Lobbies are split on whether to shape a new measure or try to kill it
Largely shut out of the talks, they actively opposed the bill, firing off angry letters and in some cases airing ads aimed at vulnerable House Republicans.
.. in the Senate, which hopes to complete its own version of a health overhaul by August
.. “We are not philosophically opposed to ‘repeal and replace,’ but Americans need to have a conversation about whether replacement is better than what we’ve got,” said Andrew Gurman, president of the American Medical Association. The House health measure “was in our estimation a potentially very bad bill.”
.. Some groups, believing it is inevitable that legislation passes the Senate in some form, plan to offer proposals they believe would improve it. Others, in contrast, hope they can convince at least three GOP Senators to oppose any effort, stripping Republican leaders of the majority they need.
.. Hospitals are concerned about the impact of potential cuts to Medicaid, and their proposals include using state waivers to introduce structural changes to the program that could bring down costs to the federal government.
President Trump’s Growth Budget
It will restore the Clinton-Gingrich welfare reforms that made it more profitable to work than not work.
the measure of budget success for the Trump administration is not how much federal assistance is given out, but how many people leave government dependency and join the private labor force as full-fledged workers.
.. the best of government intentions have actually backfired by reducing incentives to work and earn.
.. The expansion of food stamps, welfare, health-insurance subsidies, unemployment assistance, and disability assistance have led to unintended consequences and perverse after-tax incentives, such that it pays more to stay on assistance then to go to work. At the working-poor margin, taking a job may rob you of Obamacare subsidies. So better off not to work.
.. Mulligan estimated that the marginal tax rate — the extra taxes paid and subsidies foregone as the result of working — had increased from 40 percent to 48 percent.
.. increase federal Medicaid spending from $378 billion today to $524 billion in 2027. That ain’t a cut either. It’s an increase.
.. Adding up each and every new year between now and 2027, the federal government will spend about $55 trillion. Do we think that’s enough? And the Trump budget would curb that by about 7 percent, or roughly $4 trillion. That’s all that’s happening.
It’s All About Trump’s Contempt
There is, however, a unifying theme — Donald Trump’s contempt for the voters who put him in office.
“I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.” Well, he hasn’t done that, at least so far. He is, however, betting that he can break every promise he made to the working-class voters who put him over the top, and still keep their support. Can he win that bet?
.. remember his claims that he would pay off the national debt?
.. 29 percent of the population is on Medicaid, almost 19 percent on food stamps.
.. West Virginians .. more than 4 percent of the population, the highest share in the nation, receives Social Security disability payments, partly because of the legacy of unhealthy working conditions, partly because a high fraction of the population consists of people who suffer from chronic diseases, like diabetics
.. they supported Trump because he promised — falsely, of course — that he could bring back the well-paying coal-mining jobs of yore.
.. Maybe he would take benefits away from Those People, but he would protect the programs white working-class voters
.. it would be apocalyptic: Hundreds of thousands would lose health insurance; medical debt and untreated conditions would surge; and there would be an explosion in extreme poverty, including a lot of outright hunger.
.. Coal isn’t coming back; these days, West Virginia’s biggest source of employment is health care and social assistance. How many of those jobs would survive savage cuts in Medicaid and disability benefits?
.. people who voted for Donald Trump were the victims of an epic scam by a man who has built his life around scamming.
Trump Budget Would Cut Medicaid, Rely on Rosy Growth Projection
White House’s $4.1 trillion spending blueprint relies on economic growth of 3% by 2021
The primary driver of savings in Mr. Trump’s budget comes from more than $800 billion in cuts to Medicaid, the federal-state health program for the poor, despite a pledge from the president on the campaign trail not to touch the program.
.. Mr. Trump’s budget director Mick Mulvaney said Monday much of the savings will come from changes in the GOP’s health-care overhaul bill, which Mr. Trump supports. But the administration’s budget would cut more than $600 billion from Medicaid and the federal Children’s Health Insurance Program on top of the $250 billion saved from repealing and replacing the Affordable Care Act.
.. Many economists have questioned whether the economy can grow much faster than its current pace without long-term investments in programs that boost worker productivity or help expand the labor force.
.. slash funding for disability insurance by $72 billion. Other spending cuts include $143 billion from changes to student-loan programs, $63 billion in reduced retirement benefits for federal employees, and $38 billion to curb certain farm subsidies.