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While the US is reeling from COVID-19, the Trump administration is trying to take away health care

While the US is reeling from COVID-19, the Trump administration is trying to take away health care

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4 years ago

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People affected by the downturn in the economy caused by coronavirus at a food bank in Central Florida in April, 2020. Paul Hennessy/NurPhoto/Getty Images

The death toll from COVID-19 keeps rising, creating grief, fear, loss and confusion.

Unfortunately for us all, the pain only begins there. Other important health policy news that would ordinarily make headlines is buried under the crushing weight of the coronavirus. Many have not had time to notice or understand the Trump administration’s efforts to wreck health care coverage.

We are both professors at Boston University School of Public Health who study health insurance, one using economics and statistics and the other focusing on law and policy. We have researched the big picture of COVID-19’s impact on the safety net and the details of how our federalist system, with states having considerable control over policy, has made a coordinated response to the pandemic more difficult.

Here, we highlight two major actions by the Trump administration that should be receiving more attention – attempting to cap federal Medicaid funding, and arguing to the Supreme Court that the entire Affordable Care Act should be struck down.

Several patients on gurneys outside a hospital.
COVID-19 patients arrive to the Wakefield Campus of the Montefiore Medical Center on April 06, 2020 in the Bronx borough of New York City. John Moore/Getty Images

Limits on Medicaid funding

Complicated language and political posturing make it hard to understand health care in the best of times. This is particularly true for proposals to change the funding for Medicaid, the health insurance program for low-income Americans that also covers many disabled and elderly people.

Medicaid has historically been funded like this: States pay a percentage of Medicaid costs, and the federal government covers the rest. The federal match ranges from 50% to as much as 83% of every dollar. It doesn’t matter whether a state has one thousand or one million Medicaid enrollees, that same cost sharing applies. Uncapped federal funding gives Medicaid flexibility to meet that need.

The Trump administration wants to change the promise of unlimited federal funding and instead use a payment method often called “block grants.”

Block grants are pre-set amounts of money that the federal government offers to states, which then have control over the money within broad guidelines. While that may sound harmless and even appealing to some, block granting reduces the amount of federal money available and shifts the risk of economic, health, and other emergencies to states. Medicaid block grants would set limits on how much money the federal government spends, either in total or per person.

President Johnson shaking hands with former President Harry Truman.
President Lyndon Johnson, left, shakes hands with former President Harry Truman when Medicare and Medicaid became law in 1965. Truman had tried to pass Medicare-like bill but failed. Vice president Hubert Humphrey is in the background. LBJ Presidential Library

Medicaid has never been capped this way in its 55-year history, but block granting for Medicaid has long been an unfulfilled dream for conservatives, with Ronald Reagan, Newt Gingrich, and Paul Ryan trying but failing to make block grants a reality.

A work-around

When the GOP-dominated Congress tried in 2017 to repeal the ACA, many replacement bills featured Medicaid block grants. The bills failed in the Senate, with the late Sen. John McCain, R-Arizona, casting a famous deciding vote.

The Trump administration decided to try a different road. In January 2020, the Centers for Medicare and Medicaid Services issued a letter to state Medicaid directors describing a new Healthy Adult Opportunity policy that would fundamentally change the way Medicaid has always worked by implementing block grants.

Instead of the current partnership, in which the pie (Medicaid spending) can expand but the pieces (federal and state share of costs) stay the same size relatively, this new block grant policy would provide states either a set dollar amount for each enrollee (a per capita cap) or for their entire program (a fixed annual grant). Either way, the state would be responsible for any extra costs. To be clear, we and others believe this policy is illegal without a change in federal law.

So why would states pursue this? Political ideology and less federal oversight are big factors.

Giving states greater control over health policy could encourage states to find savings in their Medicaid programs. But unexpected spending on Medicaid, such as spikes in enrollment from natural disasters, could lead states to cut benefits, payments to providers, or other necessary services. This could make good quality care harder to get. It could also lead states to shift funding away from other essential services, like education, to meet medical needs.

We believe this is an especially bad time to pick this fight, while the nation tries to prevent spikes in COVID-19 and state budgets are in decline. Limiting the amount of money states have for Medicaid could not only limit health care access for the 65 million Americans already enrolled in Medicaid, but also potentially millions more who may need it as a result of the pandemic.

Killing the ACA

The ACA has faced near constant legal and political challenges since it became law a decade ago. Even enthusiastic supporters admit that it is far from perfect. But, some 20 million people gained insurance through the law.

The first challenge came when some states claimed that the law’s individual mandate, a requirement to have health insurance or pay a penalty, was unconstitutional. The Supreme Court ruled in 2012 that the mandate is constitutional, and the law was implemented.

In 2017, the Republicans controlling Congress tried but failed to repeal the ACA. Congress was only able to reduce the tax penalty to zero for the individual mandate, meaning the law still requires having health insurance coverage but the penalty is now $0.

Now, states argue once again that the mandate is unconstitutional because the penalty fails to “produce at least some revenue.” This new case is scheduled to be heard by the Supreme Court on Nov. 10. Texas v. California is the third major legal challenge to the ACA, but the first time that the federal government will not defend the law in court.

Texas leads 17 other states, with full support from the Trump administration, in arguing that the ACA cannot exist without the individual mandate penalty because the law is not “severable” – meaning that if one part of a law fails, then the entire law falls.

Of course, Congress did exactly that, severing the penalty from the rest of the ACA when it enacted the Tax Cuts and Jobs Act of 2017.

And, the Supreme Court already decided that the ACA is severable when it made Medicaid expansion optional in 2012. This case has been called “balderdash” by legal scholars, yet the court could issue a decision in a few months that eliminates the ACA.

If the ACA is struck down, that means the loss of coverage for preexisting conditions, the return of annual or lifetime caps, or policies being revoked for cancer patients. Those who don’t earn much money still deserve good health care. Nearly everyone will feel it if the Trump administration and Texas are successful, regardless of whether your health insurance is through your work, HealthCare.gov, Medicaid or Medicare.

Staying healthy is first priority during this pandemic, but understanding that health insurance could be on the brink of evaporating for millions is a close second.

Paul Shafer has received funding in the past three years from the Kate B. Reynolds Charitable Trust, Robert Wood Johnson Foundation, Horowitz Foundation for Social Policy, and the North Carolina Translational and Clinical Sciences Institute.

Nicole Huberfeld does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Survey Shows Declining Concerns Among Americans About COVID-19

Survey Shows Declining Concerns Among Americans About COVID-19

A new survey reveals that only 20% of Americans view covid-19 as "a major threat"…

Published

5 hours ago

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March 11, 2024

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Survey Shows Declining Concerns Among Americans About COVID-19

A new survey reveals that only 20% of Americans view covid-19 as "a major threat" to the health of the US population - a sharp decline from a high of 67% in July 2020.

(SARMDY/Shutterstock)

What's more, the Pew Research Center survey conducted from Feb. 7 to Feb. 11 showed that just 10% of Americans are concerned that they will  catch the disease and require hospitalization.

"This data represents a low ebb of public concern about the virus that reached its height in the summer and fall of 2020, when as many as two-thirds of Americans viewed COVID-19 as a major threat to public health," reads the report, which was published March 7.

According to the survey, half of the participants understand the significance of researchers and healthcare providers in understanding and treating long COVID - however 27% of participants consider this issue less important, while 22% of Americans are unaware of long COVID.

What's more, while Democrats were far more worried than Republicans in the past, that gap has narrowed significantly.

"In the pandemic’s first year, Democrats were routinely about 40 points more likely than Republicans to view the coronavirus as a major threat to the health of the U.S. population. This gap has waned as overall levels of concern have fallen," reads the report.

More via the Epoch Times;

The survey found that three in ten Democrats under 50 have received an updated COVID-19 vaccine, compared with 66 percent of Democrats ages 65 and older.

Moreover, 66 percent of Democrats ages 65 and older have received the updated COVID-19 vaccine, while only 24 percent of Republicans ages 65 and older have done so.

“This 42-point partisan gap is much wider now than at other points since the start of the outbreak. For instance, in August 2021, 93 percent of older Democrats and 78 percent of older Republicans said they had received all the shots needed to be fully vaccinated (a 15-point gap),” it noted.

COVID-19 No Longer an Emergency

The U.S. Centers for Disease Control and Prevention (CDC) recently issued its updated recommendations for the virus, which no longer require people to stay home for five days after testing positive for COVID-19.

The updated guidance recommends that people who contracted a respiratory virus stay home, and they can resume normal activities when their symptoms improve overall and their fever subsides for 24 hours without medication.

“We still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses, this includes vaccination, treatment, and staying home when we get sick,” CDC director Dr. Mandy Cohen said in a statement.

The CDC said that while the virus remains a threat, it is now less likely to cause severe illness because of widespread immunity and improved tools to prevent and treat the disease.

“Importantly, states and countries that have already adjusted recommended isolation times have not seen increased hospitalizations or deaths related to COVID-19,” it stated.

The federal government suspended its free at-home COVID-19 test program on March 8, according to a website set up by the government, following a decrease in COVID-19-related hospitalizations.

According to the CDC, hospitalization rates for COVID-19 and influenza diseases remain “elevated” but are decreasing in some parts of the United States.

Tyler Durden Sun, 03/10/2024 - 22:45

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Rand Paul Teases Senate GOP Leader Run – Musk Says “I Would Support”

Rand Paul Teases Senate GOP Leader Run – Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump…

Published

8 hours ago

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March 10, 2024

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Rand Paul Teases Senate GOP Leader Run - Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump into the race to become the next Senate GOP leader, and Elon Musk was quick to support the idea. Republicans must find a successor for periodically malfunctioning Mitch McConnell, who recently announced he'll step down in November, though intending to keep his Senate seat until his term ends in January 2027, when he'd be within weeks of turning 86. 

So far, the announced field consists of two quintessential establishment types: John Cornyn of Texas and John Thune of South Dakota. While John Barrasso's name had been thrown around as one of "The Three Johns" considered top contenders, the Wyoming senator on Tuesday said he'll instead seek the number two slot as party whip. 

Paul used X to tease his potential bid for the position which -- if the GOP takes back the upper chamber in November -- could graduate from Minority Leader to Majority Leader. He started by telling his 5.1 million followers he'd had lots of people asking him about his interest in running...

...then followed up with a poll in which he predictably annihilated Cornyn and Thune, taking a 96% share as of Friday night, with the other two below 2% each. 

Elon Musk was quick to back the idea of Paul as GOP leader, while daring Cornyn and Thune to follow Paul's lead by throwing their names out for consideration by the Twitter-verse X-verse. 

Paul has been a stalwart opponent of security-state mass surveillance, foreign interventionism -- to include shoveling billions of dollars into the proxy war in Ukraine -- and out-of-control spending in general. He demonstrated the latter passion on the Senate floor this week as he ridiculed the latest kick-the-can spending package:   

In February, Paul used Senate rules to force his colleagues into a grueling Super Bowl weekend of votes, as he worked to derail a $95 billion foreign aid bill. "I think we should stay here as long as it takes,” said Paul. “If it takes a week or a month, I’ll force them to stay here to discuss why they think the border of Ukraine is more important than the US border.”

Don't expect a Majority Leader Paul to ditch the filibuster -- he's been a hardy user of the legislative delay tactic. In 2013, he spoke for 13 hours to fight the nomination of John Brennan as CIA director. In 2015, he orated for 10-and-a-half-hours to oppose extension of the Patriot Act. 

Rand Paul amid his 10 1/2 hour filibuster in 2015

Among the general public, Paul is probably best known as Capitol Hill's chief tormentor of Dr. Anthony Fauci, who was director of the National Institute of Allergy and Infectious Disease during the Covid-19 pandemic. Paul says the evidence indicates the virus emerged from China's Wuhan Institute of Virology. He's accused Fauci and other members of the US government public health apparatus of evading questions about their funding of the Chinese lab's "gain of function" research, which takes natural viruses and morphs them into something more dangerous. Paul has pointedly said that Fauci committed perjury in congressional hearings and that he belongs in jail "without question."   

Musk is neither the only nor the first noteworthy figure to back Paul for party leader. Just hours after McConnell announced his upcoming step-down from leadership, independent 2024 presidential candidate Robert F. Kennedy, Jr voiced his support: 

In a testament to the extent to which the establishment recoils at the libertarian-minded Paul, mainstream media outlets -- which have been quick to report on other developments in the majority leader race -- pretended not to notice that Paul had signaled his interest in the job. More than 24 hours after Paul's test-the-waters tweet-fest began, not a single major outlet had brought it to the attention of their audience. 

That may be his strongest endorsement yet. 

Tyler Durden Sun, 03/10/2024 - 20:25

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The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While “Waiting” For Deporation, Asylum

The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While "Waiting" For Deporation, Asylum

Over the past several…

Published

9 hours ago

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March 10, 2024

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The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While "Waiting" For Deporation, Asylum

Over the past several months we've pointed out that there has  been zero job creation for native-born workers since the summer of 2018...

... and that since Joe Biden was sworn into office, most of the post-pandemic job gains the administration continuously brags about have gone foreign-born (read immigrants, mostly illegal ones) workers.

And while the left might find this data almost as verboten as FBI crime statistics - as it directly supports the so-called "great replacement theory" we're not supposed to discuss - it also coincides with record numbers of illegal crossings into the United States under Biden.

In short, the Biden administration opened the floodgates, 10 million illegal immigrants poured into the country, and most of the post-pandemic "jobs recovery" went to foreign-born workers, of which illegal immigrants represent the largest chunk.

Asylum seekers from Venezuela await work permits on June 28, 2023 (via the Chicago Tribune)

'But Tyler, illegal immigrants can't possibly work in the United States whilst awaiting their asylum hearings,' one might hear from the peanut gallery. On the contrary: ever since Biden reversed a key aspect of Trump's labor policies, all illegal immigrants - even those awaiting deportation proceedings - have been given carte blanche to work while awaiting said proceedings for up to five years...

... something which even Elon Musk was shocked to learn.

Which leads us to another question: recall that the primary concern for the Biden admin for much of 2022 and 2023 was soaring prices, i.e., relentless inflation in general, and rising wages in particular, which in turn prompted even Goldman to admit two years ago that the diabolical wage-price spiral had been unleashed in the US (diabolical, because nothing absent a major economic shock, read recession or depression, can short-circuit it once it is in place).

Well, there is one other thing that can break the wage-price spiral loop: a flood of ultra-cheap illegal immigrant workers. But don't take our word for it: here is Fed Chair Jerome Powell himself during his February 60 Minutes interview:

PELLEY: Why was immigration important?

POWELL: Because, you know, immigrants come in, and they tend to work at a rate that is at or above that for non-immigrants. Immigrants who come to the country tend to be in the workforce at a slightly higher level than native Americans do. But that's largely because of the age difference. They tend to skew younger.

PELLEY: Why is immigration so important to the economy?

POWELL: Well, first of all, immigration policy is not the Fed's job. The immigration policy of the United States is really important and really much under discussion right now, and that's none of our business. We don't set immigration policy. We don't comment on it.

I will say, over time, though, the U.S. economy has benefited from immigration. And, frankly, just in the last, year a big part of the story of the labor market coming back into better balance is immigration returning to levels that were more typical of the pre-pandemic era.

PELLEY: The country needed the workers.

POWELL: It did. And so, that's what's been happening.

Translation: Immigrants work hard, and Americans are lazy. But much more importantly, since illegal immigrants will work for any pay, and since Biden's Department of Homeland Security, via its Citizenship and Immigration Services Agency, has made it so illegal immigrants can work in the US perfectly legally for up to 5 years (if not more), one can argue that the flood of illegals through the southern border has been the primary reason why inflation - or rather mostly wage inflation, that all too critical component of the wage-price spiral  - has moderated in in the past year, when the US labor market suddenly found itself flooded with millions of perfectly eligible workers, who just also happen to be illegal immigrants and thus have zero wage bargaining options.

None of this is to suggest that the relentless flood of immigrants into the US is not also driven by voting and census concerns - something Elon Musk has been pounding the table on in recent weeks, and has gone so far to call it "the biggest corruption of American democracy in the 21st century", but in retrospect, one can also argue that the only modest success the Biden admin has had in the past year - namely bringing inflation down from a torrid 9% annual rate to "only" 3% - has also been due to the millions of illegals he's imported into the country.

We would be remiss if we didn't also note that this so often carries catastrophic short-term consequences for the social fabric of the country (the Laken Riley fiasco being only the latest example), not to mention the far more dire long-term consequences for the future of the US - chief among them the trillions of dollars in debt the US will need to incur to pay for all those new illegal immigrants Democrat voters and low-paid workers. This is on top of the labor revolution that will kick in once AI leads to mass layoffs among high-paying, white-collar jobs, after which all those newly laid off native-born workers hoping to trade down to lower paying (if available) jobs will discover that hardened criminals from Honduras or Guatemala have already taken them, all thanks to Joe Biden.

Tyler Durden Sun, 03/10/2024 - 19:15

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