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You are here: Home / 2025 Activism / Medicaid, Medicaid Expansion and Deservingness

Medicaid, Medicaid Expansion and Deservingness

by David Anderson|  April 16, 20255:08 pm| 20 Comments

This post is in: 2025 Activism, Anderson On Health Insurance

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Punchbowl published a letter written by about a dozen Republicans in marginal seats on their objectives for the reconciliation bill that is slowly making its way through the House and the Senate.  I want to highlight a few sections:

“We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help.

“However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations. [my emphasis]”

If I am reading that with the right type of squint, I am hearing that these marginal seat Republicans are totally on board with work requirements, totally on board with very frequent redetermination of eligibility, and against allowing states to levy provider taxes to fund the state share of Medicaid’s costs. All of this is the the phrase ” program integrity, reduce improper payments, and modernize delivery systems”

Those policies are worth a couple hundred billion dollars for Energy and Commerce jurisdiction in the House and the Finance Committee in the Senate.

This is also a statement, from the right type of squint, that these marginal Republicans are on-board with eliminating the ACA’s 90% federal share of funding for Medicaid Expansion.

divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help….any reduction in Medicaid coverage for vulnerable populations.

The Medicaid Expansion component is not kids, not seniors, not individuals with disabilities and not pregnant. The very absence of the working poor is exceptionally notable.

This is the ball game.

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Reader Interactions

20Comments

  1. 1.

    Sister Golden Bear

    April 16, 2025 at 5:17 pm

    Given RFK Jr. is a eugenicist, I’m sure that the increased death rates among the working poor will be seen as a feature, not a bug. I’m not even sure he’d worry that it be only confined to those people.

  2. 2.

    Mathguy

    April 16, 2025 at 5:27 pm

    I see my dipshit rep Don Bacon signed on to this idiocy. Quelle surprise.

    People that would have been considered reactionaries even 20 years ago are now “moderate” republicans.

  3. 3.

    Mathguy

    April 16, 2025 at 5:29 pm

    @Sister Golden Bear:

    Because they are obviously not worthy if they got sick.

    We live in the worst timeline now.

  4. 4.

    lowtechcyclist

    April 16, 2025 at 5:29 pm

    What a bunch of horrid motherfuckers.

  5. 5.

    Sister Golden Bear

    April 16, 2025 at 5:34 pm

    @Mathguy:

    Because they are obviously not worthy if they got sick.

    Especially galling when we’re told that by someone who looks like Pepe the Frog deep fried in beef tallow.

  6. 6.

    TheOtherHank

    April 16, 2025 at 5:44 pm

    I firmly believe that people who have done wrong should be able to achieve redemption. But… a former heroin addict who still thinks every shitty thing he ever thought is right, has not redeemed himself and should be given the opportunity to work on himself before becoming a high government official.​

  7. 7.

    Miss Bianca

    April 16, 2025 at 5:48 pm

    Anyone who is on Medicaid for whatever reason is part of a “vulnerable population”. Yes, even my Trumpy little brother, who under normal circumstances would be happy to take part in the white male Republican privilege of scapegoating poor and disabled people as moochers.

    Unfortunately for him, he was felled by a massive stroke last year, in part because instead of taking care of his diabetes and other various health issues under the care of a doctor, he tried quacking himself under the influence of all kinds of horseshit medical woo. Now he’s living the dream in a nursing home…on Medicaid.

    It can happen to anyone, you Republican dipshits. Anyone, at any time, can become part of a “vulnerable population” with no warning…even you.

  8. 8.

    Steve LaBonne

    April 16, 2025 at 5:52 pm

    All Republicans hate the working poor. It’s obviously their own fault that they aren’t rich.

  9. 9.

    Ohio Mom

    April 16, 2025 at 5:54 pm

    Well the Medicaid expansion was Obama’s crowning achievement, and that alone is reason to toss it, if it is a Democratic accomplishment, it can not stand.

    I’m not sure how work requirements square with the target populations of children, seniors, people with disability and pregnant women. Children and most seniors aren’t going to be earning money for obvious reasons, people with disability are generally not easily employable, plus if they make too much they lose their Social Security, which leaves pregnant women, who I am guessing are not that attractive to hiring managers.

  10. 10.

    lowtechcyclist

    April 16, 2025 at 5:55 pm

    @TheOtherHank:

    I am firmly believe that people who have done wrong should be able to achieve redemption. But… a former heroin addict who still thinks every shitty thing he ever thought is right, has not redeemed himself and should be given the opportunity to work on himself before becoming a high government official.

    As Jesus said, “I send you out as sheep among wolves: be wary as serpents, innocent as doves.” (Matt. 10:16)  We are to allow for the possibility that the vilest offender can be redeemed. But that doesn’t mean we should trust that person, let alone put (or keep) that person in a position of trust over others. No need to set aside skepticism.

  11. 11.

    Math Guy

    April 16, 2025 at 5:57 pm

    @Mathguy: Wow, so you live in NE 2nd Congressional District. I was born there.

  12. 12.

    Ohio Mom

    April 16, 2025 at 6:00 pm

    I don’t know about other states but in Ohio, most people on Medicaid are forced into managed care programs.

    Which I would bet are a lot more expensive for the state than plain old fee-for-service Medicaid, similar to the way privatized Medicare Advantage costs the government lots more than traditional Medicare.

    That to me would be the first place to look for savings but I am not an elected official hungry for donations from health insurers.

  13. 13.

    Rugosa

    April 16, 2025 at 7:29 pm

    @Miss Bianca: ​
     I’m so sorry for your brother – that’s a hard way to learn a lesson. It’s easy to say FAFO to Trump supporters but they’re family and neighbors.

  14. 14.

    WTFGhost

    April 16, 2025 at 7:30 pm

    You did call out one of the things that I found upsetting – yes, they’re going for medicaid expansion, and, their only promise is that they won’t cut benefit levels.

    That means, people getting paid benefits this year, get the SAME benefits. Next year, they’ll get the SAME benefits – or maybe an increase, less than the increase in medicaid inflation, so that the net benefit is smaller, but the nominal  benefit is the same, or even slightly larger.

    So: they want to cut the eff out of eligibility (cutting medicaid and medicare in that manner), reduce the rate of growth below the rate of medical inflation, and turned the entire program into Medicare (dis)Advantage, where insurance companies get to kill you, by denying you coverage, but get to pretend they’re just asking questions.

  15. 15.

    EthylEster

    April 16, 2025 at 7:30 pm

    I don’t think I am getting the point you are making.

    but then I often do not understand your posts.

    oh, well. Maybe my brain is fried.

  16. 16.

    Another Scott

    April 16, 2025 at 7:58 pm

    @Ohio Mom: +1  They want to destroy any and every good thing that the federal government has done, especially if those things were done by Democrats.

    What’s also insidious about these proposals is coupling them with what Melon and 47 are doing is they can institute all kinds of rules and not hire people to administer and enforce those rules.  So, the government bureaucracy backs up, approvals or denials take forever, and they can run yet again on The Government Is Broken So Send Me to DC to Break it Some More.  Plus, they know that they don’t need to hire actual people any more – they can use AI or get volunteers!  They can have ubiquitous phone and e-mail snitch lines, and maybe throw in some “bounties”, for everyone to rat on their neighbors or any people they don’t like for some magic beans.

    Win Win!!11ONE

    Grr…

    We’re 86 days in.  Is the madness reaching a climax??

    I guess we’ll see.

    Hang in there, everyone.  It’s going to be a slog…

    Best wishes,
    Scott.

  17. 17.

    cw moss

    April 16, 2025 at 8:23 pm

    @EthylEster: I’m with you. I don’t understand the quoted parts of the letter, and David’s paraphrasing seems to conflict with what I take to be the (vaguely worded) meaning of the quoted passages. I’d very much like an expanded post from DA further explaining his take on what these marginal-seat Rs are saying they’ll support and what they won’t support.

  18. 18.

    Another Scott

    April 16, 2025 at 8:42 pm

    @EthylEster: @cw moss:

    My take on what David’s saying is:

    These GQPers voted for the reconciliation instructions which will actually necessitate cutting $880B (or more) from Medicaid (IIRC). Now they’re saying, in so many words, to try to save their skins, that all those cuts are just going to be the old “Waste, Fraud, and Abuse” cuts that everyone sensible supports – because these GQPers obviously aren’t monsters and never would cut support for actual real people who need it. They’re saying, and want to convince enough donors and voters that they’re good people and just doing what’s right and necessary. That what’s left will just go to the people that the program is designed to support (in their interpretation) and not those others who are living high on the hog on the taxpayer’s dime.

    So don’t blame them when the programs are functionally destroyed. It’s not their fault!! Even though they voted for it.

    That’s how I read it, anyway.

    Corrections welcome.

    HTH!

    Best wishes,
    Scott.

  19. 19.

    EthylEster

    April 17, 2025 at 2:52 pm

    @cw moss: yeah, I thought it was self-contradictory. But most I just don’t understand. I don’t think the post was intended as an explainer. But that might be what I need.

  20. 20.

    EthylEster

    April 17, 2025 at 2:57 pm

    @Another Scott: Thanks for the response. My take on your comment…that’s some world class squinting. But at least I understand what you wrote. I’ve re-read the OP again and still cannot map your comments back on Anderson’s words and his excerpts of others’ words. Oh, well.

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