-term? Here’s my guess: Another pilot project that won’t put a dent in industry revenue. Why? There is bipartisan support in Congress for not jeopardizing “innovation,” even though the Congressional Budget Office estimated the drug price negotiations enacted by the Biden administration will have almost no impact on the number of new drugs coming to market.

Reprinted with permission from Gooznews Substack. Please visit and consider subscribing.

In Kennedy's FDA, Hype Trumps Science (And Prasad Gets Dumped)

That didn’t take long. The moment Dr. Vinay Prasad crossed the drug industry and the rightwing fever swamp, he was ousted. His tenure at the Food and Drug Administration lasted less than three months.

His crime? Late last week, the recently appointed chief science officer at FDA had the temerity to tell Sarepta Therapeutics to stop shipping patients its gene therapy for a rare muscle-wasting disease called Duchenne muscular dystrophy, a genetic disorder that manifests in toddler boys and kills most by the time they are young adults. Several reports of sudden deaths among young patients taking the therapy triggered the recall.

It was the right move. An early version of the drug that treated some Duchenne patients had failed in its final efficacy trials submitted to the FDA in 2016. But Dr. Janet Woodcock, then head of the Center for Drug Evaluation and Research, overruled the scientific staff’s negative recommendation to approve the gene-based therapy.

Last year, Drl Peter Marks, head of the Center for Biologics Evaluation and Research, approved a later iteration of the gene therapy called Elevidys that was designed to help all Duchenne patients. He ignored internal staff recommendations against approval by citing improvements in secondary endpoints, anecdotal evidence, and patient desperation. The company never completed clinical trials showing better evidence of efficacy for its primary endpoint.

Marks was forced out earlier this year after Robert F. Kennedy Jr. took over at the Health and Human Services Department. That gave Prasad his chance to assume the reins at CBER.

While early in his career Prasad exposed conflicts of interest in medicine, attacked the paucity of evidence behind new cancer drugs, and blasted the FDA’s decisions approving Sarepta’s gene therapies; the Covid pandemic pushed his contrarian attitudes in a rightward direction. He used his platform on the Sensible Medicine Substack to rail against lockdowns and a broadly administered Covid vaccine, which helped him win a position at FDA under new commissioner Dr. Marty Makary.

The new leadership at FDA must have thought ordering the withdrawal of Elevidys was a no brainer. No proven benefits. Obvious harms. Given they had been raising safety questions about vaccines (without much evidence) to please their new boss at HHS, they were probably caught off guard by the firestorm their decision generated.

“Right to try”

For decades, the most conservative wing of the Republican Party has been pushing what is known as “right to try” legislation. Patients and their doctors, the argument goes, should be allowed to take experimental drugs despite the absence of evidence they work or concerns they cause harm. This movement works hand-in-glove with industry efforts to relax safety and efficacy standards. Rupert Murdoch’s Wall Street Journal editorial page is a vociferous backer of “right to try.”

A limited version of “right to try” legislation passed during Trump’s first term. But the Makary/Prasad move on Sarepta’s gene therapies gave proponents of “right to try” the opening they needed to get rid of Prasad and send Makary a clear message about where his priorities need to be if he wants to stay atop the agency.

It began 10 days ago with a long screed by Trump whisperer Laura Loomer attacking Prasad. His “political alignment is unequivocally progressive, rooted in admiration for far-left figures like Elizabeth Warren and Bernie Sanders. His public statements and voting history reveal a deep-seated opposition to Trump and his policies, making his appointment to a key FDA role baffling,” she wrote.

Then Bob Goldberg, who resuscitates a conservative non-profit called the Center for Medicine in the Public Interest whenever the drug or food industries want to see progressive policies reversed (we frequently crossed swords when I worked for the liberal Center for Science in the Public Interest), weighed in. He attacked Prasad in an op-ed in RealClearHealth: “The 2018 law wasn’t just policy; it was a declaration that in America, a desperate parent has more standing than a bureaucratic panel. That a patient facing death deserves a shot at hope—even if the clinical endpoint isn’t yet statistically significant.”

The Wall Street Journal added its voice to the chorus on Sunday with a long editorial blasting the decision to halt distribution of Sarepta’s gene therapy. It’s worth quoting because of what it portends for future regulatory policy when it comes to new drug approvals:

“This is a regulatory mugging… Vinay Prasad, director of the FDA’s Center for Biologics Evaluation and Research, has lambasted his predecessor Peter Marks for twice overruling agency staff to approve the Duchenne therapy. Dr. Marks made good decisions to prioritize speed and patient choice over certainty on the data.” (Emphasis added.)

Its editorial page was gleeful late yesterday afternoon after the agency reversed the decision halting shipments. “Now the onus is on the agency to show it won’t repeat this debacle and will encourage the innovation that leads to faster cures.”

I assume that includes the unproven innovations that lead to more dead bodies among people receiving therapies that have not yet been shown to work. A few hours later, Prasad was fired.

The takeaway

I shed no tears for Prasad’s short career in public service. Let his experience be a lesson to anyone who thinks agreeing on one issue with the folks running the Trump regime gives you operating room to make decisions that you think are in the best interests of patients and in line with the science, particularly if those decisions are at odds with the financial interests of the biotech and pharmaceutical industries.

Sarepta’s sales of Elevidys and related Duchenne therapies soared to $1.9 billion last year despite fewer than 1,000 patients being served, a reflection of its outrageously high price tag (over $3 million per treatment). Every bit of the R&D that went into the initial development of this particular gene therapy was done with non-profit and government funding.

The patents on the technology were licensed from Nationwide Children’s Hospital in Columbus, OH, which conducted its research with funding from the Muscular Dystrophy Association and the National Institutes of Health. Sarepta’s chief science officer, Louise Rodino-Klapac, did much of her early work on gene therapy for Duchenne’s at Nationwide with NIH grants.

The stock market is clearly pleased by this latest turn of events in the Sarepta saga. Its stock is up over 14% today to more than $18 a share. But that’s a far cry from the $173 a share it traded at a year ago.

Just like its stock price, the company has a long way to go to prove this therapy is truly useful. It spends just 14.4% of its revenue on research, development and clinical trials, just slightly more than what it earned in profits last year.

Now that its drug has clear sailing once again to treat the small patient population that suffers terribly from this disease, surely it can afford to spend the money needed to learn whether it truly works. Commissioner Makary could order Sarepta to create a registry that collects data on every patient that gets treated, which would enable statisticians, regulators and families to track these young patients’ progress and outcomes over time. He could demand Sarepta finally complete a well-controlled clinical trial with endpoints that matter.

In other words, he could require the company meet the evidentiary standards that once earned the FDA the reputation of being the gold standard for regulatory science. Isn’t that more important than keeping one’s job?

(An earlier version of this story incorrectly reported the uses of Elevidys. It has been approved by the FDA for all indications of Duchenne Muscular Dystrophy.)

Reprinted with permission from Gooznews Substack. Please visit and consider subscribing.

It's Not Over: Now Is The Time To Pressure Vulnerable House Republicans

It was just under eight years ago that the nation nearly did what it is about to do and has never done before: Eliminate health insurance for millions of Americans.

I vividly recall how the last effort to repeal the Affordable Care Act ended. The entire newsroom of Modern Healthcare (the magazine I edited at the time) had gathered in front of a television monitor to watch the final Senate vote. President Donald Trump had strode into office promising repeal of the ACA. The House, with a large Republican majority, had voted in favor, but only narrowly. Twenty Republicans voted against scuttling a law that had succeeded in cutting the nation’s uninsured rate in half.

In the Senate, the decision came down to one man. Everyone stared as John McCain of Arizona, who was dying of brain cancer, strode across the Senate floor to cast the deciding vote. Republicans senators Lisa Murkowski of Alaska and Susan Collins of Maine had already voted no. As he approached the well where votes are cast, he stretched out his right arm. He had just held a brief phone conversation with the president. When his name was called, he held out his fist. With a quick flourish, he turned his thumb down. The gasp was audible.

The road to an inadequate system

Unlike every other country in the industrialized world, health insurance in the U.S. is not universal. Nor is it a right (despite the United Nations, the World Health Organization and a half dozen Democratic presidents declaring it so over the past 80 years). It is not even a guaranteed benefit for working under our employer-based health insurance system. There is no legal requirement that thousands of small businesses with tens of millions of workers offer coverage to their employees or that business, large or small, make it affordable when they do.

That’s why over the past century Congress has created an inadequate patchwork quilt of health insurance systems that to this day leaves 27 million people or 8.2% of the population uninsured. We have a government-run health care system for veterans (officially organized in 1921); a government-subsidized private insurance system paid for by employers (1940s); a government-run Medicare system for the old and disabled (1965); a joint federal-state Medicaid system for the poor (1965), subsequently expanded to include millions who work at low-wage jobs (20100; a government-run program for children who fall through the cracks (1997); and government-subsidized private health insurance for individuals who otherwise don’t have coverage (2010).

As Congress stitched each program onto the quilt, the share of the population without coverage fell. During recessions, the uninsured rate would sometimes rise temporarily, but the overall trajectory of the past century has been to move slowly, seemingly inexorably toward universal coverage.

We’re now on the verge of reversing progress for the first time. Donald Trump’s idea of making America great is to take us backwards to the time a little over a decade ago when fully 17% of the population was uninsured.

Let’s not forget that passage of the ACA took place against a backdrop of private insurance rates skyrocketing to pay for the uncompensated care given to the desperately ill people who showed up on hospitals’ doorsteps. It was also a time when tens of millions of people lacked access to routine health care, especially among the poor and poorly paid working class. That led to the gross disparities in life expectancy, infant and maternal mortality, and chronic disease incidence and deaths, which still bedevils this country.

Meanwhile, Robert F. Kennedy Jr., the Trump-appointed head of the Health and Human Services Department, is presiding over the dismantling of our world-class medical research system. He’s organizing sharp reductions in childhood vaccination programs and has little to say about the budgetary evisceration of our public health infrastructure. He makes loud pronouncements about the low quality of our food supply, yet says nothing about legislation that will literally rip food out of the mouths of children. Make America healthy again? Make America unhealthy again is more like it.

There’s still hope

Despite Trump’s threat to deploy the MAGA hordes to destroy the careers of Republican Congresspersons who go against his wishes, there’s still hope that the One Big Ugly Bill can be stopped. It only takes five Republicans in the House to vote no with the 212 Democrats who will be solidly against the legislation. The Senate version that passed Tuesday sharply reduces federal support for hospitals in nearly every jurisdiction in the country in addition to maintaining massive cuts in the core Medicaid program. Its aid for rural hospitals doesn’t begin to cover the losses most will absorb.

That’s the main reason the bill barely squeaked by in the upper chamber. GOP Sens. Thom Tillis of North Carolina and Susan Collins of Maine, who couldn’t stomach the Medicaid cuts, were joined by Sen. Rand Paul of Kentucky, who didn’t think its cuts went far enough. Alaska’s Sen. Lisa Murkowski, whose largely rural state would be harmed by the bill, could have been the deciding vote by said ‘yay’ despite what she said were grave misgivings. “We do not have a perfect bill by any stretch of the imagination,” she told reporters. “My hope is that House is going to look at this and recognize that we’re not there yet.”

The reality is that had she voted no, the bill as presently constructed would have died. That would have opened the Senate up for another round of deliberations where she would have wielded enormous influence.

“This fight’s not over”

The next battleground is the House, where Speaker Mike Johnson (R-LA), who represents another district heavily dependent on Medicaid, faces a difficult choice. He could call for a conference with the Senate, which could become a long and messy negotiation between budget hawks like Paul and those pleading for special bailouts like Murkowski and Collins.

Or, he could take the politically risky path of calling for a vote on the Senate bill, which would test Trump’s power. That opens the door for citizen activists, advocates for the poor, and the hospital and physician lobbies to put maximum pressure on Republican legislators, particularly those from swing districts that will suffer greatly from reduced support for Medicaid.

That work is already underway. Hundreds of people recently showed up on a rainy night in Omaha to pressure Rep. Don Bacon (R-NE), a former Air Force general. The Nebraska Hospital Association has warned his district faces at least six hospital closings should the bill pass. Last year, he narrowly won a district that supported Kamala Harris in the presidential race. After voting for the House version of the One Big Beautiful Bill, he announced his retirement.

“Nebraskans want no cuts to Medicaid,” Kelsey Arends, a staff attorney for Nebraska Appleseed, said at a press briefing organized by Families USA, which is just one of many groups organizing protests across the country. “340,000 people here rely on it.” Voters passed a referendum in 2018 expanding Medicaid under the ACA. In 2020, there were widespread protests that succeeded in stopping the Republican governor from instituting work requirements. “Rep. Bacon vowed to protect (Medicaid), but these bills are taking it away,” she said.

Similar local organizing campaigns are taking place in all the districts where Republican won House seats by thin margins, often riding into office on Trump’s coattails. Now they’re telling their constituents that they want to protect Medicaid and keep rural hospitals open.

“This fight’s not over,” Families USA executive director Anthony Wright said. “If these members mean anything that they said, they should not vote for this bill.”

Reprinted with permission from Gooz News.

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The impact of ACA/Medicaid cuts on employer plans

Has Medicare Advantage improved quality?

Where’s the rest of us?

What’s behind rising costs?

Invasion imminent

Spreading disease

No choices

Best care

The Biden rule

What Texans do when they’re not gerrymandering

“Right to try”

The takeaway

The road to an inadequate system

There’s still hope

“This fight’s not over”

About The National Memo