In spite of the House collapse, it’s not over yet. A number of Senators hate specific aspects of this bill and claim to be voting against it. But an additional pressure point might be this: Although the Trumpists claim that there are no cuts to Medicare, it’s now coming out that the deficits created by this bill will trigger mandatory Medicare cuts voted in back in 2010, in the so-called PAYGO bill (https://www.kiplinger.com/retirement/medicare/tax-reconciliation-bill-could-trigger-billions-in-medicare-cuts). Although saying so is immoral, I’m guessing that some Senators who might look the other way at throwing low income people under the bus might balk at hitting seniors. So ask your red state senators what they intend to do about this.
My daughter is on Medicaid as her secondary insurance. She has a severe disability and qualifies for the Family Support Waiver in Indiana. This means that our income is waved when deciding on Medicaid coverage. Not all states have this and some families of kids with disabilities will move to a state with a waiver program. The waiver provides the Medicaid as well as other services like music therapy and respite care. I don't know how things will change for us after this last state legislative session. We could survive without the extra waiver services, but losing her secondary insurance would be tough. My husband's insurance (her primary, he is a fed employee) is amazing, but it doesn't cover much when it comes to specialized equipment and it didn't cover at all the in-home nursing we used before kindergarten so that I could work one day a week. (Don't get me started on child care for kids with disabilities.) Plus all of the therapy and specialist copays add up so quickly. Employer provided insurance is not designed for a person with disabilities who will require a lot more care and equipment. There are definitely ways in which things could be improved and costs could be cut. I have so much feedback. But that requires empathy, care, nuance, and knowledge of the system. And that is just not something we are valuing right now.
RE:The comment about paying for the rich's insurance/healthcare and not the poor. It feels like a long lasting legacy of the puritan era that our society continues to associate a moral value with wealth and negative moral value with poverty. I guess when money is "god" that is where is leads.
I learned so much from this. Quick Question: Where does the spending on military Healthcare and Veterans Healthcare and Insurance like champus fit into the overall Healthcare spend? Does it come from the a military spending budgets?
It falls under the Department of Defense budget (if not fully then primarily), often listed as veterans benefits or military health system. I googled this to confirm (military/retiree spouse)
My jobs in the past 10+ years have been at agencies that serve kids (and families) with Medicaid coverage and developmental disabilities and/or mental health needs. This work reality has taught me a few things. 1. Very few providers accept Medicaid which means options for care is really limited which then becomes another burden on top of the high stress of living in poverty. 2. These families are some of the hardest working, grittiest families. And they almost never catch a break. Having to pay some percentage of their income toward healthcare would make healthcare even less accessible to them.
I did a group project in grad school on work requirement, specific to TANF, but probably can be generalized to other govt benefits. The allowable activities are arbitrary and not the kind of things that are going to help families get ahead. Education can sometimes fulfill a work requirement but not work toward a bachelor's or trade school or something.
We've got to do better and neither cutting Medicaid nor adding administrative burden is the right answer. I was genuinely surprised to learn that Josh Hawley is for the working class. I thought he was just an awful human on a power grab. Heading over to read his oped now...
Every time I hear about Josh Hawley I have a tidbit pop in my brain. I want to confirm it but I am pretty sure that his state has Medicaid coverage in the state constitution, so federal cuts would be enormous to their infrastructure. He can be for working class people but there could be other factors motivating him (which is true for most everyone I imagine)
I will be completely honest in saying I have no idea how Medicaid works in my state on their end. I just had an appointment (one I had to make months ago because I could t get in sooner) cancelled by robocall for “unforeseen circumstances” and they would contact me to reschedule. Later that day I read an article about the hospital closing multiple clinics around the area in different areas of specialties and consolidating other clinics. The reason given was lack of Medicaid reimbursements and lower funding or something like that. I didn’t wait for them to call me to reschedule, I called the next day to find out the local clinic was closing and they could reschedule me at one further away at the end of July. 😳 Even before all of this the wait to get into doctors was months out. My dad got referred to the pulmonologist but couldn’t get an appointment until July. He’s in a cancelation list, but my goodness he shouldn’t have to wait so long when he’s struggling to breathe. ER visits get old! This is all going to get so much worse if the Republicans pass their bill.
I know my privilege is showing a little considering I’m blessed to have insurance coverage, but I’m frustrated and it’s where my head is right now. Tomorrow I’ll be big mad about those losing coverage.
1) My whole family is on my husband's insurance, but he may be in danger of losing his job. Yesterday, if everyone went on the insurance that is offered through my workplace, it would cost about half of my take home pay. Today, our Board of Trustees voted to double the amount of money my employer puts towards health insurance, which is great. Now it will be only a quarter of my take home pay unless my kids go on Medicaid, which is what many of my colleagues do, but what do the cuts mean for that.
2) My oldest rolled off of our insurance in January. She has insurance through her school, but that will expire in August. She is worried about finding a job with insurance before then. I told her that she could go on Medicaid if she didn't have a job. Then I heard about the work requirement. I am sure she would LOVE to work once she graduates, but the way hiring is looking for 2025 grads (as umpteen articles tell me) is really bad. Now I know she doesn't have to worry for a few years!
3) Even with those huge rates in insurance, I don't see how the industry stays solvent given the costs of things. I had a routine, in-patient surgery last month. It cost $5000, which is a bargain for a 3 hour surgery. if a family has a couple of those, prescriptions, routine vaccinations, a few infections, etc. and the entire insurance premium has been spent. Not every family has that, of course, but there are families that have accidents or surgeries that cost tens of thousands of dollars. A friend's 20 year old son had a stroke - totally unexpected - and by the time all was said and done, the total cost was about $800,000, as far as she can tell from the thick sheaf of insurance documentation she has. She is thankful every day that she had insurance because she saw enough people in the hospital who didn't, but those bills have to get paid somehow.
Something not mentioned in the healthcare talk, that is maybe kinda tangential, is the financial strain on hospitals and other medical facilities right now. We all know how inflation has increased the price of everything. Guess what is included in that? All the goods & “stuff” required by hospitals etc. to provide care. Guess whose reimbursement rates have not gone up post-inflation despite the increase in their cost to provide care? It’s untenable, could very well lead more facilities to close, and access to become more difficult.
Re: work requirements and Medicaid- many people need to have health issues addressed BEFORE they can be gainfully employed. This is especially true for folks with substance use disorders, chronic pain, untreated chronic illnesses and severe mental health issues. Medicaid is a huge gateway to employment for folks who can get meaningfully treatment for health issues that prevent them from working. Work requirements undermine this.
And let’s remember that having healthcare reimbursed creates jobs. Specifically in Montana, “Medicaid expansion creates 5,600 to 8,000 jobs and generates $350 to $560 million in personal income throughout Montana’s economy annually.” This is from the Montana Healthcare Foundation.
And most adult Medicaid participants already work! So we are just adding more work for people who are already working. Data from Montana, “Most Medicaid expansion beneficiaries work, and those who do not have caregiving responsibilities or disabilities. 72% of adult Medicaid enrollees are in the labor force or attending school.”
One thing not mentioned is the cost of folks not having healthcare. If a population is not healthy, it cannot participate in society: work, buy things, pay taxes, social and civic participation. These costs are much higher than actually paying to keep folks healthy. It’s not only the ‘right thing’ but also has major economic implications.
You mention that what the populous can probably all agree on is that we want a social safety net that is the federal government providing poverty insurance. Which is true. But when income and wealth inequality keep growing, the number of people needing that type of insurance keeps growing. I am in a middle-to-upper income bracket, but I pay gigantic monthly premiums for my private insurance. Which is why I would like the federal government to do the hard work of figuring out how to make healthcare universal in some way. Plus, if you combine this with the lack of protections for workers (lack of sick time, family leave, etc.), everyone just gets a bad deal.
One thing I didn’t hear mentioned was how these cuts would negatively impact hospitals themselves, particularly in rural areas. If hospitals don’t get that Medicaid reimbursement, they will crumble and close faster than they already are.
Re: states, Indiana just reduced its Medicaid expansion during session which is likely to kick about 200,000 people off anyway. 1.8 million Hoosiers are covered under Medicaid. So I guess a large percentage of those people are just going to be screwed.
Re: creative pursuits, I shared in the chat yesterday that I picked up needlepoint a couple months ago and also write here on Substack, mostly about motherhood, being a recovering perfectionist, and what I’m reading: https://ellenfitzgerald.substack.com/.
Related to both the topic of today’s show and the exhale, I write a Substack about supporting medical trainees: https://whitecoatwife.substack.com
My husband is currently a fellow in his 14th year of training, and a lot of people don’t realize funds from Medicare and Medicaid contribute significantly to the training of medical professionals. Our modern residency program relies *heavily* on these programs, and in addition to all of what you discussed on the episode, I worry a lot about what a struggling pipeline of trainees will do to healthcare accessibility in this country.
Also medical students! I work at a medical school, and most of our students are on Medicaid because they can’t work while they attend school and they are too old to be on their parents health insurance (if that is even an option for them)
In spite of the House collapse, it’s not over yet. A number of Senators hate specific aspects of this bill and claim to be voting against it. But an additional pressure point might be this: Although the Trumpists claim that there are no cuts to Medicare, it’s now coming out that the deficits created by this bill will trigger mandatory Medicare cuts voted in back in 2010, in the so-called PAYGO bill (https://www.kiplinger.com/retirement/medicare/tax-reconciliation-bill-could-trigger-billions-in-medicare-cuts). Although saying so is immoral, I’m guessing that some Senators who might look the other way at throwing low income people under the bus might balk at hitting seniors. So ask your red state senators what they intend to do about this.
My daughter is on Medicaid as her secondary insurance. She has a severe disability and qualifies for the Family Support Waiver in Indiana. This means that our income is waved when deciding on Medicaid coverage. Not all states have this and some families of kids with disabilities will move to a state with a waiver program. The waiver provides the Medicaid as well as other services like music therapy and respite care. I don't know how things will change for us after this last state legislative session. We could survive without the extra waiver services, but losing her secondary insurance would be tough. My husband's insurance (her primary, he is a fed employee) is amazing, but it doesn't cover much when it comes to specialized equipment and it didn't cover at all the in-home nursing we used before kindergarten so that I could work one day a week. (Don't get me started on child care for kids with disabilities.) Plus all of the therapy and specialist copays add up so quickly. Employer provided insurance is not designed for a person with disabilities who will require a lot more care and equipment. There are definitely ways in which things could be improved and costs could be cut. I have so much feedback. But that requires empathy, care, nuance, and knowledge of the system. And that is just not something we are valuing right now.
Thanks!
I love this team!! Thanks for sharing your creative outside of politics with us ❤️
RE:The comment about paying for the rich's insurance/healthcare and not the poor. It feels like a long lasting legacy of the puritan era that our society continues to associate a moral value with wealth and negative moral value with poverty. I guess when money is "god" that is where is leads.
I learned so much from this. Quick Question: Where does the spending on military Healthcare and Veterans Healthcare and Insurance like champus fit into the overall Healthcare spend? Does it come from the a military spending budgets?
It falls under the Department of Defense budget (if not fully then primarily), often listed as veterans benefits or military health system. I googled this to confirm (military/retiree spouse)
My jobs in the past 10+ years have been at agencies that serve kids (and families) with Medicaid coverage and developmental disabilities and/or mental health needs. This work reality has taught me a few things. 1. Very few providers accept Medicaid which means options for care is really limited which then becomes another burden on top of the high stress of living in poverty. 2. These families are some of the hardest working, grittiest families. And they almost never catch a break. Having to pay some percentage of their income toward healthcare would make healthcare even less accessible to them.
I did a group project in grad school on work requirement, specific to TANF, but probably can be generalized to other govt benefits. The allowable activities are arbitrary and not the kind of things that are going to help families get ahead. Education can sometimes fulfill a work requirement but not work toward a bachelor's or trade school or something.
We've got to do better and neither cutting Medicaid nor adding administrative burden is the right answer. I was genuinely surprised to learn that Josh Hawley is for the working class. I thought he was just an awful human on a power grab. Heading over to read his oped now...
Every time I hear about Josh Hawley I have a tidbit pop in my brain. I want to confirm it but I am pretty sure that his state has Medicaid coverage in the state constitution, so federal cuts would be enormous to their infrastructure. He can be for working class people but there could be other factors motivating him (which is true for most everyone I imagine)
I will be completely honest in saying I have no idea how Medicaid works in my state on their end. I just had an appointment (one I had to make months ago because I could t get in sooner) cancelled by robocall for “unforeseen circumstances” and they would contact me to reschedule. Later that day I read an article about the hospital closing multiple clinics around the area in different areas of specialties and consolidating other clinics. The reason given was lack of Medicaid reimbursements and lower funding or something like that. I didn’t wait for them to call me to reschedule, I called the next day to find out the local clinic was closing and they could reschedule me at one further away at the end of July. 😳 Even before all of this the wait to get into doctors was months out. My dad got referred to the pulmonologist but couldn’t get an appointment until July. He’s in a cancelation list, but my goodness he shouldn’t have to wait so long when he’s struggling to breathe. ER visits get old! This is all going to get so much worse if the Republicans pass their bill.
I know my privilege is showing a little considering I’m blessed to have insurance coverage, but I’m frustrated and it’s where my head is right now. Tomorrow I’ll be big mad about those losing coverage.
This was timely for me:
1) My whole family is on my husband's insurance, but he may be in danger of losing his job. Yesterday, if everyone went on the insurance that is offered through my workplace, it would cost about half of my take home pay. Today, our Board of Trustees voted to double the amount of money my employer puts towards health insurance, which is great. Now it will be only a quarter of my take home pay unless my kids go on Medicaid, which is what many of my colleagues do, but what do the cuts mean for that.
2) My oldest rolled off of our insurance in January. She has insurance through her school, but that will expire in August. She is worried about finding a job with insurance before then. I told her that she could go on Medicaid if she didn't have a job. Then I heard about the work requirement. I am sure she would LOVE to work once she graduates, but the way hiring is looking for 2025 grads (as umpteen articles tell me) is really bad. Now I know she doesn't have to worry for a few years!
3) Even with those huge rates in insurance, I don't see how the industry stays solvent given the costs of things. I had a routine, in-patient surgery last month. It cost $5000, which is a bargain for a 3 hour surgery. if a family has a couple of those, prescriptions, routine vaccinations, a few infections, etc. and the entire insurance premium has been spent. Not every family has that, of course, but there are families that have accidents or surgeries that cost tens of thousands of dollars. A friend's 20 year old son had a stroke - totally unexpected - and by the time all was said and done, the total cost was about $800,000, as far as she can tell from the thick sheaf of insurance documentation she has. She is thankful every day that she had insurance because she saw enough people in the hospital who didn't, but those bills have to get paid somehow.
Something not mentioned in the healthcare talk, that is maybe kinda tangential, is the financial strain on hospitals and other medical facilities right now. We all know how inflation has increased the price of everything. Guess what is included in that? All the goods & “stuff” required by hospitals etc. to provide care. Guess whose reimbursement rates have not gone up post-inflation despite the increase in their cost to provide care? It’s untenable, could very well lead more facilities to close, and access to become more difficult.
Re: work requirements and Medicaid- many people need to have health issues addressed BEFORE they can be gainfully employed. This is especially true for folks with substance use disorders, chronic pain, untreated chronic illnesses and severe mental health issues. Medicaid is a huge gateway to employment for folks who can get meaningfully treatment for health issues that prevent them from working. Work requirements undermine this.
And let’s remember that having healthcare reimbursed creates jobs. Specifically in Montana, “Medicaid expansion creates 5,600 to 8,000 jobs and generates $350 to $560 million in personal income throughout Montana’s economy annually.” This is from the Montana Healthcare Foundation.
And most adult Medicaid participants already work! So we are just adding more work for people who are already working. Data from Montana, “Most Medicaid expansion beneficiaries work, and those who do not have caregiving responsibilities or disabilities. 72% of adult Medicaid enrollees are in the labor force or attending school.”
One thing not mentioned is the cost of folks not having healthcare. If a population is not healthy, it cannot participate in society: work, buy things, pay taxes, social and civic participation. These costs are much higher than actually paying to keep folks healthy. It’s not only the ‘right thing’ but also has major economic implications.
YESSSSSSSS!!!!!!
Ok, I want this on a bumper sticker: Just Say No to #PaperworkandPaternalism! WELL said, Beth! 👏👏
You mention that what the populous can probably all agree on is that we want a social safety net that is the federal government providing poverty insurance. Which is true. But when income and wealth inequality keep growing, the number of people needing that type of insurance keeps growing. I am in a middle-to-upper income bracket, but I pay gigantic monthly premiums for my private insurance. Which is why I would like the federal government to do the hard work of figuring out how to make healthcare universal in some way. Plus, if you combine this with the lack of protections for workers (lack of sick time, family leave, etc.), everyone just gets a bad deal.
One thing I didn’t hear mentioned was how these cuts would negatively impact hospitals themselves, particularly in rural areas. If hospitals don’t get that Medicaid reimbursement, they will crumble and close faster than they already are.
Re: states, Indiana just reduced its Medicaid expansion during session which is likely to kick about 200,000 people off anyway. 1.8 million Hoosiers are covered under Medicaid. So I guess a large percentage of those people are just going to be screwed.
Re: creative pursuits, I shared in the chat yesterday that I picked up needlepoint a couple months ago and also write here on Substack, mostly about motherhood, being a recovering perfectionist, and what I’m reading: https://ellenfitzgerald.substack.com/.
Related to both the topic of today’s show and the exhale, I write a Substack about supporting medical trainees: https://whitecoatwife.substack.com
My husband is currently a fellow in his 14th year of training, and a lot of people don’t realize funds from Medicare and Medicaid contribute significantly to the training of medical professionals. Our modern residency program relies *heavily* on these programs, and in addition to all of what you discussed on the episode, I worry a lot about what a struggling pipeline of trainees will do to healthcare accessibility in this country.
Also medical students! I work at a medical school, and most of our students are on Medicaid because they can’t work while they attend school and they are too old to be on their parents health insurance (if that is even an option for them)
Yes!!!
Ok I didn’t know that!
Working on a series for the summer about it! Funding for residency is SO complicated.
Maybe we should look at the root cause for why so many people need to be on Medicaid. Just a thought.