Cruel and Usual: Republicans Prepare to Gut Medicaid
And their own supporters will be among the biggest victims
A fool and his money life are soon parted.
S E E D E D C O N T E N T
It's also a poor state, left behind by the 21 st century economy. Because incomes are low, it pays very little in federal income taxes — less per household than any other state.
However, at least the great majority of West Virginians — more than 94 percent — have health insurance. The reason for this good news is that unlike many red states, WV accepted Medicaid expansion under the Affordable Care Act, which was passed in 2010 but didn't fully go into effect until 2014. The effect was dramatic; Medicaid now covers more than a quarter of the state's population:
Source: KFF
And Medicaid covers 45 percent of the state's children.
But now the Republicans West Virginia helped put in power are preparing to impose savage cuts on a program that has literally been a lifeline for many in the state, in order to help offset the cost of huge tax cuts for high-income Americans, hardly any of which will trickle down to WV voters. Populism!
We'll be hearing a lot of lies about Medicaid in the weeks ahead, starting with Trump's arithmetically impossible claim last week that Medicaid won't be "touched" by the planned spending cuts. So here are two things you should know about a program Trump and his allies have in their crosshairs: it's extremely important to many Americans, and it's much more cost-efficient than the rest of our health care system.
Medicaid is really, really important
I often encounter generally well-informed people who are surprised to learn that Medicaid is a much bigger program, in terms of the number of people covered, than Medicare — 69 million versus 48 million. The perception that Medicare is much more important may reflect the fact that Medicaid still costs taxpayers less than Medicare. This is partly because older people have higher health costs than the young adults and children who make up much of the Medicaid population. But it's also because Medicaid is quite cost-efficient; more about that shortly.
There's also, let's be frank, a perception that Medicaid is politically unimportant, that conservatives can safely target it for cuts, because it's mainly a program for inner city people of color. But that was never as true as people imagined and is definitely not true now. Again, consider West Virginia. It's one of America's most rural states and overwhelmingly — 90 percent — white. Yet as we've seen, it's deeply dependent on Medicaid.
In fact, Medicaid is especially important for rural and small-town Americans, even if they aren't beneficiaries themselves, because it helps keep health care accessible.
Hospitals have been closing across much of rural America, because there aren't enough paying patients to keep them operating; the picture at the top of this post shows one such hospital, in Cuthbert, Georgia. Georgia is one of the states that, unlike West Virginia, refused to accept a federally-funded expansion in Medicaid under the Affordable Care Act. As a result, fewer Georgians are able to pay for medical care. Rural hospital closures have been overwhelmingly concentrated in these "non-expansion" states.
All in all, if Republicans think they can slash Medicaid without paying a heavy political price, because only Those People will be hurt, they're going to be mightily surprised. According to one recent poll, 71 percent of Trump voters say that cutting Medicaid would be unacceptable.
Medicaid is cost-efficient
Some conservatives claim that we can achieve big cuts in Medicaid outlays by eliminating wasteful spending, because that's their rote line. And there's surely some waste in Medicaid, as there is in any large program. But there is nothing comparable to the massive overpayments Medicare makes to insurance companies selling Medicare Advantage plans. Funny how that never comes up in conservative diatribes against waste, fraud and abuse.
In fact, compared with other parts of the U.S. health care system, Medicaid stands out for its remarkably low costs. Making comparisons among different types of insurance coverage can be a bit tricky, because the populations are different; for example, people in poor health often have low incomes, and hence qualify for Medicaid. But careful comparisons that adjust for these differences find that Medicaid is a lot cheaper than private health insurance:
How does Medicaid manage this? It has lower administrative costs than private insurance, in part because it doesn't have to devote resources to marketing, determining eligibility, denying coverage, and so on. It also pays providers less, which can sound like a bad thing until you realize that this includes things like bargaining for lower prices on drugs and medical equipment.
I'm not an expert here, but my understanding is that Medicaid, as a program for low-income Americans, has something that, for different reasons, neither Medicare nor private insurers have: The ability to say no. No, we won't pay for that expensive drug being advertised on TV when there's a much cheaper alternative that's equally effective, or close to it. No, we won't pay inflated prices for medical procedures of dubious effectiveness. And the ability to, say, exclude overpriced drugs from Medicaid's formulary unless the pharma company cuts its price gives Medicaid a lot of bargaining power.
Does this low cost lead to low-quality coverage? Medicaid recipients may sometimes have trouble finding a doctor, because of those lower payments. Yet according to patients themselves, Medicaid does fine — Americans on Medicaid are roughly as satisfied with their coverage as those with employer-sponsored insurance:
Source: KFF
Furthermore, those in poor health, who need health coverage most, appear to be significantly more satisfied if they get their coverage from Medicaid than those getting insurance through their employer:
Source: KFF
All in all, if you were looking for a way to reduce America's extremely high health care costs without reducing the quality of care, Medicaid actually looks like a model rather than a problem case.
Oh, and a quick word about work requirements for Medicaid recipients, which are all too likely to be part of what Republicans try to impose: They're basically a fraud. There are almost no Americans choosing not to work because they can live on government benefits instead; our social safety net isn't generous enough for that. The real purpose of work requirements is to create more hoops for people to jump through, to make it harder to collect the benefits they're legally owed.
Cruel and usual
I don't know whether draconian, cruel cuts to Medicaid will actually happen. It may turn on whether Republicans in Congress are more afraid of their constituents or of Donald Trump.
But what is worth noting is that what we're seeing is that for all the talk about how the G.O.P. is now the party of the working class, the policy agenda is as cruelly plutocratic as ever: Take away health care from Americans who need it so you can cut taxes for the wealthy.
Whatever
Tags
Who is online
31 visitors
Stupid voted for President Musk.
In this case, stupidity may carry a death sentence.
Let them eat cake.
Krugman?
Mindless fearmongering
This is all well and good, but many people don't want to pay a dime for health insurance for poor people, no matter how acceptable the outcomes are.
Health care: Yet another political football that somehow we have not figured out yet. Single payer sounds good to me.
Single payer equates to rationed care, bureaucrats making medical decisions instead of doctors, long wait times for appointments and procedures, and possibly even death panels
Sounds like what we have now just with more players
Why is America incapable of doing what Belgium or Portugal can do? Or any of the other twenty-odd nations in Europe?
Because we didn't have to rebuild after WWII and we don't own the hospitals.
No, Greg, that is what the people making money from the system want you to think.
You already have that whether your insurance is public or private.
Too many people want to ignore what happened to many rural hospitals and smaller hospitals during the Covid years. So many of them closed up completely as the only money they were getting in was Medicare/Medicaid payments which are very small as defined by the ICD-10 codes and federal reimbursement rates. Nations that have a national healthcare system like Great Britian are able to do so because the doctors and nurses are government employees who work at government owned sites, so they are able to control the costs.
Thank you.
Partly, yeah. But partly also because all non essential surgeries were canceled. So even if it was Medicare/Medicaid, there were no knee replacements, hip replacements, tonsillectomies, sinus scrapes, or anything else if the condition wasn't life threatening.
Dentists were hit especially had. Here in Dallas you couldn't even get a root canal. Your dentist doesn't stay open on revenue from cleanings and x rays.
That's one of a thousand things people don't understand and don't want to understand. "People get this in XYZ country, so we should get it here".
They don't think for half a second what it would take to convert the American system, or how much their taxes would go up. They always imagine it's "a few dollars more" or some asinine thing, when in reality we would need to nearly double everybody's taxes.
That's making my point for me. All those other 'non-essential' surgeries that were canceled, they also paid a higher fee than the amount provided by law thru Medicare/Medicaid. If the dollar value to keep the doors open is higher than the dollars generated by services, it only makes sense to close the doors.
I was agreeing with you.
Well yeah.
I also don't think people stop to consider the fixed costs inherent with keeping a hospital open. The $$$ out the door before a single doctor gets hired are huge.
All of Europe has universal health care. Completely different systems in different countries. But one thing in common: no one ever loses everything because of a health problem.
Americans must live in fear. Europeans need not.
This is genuine "freedom" - freedom from fear.
No.
You lack of understanding about American healthcare aside, you pretend fear is not a choice.
If you choose to be afraid, that's up to you. It's none of my business, not something I can change, and not my responsibility.
Does a civilized society have any "responsibilities" towards its members ?
Why do we have police and fire departments? Why should I pay for a fire department to go put a fire out at YOUR house, which is not my problem.
Except, you know, their life because of inferior care.
Sure. Dealing with your fear isn't one of them.
What if you're afraid of cars? Afraid of minorities? Do we do away with whatever scares you?
My next door neighbor cut down a 60 foot oak tree in her front yard because she was afraid it was going to fall on her house. Do we cut down all the trees now?
Well, then how come My new friend Chat GPT Says (after "reasoning" for 5 seconds):
The emphasis was added by me.
I look at things were medicine plays a determinative role, cancer survival rates.
That's probably why Europeans live longer than Americans....
Gee Bob, see if you can figure out other issues that might be at play. It's one of those things you really, really should be able to figure out.
Dang, I'm dead?
Cost of Health Care is going to be a mess no matter if it is private or government.
Americans pay twice as much for half as much because of our health system is more about collecting money than providing healthcare...
Exactly.
Having proved that confiding public health care to private corporations is a terrible idea because - obviously - that corporation's purpose is to make profits for Management and Shareholders, rather than provide care to patients... now the
RepublicansFascists want to give taxpayers‘ money to private schools... whose purpose is to make profits for Management and Shareholders, rather than provide education to students.Of course.
For a country that considers itself to be exceptional our inability to produce a heath plan for everyone certainly says differently.
if we would open up our minds to solutions that other countries are using perhaps we could have something. Oh wait we are exceptional we can’t take advice from anyone.
I have it!
Let's repeal and replace Obamacare. We should be able to invent a good replacement in just a few days...
Or weeks, years or decades.
Paul Krugman is such a fucking idiot. Dear brilliant economist, please, show us where people go to their insurance agent to obtain medical treatment? Krugman's argument is all about money; it's not about healthcare. Krugman is trying to protect insurance and the flow of taxpayer money to financial institutions.
Medicaid has been around for 60 years. Medicaid has not allowed small rural hospitals and clinics to remain open. Medicaid has not prevented the emergence of healthcare deserts. Medicaid has not enticed more doctors to those healthcare deserts. Medicaid has not reversed the decline in access to and delivery of medical care.
Liberals have complained because women have to travel out of state to obtain abortions. Yet those same women may have to travel out of state for gall bladder surgery. But apparently that's no big deal because Federal money flows freely to insurance providers. What is the value of Cadillac insurance if no doctors are available? Things have gotten so bad that for profit medicine is now relying on tele-medicine. We're supposed to believe that adequate medical care can be delivered with a Zoom call? Really?
Hey, Paul Krugman, what happens if more money is thrown at profit seeking middle men? Insurance is a financial activity that contributes absolutely nothing to availability and delivery of medical care. Medicaid has become a public funded subsidy for profit seeking stock investors. What, exactly, is Paul Krugman defending?
Not sure what you mean by that, but pre-approval is a real thing with all insurance companies.
Hospitals close all the time for a variety of reasons.
Where?
Sure! For some things. Absolutely. I’ve used it a couple of times with great success. Depends what the issue is.