Medicaid

SEE IMPORTANT UPDATES BELOW.

With all the understandable focus on Congressional Republicans efforts to effectively end Medicaid coverage for nearly 21 million Americans enrolled via ACA expansion, there's been much less attention paid to the other looming threat to healthcare coverage: The expiration of the upgraded financial subsidies for ~24.2 million ACA exchange enrollees, which are currently scheduled to end this New Year's Eve.

As I've explained numerous times before, the ACA's original premium subsidy formula was always far too stingy to make individual market policies affordable for many people...and worse yet, the subsidies cut off entirely for households making more than 4 times the Federal Poverty Level (FPL).

As regular readers know, I've been a bit obsessed over the past month or so with generating pie charts which break out the total healthcare program enrollment for the entire population of all 435 U.S. Congressional Districts as well as all 50 states +DC.

As you can imagine, this has been a monumental task; not only did I have to crunch a lot of data to break out the statewide numbers into House district-level estimates, I also had to convert that data into nearly 480 easy-to-read graphics...and then I doubled my workload by going one step further and adding high-res PDF versions for folks to print out in large format for town halls, rallies and #HandsOff protests nationally.

Now that I've finally completed this project, it's time to turn back to the main reason for it in the first place: The imminent threat to healthcare coverage for literally tens of millions of Americans being posed by the budget resolution recently passed by House Republicans, which (fortunately) still has a number of points where it can potentially be stopped.

After a concerning 2-month delay, the Centers for Medicare & Medicaid Services (CMS) has finally published an update to the official Medicaid/CHIP enrollment data:

November 2024 Key Findings

Medicaid and CHIP Enrollment

• In November 2024, 79.0 million individuals were enrolled in Medicaid and CHIP.
  • 71.8 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.5 million adults were enrolled in Medicaid, and there were 37.5 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.

Originally posted 3/07/25

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

With the pending dire threat to several of these programs (primarily Medicaid & the ACA) from the House Republican Budget Proposal which recently passed, I'm going a step further and am generating pie charts which visualize just how much of every Congressional District's total population is at risk of losing healthcare coverage.

USE THE DROP-DOWN MENU ABOVE TO FIND YOUR STATE & DISTRICT.

On January 19th, the day before the Musk/Trump Regime took office, I posted the following:

DON'T GET ME WRONG: I'm not saying that everything posted by HHS or CMS under the Trump 2.0 Administration will be bullshit. My guess is the vast majority of it will probably be reasonably accurate, at least for the first few months...if only because it will take awhile for whatever sycophants/grifters he puts in charge of those departments (likely antivaxxer nutjob RFK Jr. for HHS and grifter/snake oil salesman Dr. Oz for CMS) to purge their departments of career professionals and replace them with MAGA/Trump loyalists.

Even then, it's quite possible that some or even most reports will remain reasonably accurate, in some cases simply because Trump doesn't see any reason to cook those particular books; in other cases they may simply not be aware that some data is even being made publicly available.

via Liz Essley Whyte and Betsy McKay of the Wall Street Journal:

The White House is working on an executive order to fire thousands of U.S. Department of Health and Human Services workers, according to people familiar with the matter.

Under the order, the Food and Drug Administration, Centers for Disease Control and Prevention and other health agencies would have to cut a certain percentage of employees. 

...The agencies are responsible for a range of functions, from approving new drugs to tracing bird-flu outbreaks and researching cancer. A loss of staff could affect the efforts depending on which workers are cut and whether they are concentrated in particular areas.

...Agency officials have been told to prepare lists of probationary workers who have essential roles and must be retained, and of employees who don’t, according to people familiar with the instructions.

Federal employees must decide today whether to take the administration’s buyout offer. More than 40,000 federal workers to date have said they would resign under the deal. 

(Yes, I'm aware Elon Musk is a naturalized citizen, but given the Musk/Trump Administration's obsession with demonizing immigrants it seems like an appropriate headline)

via the Wall Street Journal:

Representatives of Elon Musk’s Department of Government Efficiency have been working at the Centers for Medicare and Medicaid Services, where they have gotten access to key payment and contracting systems, according to people familiar with the matter.

The DOGE representatives have been on site at the agency’s offices this week, the people said, and they are looking at the systems’ technology as well as the spending that flows through them, with a focus on pinpointing what they consider fraud or waste. DOGE representatives are also examining the agency’s organizational design and how it is staffed, the people added.

UPDATE 4/18/25: More recent Medicaid/CHIP enrollment data has become available since I first published the spreadsheet, as well as more recent total population estimates. I'm in the process of updating each but the existing spreadsheet data should still be pretty accurate. I'll post again once the spreadsheet itself has been updated.

I recently posted Congressional District-level breakouts of total enrollment in ACA Exchange Plans & Basic Health Plans as well as Medicare (both Fee For Service and Advantage plans). The master spreadsheet also includes enrollment in Medicaid (both ACA Expansion as well as non-Expansion) and the Children's Health Insurance Program (CHIP).

However, for no particular reason, I included the methodology for Medicaid & CHIP data in with the ACA enrollment post, since it ACA Expansion Medicaid overlaps with that.

Via Marisa Kabas of The Handbasket (later confirmed by various other news agencies):

Early Monday evening I received a copy of a memo that will impact thousands of institutions supported by funding from the federal government. 

A copy of the memo from the Office of Management and Budget (OMB) was provided to The Handbasket at approximately 5pm ET by a source whose anonymity is being protected for fear of professional retribution. The memo was sent to the heads of executive departments and agencies with the subject, “Temporary Pause of Agency Grant, Loan, and Other Financial Assistance Programs.” I shared the news on Bluesky at 6:04pm ET, and my reporting was confirmed by the Washington Post a few hours later.

It is a truly unhinged document that sounds like it was written by the world’s most petty 4Chan poster—but then again, that’s who’s currently running our federal government. Here’s the first paragraph to get a feel for it (emphasis mine):