By T N Ashok
WASHINGTON: President Trump’s “One Big Beautiful Bill” even after revisions accommodating concerns of republican holdouts, impacts various spheres of economic activity in the country and people in ways that could be best described as being unfair to a certain class of citizens who end up paying more for subsidizing the very rich class of citizens.
No doubt it cuts federal spending on Medicaid and Affordable Care Act marketplaces by about $1 trillion over a decade, according to the nonpartisan Congressional Budget Office, threatening the physical and financial health of tens of millions of Americans. It eliminated 11.65 million people from health care benefits and raised insurance costs and costs of health care substantially and weeds out those who were not entitled to receive medical benefits under the said schemes.
The bill, which the Senate passed Tuesday, would reverse many of the health coverage gains of the Biden and Obama administrations, whose policies made it easier for millions of people to access health care and reduced the U.S. uninsured rate to record lows.
America is indeed going through tumultuous times with middle class urbanites being the major victims of government policies.
The Senate plan to slash Medicaid and ACA marketplace funding could lead to nearly 12 million more people without insurance by 2034, the CBO estimates. The finances of hospitals, nursing homes and community health centres in turn would be affected — which would have to absorb more of the cost of treating uninsured people — and may force them to reduce services and employees, as well as close facilities.
The legislation will be on Trump’s desk by Friday. The Senate has already passed and now the house of representatives are expected to clear it by Thursday night.. The House passed its own version in May and is considering the Senate’s revised version Wednesday/ Thursday which adds costs , according to House Majority Whip Tom Emmer.
The deepest cuts to health care spending come from a proposed Medicaid work requirement, which would cut off coverage for millions of enrollees who do not meet new employment or reporting standards.
In 40 states and Washington, D.C., all of which have expanded Medicaid under the Affordable Care Act, some Medicaid enrollees would have to regularly file paperwork proving that they are working, volunteering, or attending school at least 80 hours a month or that they qualify for an exemption, such as caring for a young child.
The bill’s requirement would not apply to people in the 10 largely GOP-led states that have not expanded Medicaid.
Health researchers say the policy would have little impact on employment. Most working-age Medicaid enrollees who don’t receive disability benefits already work or are looking for work or are unable to do so because they have a disability, attend school, or care for a family member, according to KFF.
State experiments with work requirements have been plagued with administrative issues, such as eligible enrollees’ losing coverage over paperwork problems, and budget overruns. Georgia’s work requirement, which officially launched in July 2023, has cost more than $90 million, with only $26 million of that spent on health benefits, according to the Georgia Budget & Policy Institute, a nonpartisan research organization.
“The hidden costs are astronomical,” said Chima Ndumele, a professor at the Yale School of Public Health.
Belt-tightening that would target states could translate into fewer health services, medical professionals and even hospitals, especially in rural communities.
The GOP’s plan would curtail a practice, known as provider taxes, that nearly every state has used for decades to increase Medicaid payments to hospitals, nursing homes and other providers and to private managed-care companies.
States often use the federal money generated through the taxes to pay the institutions more than Medicaid would otherwise pay. (Medicaid generally pays the lowest fees for care, compared with Medicare and private insurance.)
Hospitals and nursing homes say they use these extra Medicaid dollars to expand or add new services and improve care for all patients.
Rural hospitals typically operate on thin profit margins and rely on Medicaid tax payments to sustain them. Researchers from the Cecil G. Sheps Center for Health Services Research who examined the House bill concluded it would push more than 300 rural hospitals — many of them in Kentucky, Louisiana, California and Oklahoma — toward service reductions or closure.
Marketplace policyholders would be required to update their income, immigration status and other information each year, rather than be allowed to automatically re enroll — something more than 10 million people did this year. They would also have less time to enroll; the bill shortens the annual open enrolment period by about a month.
People applying for coverage outside that period — for instance, because they lose a job or other insurance or need to add a newborn or spouse to an existing policy — would have to wait for all their documents to be processed before receiving government subsidies to help pay their monthly premiums. Today, they get up to 90 days of premium help during the application process, which can now take weeks.
Republican lawmakers and some conservative policy think tanks, including Paragon Health Institute, say the changes are needed to reduce fraudulent enrolments, while opponents say they’re the latest attempt to undo Obamacare.
The legislation also does not call for an extension of more generous subsidies put in place during the COVID-19 pandemic. If Congress doesn’t act, those enhanced subsidies will expire at year’s end, resulting in premiums rising by an average of 75% next year. (IPA Service)
