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affordable care act
Here's How the GOP Could Cut Over $5 Trillion—And Gut Healthcare, Climate Action
"Americans: We just want higher wages and lower costs. Republicans: We are going to take away your healthcare."
Jan 10, 2025
Some Democratic lawmakers and other critics of congressional Republicans on Friday pointed to a document obtained by Politico as just the latest evidence that the looming GOP trifecta at the federal level poses a threat to working families nationwide.
"Americans: We just want higher wages and lower costs. Republicans: We are going to take away your healthcare," Rep. Pramila Jayapal (D-Wash.), chair emeritus of the Congressional Progressive Caucus, said in response to the reporting, which came as Republicans have taken control of both chambers of Congress and prepare for President-elect Donald Trump's inauguration in just over a week.
The one-page list originated from the House Budget Committee, chaired by Rep. Jodey Arrington (R-Texas), Politico reported, citing five unnamed sources. One of them explained that the "document is not intended to serve as a proposal, but instead as a menu of potential spending reductions for members to consider."
The document lists various policies that it claims would collectively cut up to $5.7 trillion. Republicans have been discussing how to offset the high costs of top priorities—specifically, Trump's immigration policies and plans for tax cuts that critics warn would largely benefit the wealthy, like the law he signed in 2017.
"In order to make his rich, billionaire buddies richer, Trump wants to kick millions off healthcare coverage and starve families. How does this help working families thrive?"
The policies are divided into eight sections, with headings that critics called "dystopian" and "Orwellian." The first calls for repealing "major" health rules from outgoing President Joe Biden's administration, which would supposedly cut $420 billion. The second section takes aim at Medicare, the federal health program for seniors, proposing policies that would cut $479 billion.
A large share of the potential cuts would come from section three, which lists seven potential changes to Medicaid, a program that provides health coverage to low-income people. The policies include per capita caps, work requirements, and lowering the federal medical assistance percentages (FMAP) floor.
"In order to make his rich, billionaire buddies richer, Trump wants to kick millions off healthcare coverage and starve families. How does this help working families thrive?" Michigan state Rep. Carrie Rheingans (D-47) asked on social media. "In this leaked list of cuts, 'lower FMAP floor' for Medicaid means states pay a higher proportion of Medicaid costs for enrollees—this just shoves [federal] costs to states so billionaires get more yacht money."
Section four of the document calls for "reimagining" the Affordable Care Act (ACA) to cut $151 billion, with changes that include repealing the Prevention and Public Health Fund, limiting eligibility based on citizenship status, and reclaiming $46 billion from subsidies set to expire at the end of the year.
The fifth section lays out $347 billion in cuts by "ending cradle-to-grave dependence," targeting initiatives including Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP), often called food stamps.
Section six claims "reversing Biden climate policies" would cut $468 billion: $300 billion by discontinuing some provisions from the 2021 bipartisan infrastructure legislation, $112 billion by rolling back electric vehicle policies, and $56 billion by repealing green energy grants from the Inflation Reduction Act (IRA).
The seventh section is a catchall, listing up to $1 trillion in potential cuts through moves that include ending student debt forgiveness, restricting emergency spending, and reforming federal employee benefits. Section eight identifies up to $527 in potential tax offsets from requiring Social Security numbers for the child tax credit and green energy credits.
House Speaker Mike Johnson (R-La.), who recently agreed to use the budget reconciliation process to cut $2.5 trillion, "can't afford any Republican defections if he wants to pass a package on party lines," Politico reported. "Even proposed cuts to green energy tax credits, worth as much as $500 billion, could be tricky—as the document notes, they depend 'on political viability.' Already 18 House Republicans—14 of whom won reelection in November—warned Johnson against prematurely repealing some of the IRA's energy tax credits, which are funding multiple manufacturing projects in GOP districts."
Sharing the report on social media Friday, Rep. Nydia Velázquez (D-N.Y.) stressed that "Republicans want to cut vital food and healthcare support programs to pay for a tax cut for billionaires and large corporations. The GOP wants working families to pay for their billionaire handouts."
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For-Profit US Health System Continues to Leave Many Millions Uninsured Each Year
"With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone," said one researcher behind a new study.
Jan 10, 2025
More than 10 million workers in the United States who held full-time jobs in 2023 still lacked health insurance for the entire year.
That's just one of the troubling findings from a report released Friday which fleshes out how America's "patchwork" system of employer-provided plans, individually purchased coverage through state-level exchanges, and Medicaid, are leaving many millions of Americans without care year after year.
The new study by the Center for Economic and Policy Research (CEPR) looked at the demographic characteristics of the uninsured population from 2018 through 2023 using Census Bureau data and found lack of healthcare coverage along class, racial, and ethnic lines, as well as disparities when it comes to levels of educational attainment.
"The Affordable Care Act has delivered insurance coverage for millions of Americans, but there are still considerable gaps in coverage—particularly for workers who find themselves too young for Medicare and who earn wages above thresholds for Medicaid coverage," said Emma Curchin, one of the authors of the paper and a research assistant at CEPR.
"These gaps leave millions of people—many of them working full time all year—unable to secure insurance coverage. With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone," she added.
After it passed in 2010, the Affordable Care Act—which sought to expand health insurance coverage, including by creating nex exchanges in the for-profit market—was able to reduce the share of the U.S. population that was without health insurance by roughly half between 2009 and 2023. While 16.7% of the population lacked insurance in 2009, the latest available data shows 8% of the population is without insurance. But even with the ACA, the study found that more than 27 million U.S. residents are without insurance, and almost 16 million workers have full-time jobs, part-time jobs, or are unemployed but actively seeking work.
The report, which focused on workers between the ages of 18 and 64 found that among full-time, year-round workers, Hispanic workers were most likely to be uninsured (21%). The rate of being uninsured among that group was about four times higher than the corresponding rate for Asian or white workers, which stood at 5.1% and 5.5%, respectively.
Unmarried people are more likely to be uninsured than married people, and full-time workers who live in a household with a child or children are less likely to be uninsured—which "may reflect the greater likelihood that households with children are eligible for Medicaid, because Medicaid eligibility is determined in part by income relative to household size," according to the authors of the study.
For all worker types, higher educational attainment means lower rates of being uninsured, the researchers found. Someone who works full-time and full-year but has less than a high school degree has an uninsured rate 15 higher than a worker with an advanced degree. Workers who complete some of college but do not hold a degree are almost twice as likely to uninsured compared to those who do finish with a degree.
Across racial and ethic groups and levels of educational attainment men consistently have higher uninsured rates than women.
Other findings include that uninsured rates declined as wages increased. 21.4% of full-time, full-year workers in the bottom of the wage distribution lack health insurance, compared with only 1.7% for workers who are in the top wage quintile. Whether you were born inside the U.S. and citizenship status also play a large role in uninsured rates. 28.9% of full-time, full-year workers who were born in a different country and are not citizens are uninsured, but only 6.7% of full-time, full year workers born in the U.S. are uninsured, and 8.6% of these types of workers who were born abroad but who hold U.S. citizenship are uninsured.
What's more, "lack of coverage is particularly acute for part-time or part-year and unemployed non-citizen workers: 36% of part-time workers and 39% percent of unemployed workers are uninsured," the researchers note.
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Americans Are Angry About Their Health Insurance—With Good Reason
As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
Jan 01, 2025
How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified—and feel that something is deeply wrong with such a brazen act of murder. Ideally, we would do what we could to help sooth the survivors, condemn the violence, and bring the perpetrator to justice.
So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare CEO Brian Thompson was executed in New York City last month? Because Americans are furious with health insurance corporations—and they have every right to be.
In the immediate aftermath of the shooting, many Americans took to social media not to mourn, but to celebrate. Caustic posts about prior authorization and denied medical claims were common. Sympathetic statements were met with rancor—and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private. Even verbose political figures like Elon Musk and President-elect Donald Trump declined to comment for days. This shooting touched a raw nerve.
The health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
As a physician who’s treated countless victims of gun violence, and who’s life’s work is to care for all of my patients, I found this response to be deeply unnerving. But I also can’t waive it away with simple explanations like online radicalization or trolling. Something much deeper is at play.
For decades, health insurance corporations like United have been growing more powerful and more profitable. How do they generate these profits? By taking in as much money as possible in premiums and paying out as little as possible in medical claims. Over time, they have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance, and deductibles. When all else fails, many insurers simply deny claims.
Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.
I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?
Insurers like UnitedHealthcare will have their own responses. Their PR teams will no doubt work overtime to marginalize aggrieved voices and to highlight what they consider to be the “value” of their health plans. Expect to see glossy commercials and towering billboards touting the “peace of mind” that Americans should enjoy knowing that their medical needs are “covered.” But the health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
Behind the scenes, corporate insurers will no doubt lobby for the preferential treatment they have come to expect. Our newly elected Congress may acquiesce, or they may decide that the industry needs to be regulated—a strategy that has failed to live up to its promise.
Republicans and Democrats have made separate attempts to combine federal requirements with federal largesse in order to make corporate health insurers play nice. But both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United—without improving Americans’ health or sparing their wallets.
It’s also clear that violence is not the answer, both on a purely human level and because corporate insurers will simply not be moved. UnitedHealthcare will have a new CEO in short order, and it will be that person’s responsibility to boost profits and make shareholders wealthier. Responding to patients’ cries will not serve these ends, so it is not in the cards.
What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits—with zero out-of-pocket costs. It could be easily implemented given the gargantuan sums we spend on healthcare in this country, and it would be a boon for those who are suffering, and for those who are fearful.
Americans are crying out in pain—and are recognizing that they are not alone in their pain. We should listen to these cries and we should finally, after decades of delay, do something about it.
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