Repeal and Replace in 2017 was not really an anti-ACA bill. It was, but that was not where the net cuts were coming from. It was a massive cuts to Medicaid bill.
We’re repeating the process:
💸 Scoop in this morning’s Early Brief:
The House GOP is kicking around a $1.5 trillion budget number for the “big, beautiful bill,” @mariannasotomayor.bsky.social and I can report.
Still spaghetti-on-the-wall phase of talks, but they’re tilting toward what the Freedom Caucus wants.
— Jacob Bogage (@jacobbogage.bsky.social) February 6, 2025 at 9:03 AM
From a political pressure point of view this reinforces that all of the leverage is in the House. At the moment, Johnson can afford 0 NO votes and 2 Republicans who got delayed flying into National Airport to pass a party line bill. His majority has a dozen members who won in 2024 with less than a 4% margin. We’re highly likely to get a much bluer generic ballot in 2026 than 2024. Those members are at substantial risk of losing in November 2026. And now they are likely going to be voting for bills that tickle the fancy of the hardest of hard liners from safe to very safe Republican seats.
Scamp Dog
The fly in the ointment here is that Trump and Musk may figure they don’t need to pass any laws to gut Medicare, Medicaid, etc., just turn off the payments and that’s it.
How the population and political system respond to that is beyond me.
MazeDancer
In NY, upstate red guy Molinaro lost. But slightly less upstate red guy Lawler won. So there is a risk.
Hoping some of the GOP wake up. But what they have going for them is flood the zone. People don’t want to follow politics.
OTOH, people who do follow will be loud when these idiots run.
lowtechcyclist
Over what period of time? For the rest of FY 2025, per year, or over 10 years, or what
ETA: Numbers for spending increases or cuts don’t really mean much without the per unit of time.
AM in NC
What the Fuck does Thom Tillis think is going to happen to NC rural hospitals when Medicaid is shut down?
I hope his voters can be made to understand who took their medical care away and condemned them to sickness, poverty, pain, and early death. And I hope they rip him to pieces. Not holding my breath.
RaflW
Every Republican governor needs to be told, over and over, about the rural hospitals in their states that will shrivel up and die (along with R-voting rural residents who will also die) if this Medicaid slash goes thru.
If they think they can weather that political storm, well good luck to them. They’ll still be moral monsters. That said, everything is so politically fractured right now, I’m not even sure R governors can exert very much influence or power over R Congrescritters from their states.
FDRLincoln
I find myself every day trying to game out how this all ends, and I can’t think of anything but a binary:
A) Acceptance of white Christian Nationalist dictatorship, or
B) Civil War.
It is apparent that the preferable option C, resumption of normal politics as we have known it since 1945, is increasingly less likely with each passing day.
Barbara
@MazeDancer: You have to paint them with the same toxic sludge even if they try to sound reasonable because at the end of the day THEY WILL VOTE FOR IT. Ergo, they have to own it. Don’t say “Trump this or Musk that.” Say, “Candidate A is going to eliminate your social security when Congress puts forward the mega budget act. How many times are you going to let him lie about this?” If he tries to weasel out of it, “Trump said so. Are you saying you don’t support Trump?”
Surly Duff
Huh? They probably meant $1.8 trillion in tax cuts
Kristine
Doesn’t Medicaid also cover nursing home bills?
I know it’s the far right’s dream that all women get swept out of the workforce and into unpaid caregiver roles, but I can’t believe that will go over well with the families that find a parent or grandparent parked in their doorstep, however they voted.
lowtechcyclist
@FDRLincoln:
There’s always (D) Blue state secession. The remaining states can decide whether they want us badly enough to turn that into option (B). I wouldn’t be surprised if they just said Good Riddance.
Barbara
@RaflW: I hate to be the one who tells you, but the shriveling and dying has been happening for more than a generation. It’s one of the reasons — perhaps the only for some — that many red states capitulated and expanded Medicaid. If there is no hospital at all, then you and your kids will also not be able to access medical care during an emergency.
Which takes me to one of the most infuriating aspects of current polarization — that people who vote reliably Republican expect or at least tolerate governance that is absolutely inimical to their welfare. Republican legislators don’t give a flying fuck about rural broadband access, shuttering hospitals, zero physicians in an entire county, or local water or alternative energy projects. Increasingly, I don’t care either. There are too many other things to care about than wasting energy on people who are primed to hate you no matter how much you try to help.
lowtechcyclist
@Kristine:
Yes, it most certainly does. Medicare will cover the first 20 or 30 days, I think it is. After that, it’s all Medicaid.
David Anderson
@lowtechcyclist: decade
Geminid
@MazeDancer: I read that Mike Lawler is considering a run for New York Governor next year. He’d lose, but that might be better than losing his House race.
Lawler made a lot of big talk about getting this Congress to raise the SALT exemption, and it looks like he’ll come up empty. That and an anti-Trump political climate will likely do him in if the Democrats run a strong opponent, which I think they will.
RaflW
@FDRLincoln: Yep. As Jamelle Bouie wrote yesterday:
RaflW
@lowtechcyclist: We may very soon have very large numbers of white Trump voters discover, very personally, that their mom, uncle or grandma live in a nursing home thanks to Medicaid.
And some of those Trump voters might even work in nursing homes that only survive because of Medicaid. FAFO with a lot of human suffering.
CaseyL
For generations, the voters in Red states have elected officials who have gutted education, public health, and other infrastructure within those states.
The voters have been taught, for generations, that government has no business doing any of those things.
They believe it. And they resent the Blue states for still having things like education, public health, and infrastructure. They believe to their very bones that the government should not be doing that stuff, and governments that do are illegitimate. (“Socialist” or “communist.”)
(They have lately come around to the idea that one proper function of government is to enforce religious edicts. The fact that this is completely and utterly the opposite of what the Constitution says is irrelevant.)
They will not rise up in their wrath as they continue to lose health care, roads, teachers, or any of that. They will continue to believe it is right and proper to destroy publicly-funded common goods, and they will vote accordingly.
MomSense
I would love for someone to do a study related to Maine’s Medicaid history and how it affected drug use, child protection, etc. Maine expanded Medicaid in the 90s as part of a statewide program, Dirigo Health, to achieve universal coverage in our state. When ACA was passed and we elected a Republican Governor, they cut Medicaid coverage from 140 FPL to 100FPL and blamed ObamaCare. We had a massive increase in child abuse and neglect, drug use and overdoses, etc. we are finally coming out of those problems but it took 5 years to see a turnaround. And that’s the big problem we always face. It is so easy to destroy and so much more difficult to build.
JerseyBeard
Stiffen the spines of the House Dems, drive division and distrust among the GOP like a righteous wedge.
Fortunately, the stupid are easily manipulated. I’d suggest focusing on that and make the GOP house members crazy protecting their right flank.
LeftCoastYankee
One thing that gives me hope in the longer term is this initial flood of bad ideas is the work of 4 years of planning (ie Project 2025) executed in 2 weeks. All the blowback is just starting and they clearly don’t have a plan other than make hateful noises, try to break shit, and pass an awful tax cut.
The only thing which makes their nonsense inevitable is if people accept it. They’re hurting too many people for us to accept it.
That’s my self-peptalk of the day.
Layer8Problem
@RaflW: From personal experience, that will hit West By God Virginia very hard. I hope the state government can pick up the slack if it happens.
Professor Bigfoot
@FDRLincoln: Yeah, that’s the way I see it too.
I keep hoping and praying for a “Glorious Revolution” bloodless end to this madness, but there’s just not enough God in the machine for that.
My bet is that White America chooses Option A; and the rest of us can literally go hang.
Barbara
@Layer8Problem: You can trace the impact by how fast states expanded Medicaid. West Virginia and Kentucky expanded Medicaid right out of the starting gate. They not only have high rates of poverty they have low rates of employment participation. Their poor people are also mostly white.
PhoenixRising
@MomSense: Funny you should ask! That’s my field and yes, there is plenty of evidence that Medicaid enrollment at birth, with comprehensive family services that are easy to access and hard to lose via administrative burden, results in better health, higher educational attainment, lower rates of allegations of abuse & in some studies there appears to be a correlation with earnings in early adulthood.
That may be why the first step by the incoming fascists was to delete the official copy of that evidence, by taking taxpayer funded data sets offline.
lowtechcyclist
@David Anderson:
Thanks!
Steve LaBonne
@RaflW: They know it very well because they were busy hiding assets beforehand. They just believe that the leopards won’t eat their faces. Who knows how they’ll react when they Find Out.
Professor Bigfoot
Conservatives will overthrow the Constitution they claim to revere because it permitted a Black man to be elected President— twice.
It’s that simple.
Rusty
As distressing as the chaos is at the moment, the sense i get from conservatives I know is that what Trump and Musk are doing they think is great. Those conservatives have a deep, visceral dislike for government and are happy to government workers “getting what they deserve”. The consequences for all this destruction will come months, years or even decades later, which is why it is impossible to convince them of the negative outcomes. Even a few moderates i k ow are more wait ans see. It’s become apparent a lot of the press has the same feelings toward government. I hope enough of the negative shows up by the midterms that we can wrest back the house, but we are fighting a real up hill battle for at least the next year.
Barbara
@lowtechcyclist: Medicare doesn’t cover any nursing home services, per se. It covers a “spell” of medically necessary skilled nursing care that follows discharge from an inpatient hospital stay when it is required to improve or maintain a person’s function. Likewise for institutional rehabilitation services.
It’s hard to understand the difference because the same institutional setting is usually delivering both types of care, but nursing home care refers to the daily room and board and support services that are required for someone who cannot live in a less supportive environment. The nursing home is a place of residence. A nursing home, for instance, must make sure a resident has access to medications but is not financially responsible for providing them. Whereas a SNF or rehab hospital usually is.
Professor Bigfoot
@Barbara: Yes, but Americans* have been successfully propagandized into an automatic assumption that “the poor people are Black and they deserve their poverty because they’re lazy and shiftless,” and will therefore cut their own throats.
The Davis X. Machina Dictum, over and over and over.
Steve LaBonne
@Rusty: The Progressive Era reforms happened when people finally got tired of being poisoned and robbed by the robber barons. But that took decades of poisoning and robbing.
eldorado
Has anyone considered just asking the Sacker’s to restart operations?
AM in NC
@Professor Bigfoot: This white American won’t be on that side. I’ll have your back. Yes I am a woman.
VeniceRiley
How many years I contributed to Medicare and Medicaid, only to emigrated and have to pre-pay for each visa length to NHS.
If US was smart, it would cover eligible emigrants to low cost medical countries and that would relieve stresses on the system and clear out people who want to voluntarily leave, but cannot due to health care.
Chris
@Scamp Dog:
Like we just saw in Canada and Mexico, Trump remains very sensitive to the possibility of electoral backlash from normies, which makes me think that they’re not going to just turn things off for everyone (on purpose), they’re just going to do it selectively. Your Social Security checks may or may not arrive, depending on your demographic information. Your NGO’s USAID money may or may not arrive, depending on what kind of projects you work on. Etc. He’s already done this plenty of times in terms of threatening aid money to blue states (heck, our Republican governor had to have Covid vaccine convoys guarded by the National Guard because the threat of some Trump goons seizing them cause we’re a blue state was real).
Skippy-san
Will the mid-terms matter? By then, Musk would have destroyed all social safety net programs and declared martial law.
And no one in Congress on the GOP side appears to be concerned about it.
David Anderson
@Layer8Problem: West Virginia has absolutely no excess fiscal capacity to buffer against hundreds of millions/billions of dollars per year in reduced federal spending that currently floats their state budget.
MomSense
@PhoenixRising:
Maine would be an interesting case study. We were consistently in the top 5 states for metrics related to child health until the Republicans slashed Medicaid and then we plummeted. We are still trying to recover from the damage that was done those 8 awful years.
Matt McIrvin
@LeftCoastYankee: At some point they may just start killing everyone. I kind of half-expect this to end with the US Air Force bombing American cities to the ground.
Ohio Mom
@Kristine: Medicaid is complicated but yes, it will pay for nursing home care — after you have spent down all your money. You are not allowed to have more than $2,000 in your name. Or maybe you have lived hand-to-mouth and could only dream of having $2,000 in the bank. At any rate, you have to be poor to qualify.
As I often point out, Medicaid also pays for the things disabled adults need to live in the community — staff at group homes, day programs, transportation, etc, and also of course, medical care and equipment.
The priority is on having disabled adults live in the community but in extreme circumstances, if they need to live in an institution, Medicaid pays for that (sometimes it ends up being a Medicaid nursing home).
Again, to receive Medicaid as a disabled adult, you must not have more than $2,000 in assets. You can shelter more than that in a special needs trust (or similar vehicles) but when you die, Medicaid will demand everything in your estate to pay itself back. Including what is in the special needs trust, because it is a pay-back trust.
Super Dave
Sad to say this assumes facts not in evidence. At the current rate of destruction, there is a level of uncertainty that the midterm elections will be held.
Can any of my beloved jackals propose a way that blue state governors or legislators could keep the excess blue state taxes that currently subsidize red states from flowing in that direction? I’m sure that’s a pipe dream, but I’d still love to see it happen.
My wife and I attended the 50-50-1 rally at our state capitol yesterday. Small state and small capital city, probably several hundred protesters. One person opposing the gathering has been arrested for brandishing a weapon as they drove past the assembly. Not surprised.
Ohio Mom
@Super Dave: I don’t know how that would be possible— your employer withholds your federal and that money goes straight to the IRS. Even if you pay estimated taxes on your own, that money goes to tne IRS, not to your state capital.
Chris
@Matt McIrvin:
One of the many dark thoughts that’s occurred to me about the future, though this isn’t specifically an America thing…
Nuclear weapons are a big taboo in international relations because of the fear of how other countries would react to a nuclear attack, and how that might spiral out of control. Possibly even if the country you nuked wasn’t a nuclear power itself, because those that are would still feel threatened.
In contrast, I don’t think using a nuclear weapon inside your own country would ever cause that kind of reaction. Other countries might be horrified, but they couldn’t really come up with any reason to do anything about it other than purely humanitarian reasons that they ignore all the time anyway.
Now throw in the fact that the increasingly common model all around the world is for autocrats to rule with the support of their rural population, while the big cities are where anti-regime trouble is most prone to bubbling up.
Add all that together and… I’ve had a suspicion for a while that the next use of nuclear weapons isn’t going to be in an international conflict. It’s going to be some despot nuking one of his own cities, and promising to continue doing it until they’re all annihilated or the population submits.
(I don’t claim that America is where this will happen. But it’s absolutely a place where it could happen).
No Nym
Medicaid is chock full of DEI initiatives, from CMS on down to the corporations that run programs in every state. How does it survive the 20th Century Retribution Tour at all?
RevRick
@lowtechcyclist: You first have to deplete all your own resources. My mother ended up in a nursing home after she had a stroke. She spent down almost every penny of assets. My brother and I divided up what remained: $1,000 each. If she lived a month more that number would have been $0 and Medicaid would have kicked in.
catclub
Yep. Getting Grandma thrown out of her nursing home might not be popular.
catclub
Unless there is a human borne bird flu epidemic
(with Trump in charge AGAIN) 6 years after the last epidemic.
Miss Bianca
@RaflW:
Or brother. My Trump-voting brother is in a nursing home right now, and if Medicaid gets shut down, his only option is moving in with my other Trump-voting brother. Because the Harris-voting sister over here is not only 1500 miles away living in the decidedly non-ADA-accessible Mountain Hacienda, she is not going to be feeling charitable enough towards either party to volunteer to up-end her own life to help out.
“Sorry, you broke it, you bought it. Enjoy the next however many years you got together fighting like weasels in a sack.”
Quiltingfool
My county (in Missouri) is probably 98% white. Around here, they don’t target black folks, they get pissy at poor white people who do meth, or drink, or smoke and have “too many kids” on the government dime.
I taught at a rural school district, mainly white, for 21 years. There were teachers who were quite willing to deny children free lunch or other “freebies” because their parents were druggies or welfare layabouts. They thought that the parents would straighten up if we denied their children food. Really appalling. How on earth could anyone deny a child food or extras simply to punish parents?
So, in a roundabout way, people (white, mostly) will always look for someone to punish. If there are no black people, they will shit on poor whites. I think Dr. Reverend King had something to say about that, if I recollect correctly.
jeff47
It’s worse than that. The Republican caucus includes 8 Representatives who have voted against every budget in the 10+ years they’ve been in the House. They insist they will not vote for any budget that is not balanced.
The party line bill will not be balanced.
Johnson isn’t at +2 with Republican votes. He’s at -6.
Professor Bigfoot
@Quiltingfool: that says something truly distressing about American culture.
“The cruelty is the point” isn’t just a phrase, it’s the literal truth.
”Beware those in whom the urge to punish is strong.” —Friedrich Nietzsche