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...
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Our survey of voters in the most competitive Congressional Districts shows Republicans have an opportunity to overcome a current generic ballot deficit and take the lead by extending the healthcare premium tax credits for those who purchase health insurance for themselves. Without Congressional action, the tax credit expires this year.
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.
NJ Department of Banking and Insurance Warns of Congressional Reconciliation Bill Package’s Impact on Health Insurance Access
TRENTON — New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman has sent a letter to New Jersey’s Congressional delegation warning them of the devastating impacts of the reconciliation package on access to quality, affordable health coverage for millions of Americans who need it, including over 513,000 New Jerseyans. The letter follows the U.S. House passage of the reconciliation package on May 22. A version of the bill is currently pending before the U.S. Senate.
The bill package would repeal key provisions of the Affordable Care Act, making it more difficult and expensive to enroll in coverage through Get Covered New Jersey, the State’s Official Health Insurance Marketplace. This legislation would:
If this happens, it would mean the ACA exchange market would drop by more than 1/3 from the ~24.2 million currently enrolled (myself & my own family included).
However, I've repeatedly stated that even this is likely a low estimate--the remaining ~16 million exchange enrollees would still be hit with MASSIVE (and in some cases eye-poppingly huge) premium hikes which would force them to drop to far worse plans (meaning much higher deductibles & co-pays; worse provider networks and so on).
Last month, in response to House Republicans passing their version of the budget resolution bill, I broke out total enrollment in Medicaid via ACA expansion, ACA exchange Qualified Health Plan (QHP) enrollment and ACA-based Basic Health Plan (BHP) enrollment by Congressional District in order to try and get a sense of just how many Americans healthcare coverage is at risk from the bill...and how that breaks out along partisan lines at the House District level.
As I noted at the time, Republicans seem to be under the impression that it will mostly be Democrats who get screwed by their bill, since 9 of the 10 non-expansion states are Republican strongholds...while some Democrats seem to be under the impression that it will mostly be rural MAGA republicans who get screwed.
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.
16 Million Americans Would Become Uninsured Due to Reconciliation Bill and Loss of Tax Credits; 8.2 Million in Marketplaces Alone
Leaders from State-based Health Insurance Marketplaces, Enrollees, Providers, and Small Business Highlight Potential, Devastating Impacts
(Washington, DC) The Congressional Reconciliation bill and loss of federal tax credits would result in 16 million Americans losing health coverage, including 8.2 million enrolled in Health Insurance Marketplaces. By stripping millions of lives from the Marketplaces, health care will be more expensive, harder to access, create a strain on health care systems, and hurt small businesses.
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.
