Republicans prepare to crush their core constituents

The fig leaf that will probably “convince” enough reluctant senators and frontline House members to crush Medicaid is the creation of a relatively small slush fund to offset the devastating effects the cuts would have on rural hospitals. Needless to say, the fund would not remotely make up for the cuts:

This policy watch estimates how the House-passed reconciliation bill would affect federal Medicaid spending in rural areas and the number of rural Medicaid enrollees.

Building on KFF’s earlier estimates of state-by-state Medicaid cuts, this analysis estimates that Medicaid spending in rural areas could decrease by $119 billion over 10 years (Figure 1). The analysis allocates each state’s estimated spending reductions from the earlier analysis of the One Big Beautiful Bill Act to urban and rural areas using the percentage of Medicaid spending that paid for services used by rural enrollees within each state.

Overall, federal Medicaid spending in rural areas could decrease by 15% ($119 billion), which is far more than the $15 billion that has been suggested for the rural health fund. These estimates may underestimate the effects on rural areas because they do not account for the full change in total Medicaid spending, which would include the federal spending reductions and the associated reduction in state Medicaid spending stemming from lower enrollment. The estimates also do not account for the 8.2 million people who are expected to be uninsured because of changes in the Affordable Care Act. Those coverage losses stem from $268 billion in cuts to Affordable Care Act (ACA) Marketplace coverage from the reconciliation bill, the expiration of enhanced ACA subsidies that were enacted during the COVID-19 pandemic, and the impact of proposed Marketplace integrity rules. Federal spending cuts and coverage losses could have implications for rural hospitals and other providers, including increases in uncompensated care. While providers could potentially offset some of the cuts, financial pressure on hospitals and other providers could lead to layoffs of staff, more limited investments in quality improvements, fewer services, or additional rural hospital closures.

In fairness, Jeff Bezos seems to be really struggling these days, hopefully the tax cuts these closed hospitals and ruined lives will pay for will by a few more ugly designer dresses and tacky party favors.

Alaska state lawmakers:

The likely impacts from the “big, beautiful bill” are particularly ugly for our home state, Alaska: Nearly 40,000 Alaskans could lose health care coverage, thousands of families will go hungry through loss of benefits from the Supplemental Nutrition Assistance Program, or SNAP, and the shift in costs from the federal government to the state will plunge our budget into a severe deficit, cripple our state economy and make it harder to provide basic services.

This is not about partisanship. One of us is a Republican and the other is an independent. In the Alaska Legislature, our State Senate and House are led by a bipartisan governing coalition. Our focus is squarely on the survival of the people we represent.

The benefits of Medicaid and the SNAP program permeate the entire fabric of the Alaska economy, with one in three Alaskans receiving Medicaid, including more than half of the children. In remote Arctic communities, Medicaid dollars make medical travel possible for residents from the hundreds of roadless villages to the communities where they are able to receive proper medical treatments.