Ever since the MAGA Murder Bill (officially H.R. 1, the so-called "One Big Beautiful Bill Act") was passed by Republicans in the U.S. Senate & House and signed into law by Donald Trump a few days ago, I've seen a growing conventional wisdom taking hold on social media: People keep claiming that either all, "nearly all"or at least "most of" the budget cuts & other gutting of various programs and departments won't actually kick in until after the November 2026 midterms.
Now, don't get me wrong--most of those making these claims are well-intentioned; they're saying this cynically, to underscore how disingenuous Congressional Republicans are by back-loading the pain until the midterms are safely in their rearview mirrors. And, to be fair, much of the damage won't being until well after next November.
Over at The New Republic, Greg Sargent has taken this thinking one step further, noting that by delaying so much of the ugliness of the new law until 2027 or beyond...
Moments ago House Republicans joined Senate Republicans in passing H.R. 1, aka the "One Big Beautiful Bill," aka the MAGA Murder Bill, into final passage.
Donald Trump will presumably sign it into law sometime today or perhaps tomorrow...the 4th of July.
Many horrific things are about to happen. On the healthcare front, some will happen sooner (ACA IRA subsidies expire in less than 6 months, and enrollees should start getting hit with sticker shock about that sometime in October); some later (Medicaid "reporting requirements" go into effect after the midterms in late 2026).
A dark day for America, democracy and decency, which was pretty much inevitable when the polls closed on November 5, 2024.
This is what you voted for, America, whether you "meant it" at the time or not.
I'll have more--much more--to say soon, but I'm very tired, very depressed, very angry, very sickened and need some time to gather my thoughts and sanity.
Senate GOP tax bill would hit politically explosive Medicaid provision
The Finance Committee is due to brief members on its megabill draft text Monday night.
Senate Republicans are seeking to ratchet up savings from a politically explosive policy within Medicaid to pay for their megabill, and it’s already setting off shockwaves through Capitol Hill.
The Senate Finance Committee’s forthcoming portion of the party-line tax and spending package would lower the Medicaid provider tax to 3.5 percent, according to three people with direct knowledge of the legislation who were granted anonymity to discuss it.
But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
There was a lot to unpack there, all of it pretty horrible...but I felt one provision in particular was worth its own separate post:
Funding Cost-Sharing Reductions.
Enacting section 44202 would affect the cost-sharing reductions that the ACA requires insurers to offer to eligible people who purchase silver plans through the marketplaces. Those reductions increase the actuarial value—the average share of covered medical expenses paid by the insurer—above the amount in other silver plans, resulting in lower out-of-pocket costs for eligible enrollees. To be eligible for cost-sharing reductions an enrollee’s income must generally fall between 100 percent and 250 percent of the FPL; the subsidy varies with income.
The Congressional Budget Office has published several projections about how many people would lose healthcare coverage and/or become uninsured (these aren't the same thing) under various versions of the #OneBigUglyBill Act passed by House Republicans, which is currently beginning its next phase over on the Senate side of the Capitol.
Their most recent projection put the total at around 11.7 million when you include some technical weirdness which I'm a little vague about...plus another 3.8 million if you include their projection from December 2024 regarding the impact of the upgraded ACA subsidies included in the Inflation Reduction Act being allowed to expire at the end of this year. This placed the grand total at around 15.5 million...except they more recently sent a letter to the House Energy & Commerce Committee which bumped this estimate up a bit more, putting the combined total at 15.9 million.
Over the past month or so, as Congressional Republicans have pulled out all the stops in their attempt to ram through their budget bill which would gut Medicaid and ACA exchange enrollment (along with SNAP and numerous other desperately-needed social aid programs), you may have noticed that they keep using an oddly specific talking point:
Mike Johnson: Medicaid Is Not for 29-Year-Old Males Sitting on Their Couches Playing Video Games
Mike Johnson on Medicaid: "What we've talked about is returning work requirements ... you return the dignity of work to young men who need to be out working instead of playing video games all day. We have a lot of fraud, waste, and abuse in Medicaid."
So, the Congressional Budget Office has published updated estimates of the budgetary impact of the House Republican budget plan (officially called the "One Big Beautiful BIll Act" (seriously); more appropriately called the #MedicaidMassacre bill by certain individuals (ahem) were to pass & be implemented.
In addition to all the dollar amounts tossed around, however, the spreadsheet also includes some important footnotes, including the following (h/t Larry Levitt of KFF for the heads up):
Under the Title IV - Energy & Commerce tab is this:
Last week I wrote about the latest state of play regarding House Republicans so-called "big beautiful bill" to gut Medicaid in order to give fat tax cuts to billionaires. Yesterday the first official version of the legislative text was released, and it's pretty much as ugly as you might expect.
...The plan caters more to the moderate wing of the Republican party by omitting two of the biggest and most politically controversial proposals discussed: a per-capita cap on people who get coverage from Medicaid expansion, and a direct lowering of the federal matching rate.
There's two new stories out about where things stand with Congressional Republicans obsessive desire to gut Medicaid & kick millions of people off their healthcare coverage in order to give massive tax cuts to billionaires. The first, from Jessie Hellmann, Sandhya Raman and Olivia M. Bridges at Roll Call, has some pretty positive-sounding news:
...Johnson, R-La., said leadership had ruled out two Medicaid policies that could go a long way toward meeting the Energy and Commerce Committee’s $880 billion, 10-year savings target but faced strong pushback from blue-state GOP centrists.
First, Johnson said the emerging package wouldn’t touch the Federal Medical Assistance Percentage, or FMAP, rate — the portion of state Medicaid costs borne by the federal government — for the Medicaid expansion population, which is currently 90 percent.
Johnson also poured cold water over a provision that would implement per capita caps on Medicaid benefits for enrollees in expansion states, though he wasn’t quite as definitive on that front.
