The outlines for Donald Trump’s attack on health care for several million Americans are clear, but it will take some time for the practical effects to kick in.

What all parties except Trump see is that the effects of the “big, beautiful bill” will be to remove upwards of 12 million from Medicaid eligibility through budget cuts, restrictions on states and lots of new paperwork both for individuals and officials.

Indeed, The Hill.com noted that while Trump’s bill was never framed directly as a health remake, it dramatically will upend health care in America. The bill’s provisions will impact patients, doctors, hospitals, and insurers, as Republicans partially paid for it by cutting more than $1 trillion from federal health programs

As Larry Levitt, executive vice president for health policy for KFF.org, which tracks health care issues, noted last week in an op-ed, the changes forced by the bill also will make enrollment in Affordable Care Act/Obamacare health plans more difficult, technical rules will affect some Medicare payments, and rural hospitals across the country will find themselves under increased financial pressures, forcing many to close. He argues that in all, the new law and changes could lead to a staggering 17 million more people uninsured to the 25 million already not covered.

In addition, the bill basically tells Planned Parenthood to either give up offering abortions in states where they are legal or face shutdown by declaring that organization off-limits for reimbursements for non-abortion treatments at 200 clinics serving 2 million patients.

Trump, of course, continues to insist that he and Republicans have not cut any health benefits, just cut “waste and fraud,” a laughable assertion.  Apart from all else, Trump has dismissed 80,000 Veterans’ Affairs employees who handle health and services.
The Trump government is taking a broad swipe at medical services — all towards paying off (and falling well short) of the cost of tax cuts that largely will benefit the wealthiest in our country. The questions: what do we have to do practically and when?

Targeting Medicaid Eligibility

At heart, Trump’s approach, now rubber-stamped solely by House and Senate Republican majorities and the tiniest wins, is to target eligibility for Medicaid, a program serving 70 million. Trump repeatedly says that able-bodied adults slipping through the system are responsible for the hundreds of billions of dollars cut for fraud. Trump and Republicans in Congress also insist that undocumented immigrants — barred from receiving these benefits by law — are somehow responsible.

As an aside, the Centers for Medicaid and Medicare (CMS) say the prime target of fraud are extra fees and upgrading of reported disease treatments by for-profit Medicare Advantage insurers, who are not targeted in this bill.

Under the new law, beginning in December, 2026, states are required to collect and review paperwork every six months for everyone aged 19-64 to determine that they are working 80 hours a month or meet certain exemption statuses like pregnancy or disability, people in prison or rehabilitation — but individuals are now required to prove their disability or frailty or show efforts at finding work or volunteer commitments.  To be eligible, income must be below 138 percent of the federal poverty level (roughly $42,760 for a family of four) who gained insurance when their states expanded Medicaid.

You can find detailed views of the requirements at KFF.

According to CMS, at least 65% of Medicaid applicants are employed, just paid below poverty standards. Of the remainder, there are whole groups who are disabled, pregnant, children, or seniors, including overlap with Medicare, vastly reducing the number of able-bodied men whom Trump and Republicans ridicule as sitting in basements playing video games.

But states are required to maintain databases on addresses, and the feds must create a system to prevent enrollment in more than one state as well as a master database on all deaths. Of course, these same agencies are losing budget for staff or federal support, so who exactly is going to handle this paperwork or enforce it is not clear.

Individuals applying for coverage must meet requirements for one or more months preceding the month of application. If a person is denied or disenrolled because of work requirements, they are also considered ineligible for subsidized Obamacare coverage.

If tax forms give you a headache, you can imagine this will too.

In Georgia, the only state with a Medicaid work mandate, ProPublica reports that the state has enrolled just a fraction of those eligible, largely because of bureaucratic hurdles in the verification system. As of May, two years in, about 7,500 of the nearly 250,000 eligible Georgians were enrolled, even though state statistics show 64% of that group is working.

Arkansas gave up on enforcing work requirements after seeing that red tape associated with verifying eligibility resulted in more than 18,000 people losing coverage within the first few months of the policy. A federal judge halted the program in 2019, ruling that it increased the state’s uninsured rate without any evidence of increased employment.

These systems mean filing the correct forms and documentation in the correct order every six months. Failing to do so correctly opens the possibility of a person losing coverage mid-year. The bill will also require people with incomes above the poverty line to pay out-of-pocket copays for most Medicaid services, like lab tests or doctor visits.

Impacting Health Services

The legislation will make it more difficult for people to sign up for and afford health plans on Obamacare exchanges. It limits eligibility for premium subsidies to people not eligible for any other federal insurance program and bars most immigrants and lawful permanent residents from receiving subsidies.

It requires immediate verification for eligibility, limits some special enrollment periods and ends automatic reenrollment ahead of the 2028 sign-up period, meaning enrollees will need to update their income, immigration status and other information each year. According to KFF, 10 million people were automatically reenrolled in ACA plans in 2025.

The new law will threaten rural hospitals who are required by law to provide services but who could face difficulty being reimbursed.  Hospital closings would mean longer drives for rural patients and, inevitably, more deaths in emergency situations. The bill and promises from Trump will provide some money towards hospital in trouble, but not nearly enough to cover the estimated losses for hospitals expected to see a spike in emergency room usage.

Bottom line is that Trump’s sole domestic policies act is unpopular  (see the KFF poll from last month), likely will not reduce targeted “fraud,” will hit at rural areas friendly to MAGA and veterans, and will result in a sicker, untreated nation.

Together with efforts at the Department of Health and Human Services to delegitimize vaccines and to cancel medical research, to replace independent medical experts with political loyalists, to overrule the Centers for Disease Control and Prevention with bromides against measles rather than treatments, we’re beginning to see the full outline of Trump’s oft-promised health programs. It’s anything but Making America Healthy Again.

---

“FREEDOM OF THE PRESS IS NOT JUST IMPORTANT TO DEMOCRACY, IT IS DEMOCRACY.” – Walter Cronkite. CLICK HERE to donate in support of our free and independent voice.

The post Blowing Up Health Care appeared first on DCReport.org.

An impressive series, some true, mostly not, and how to state that

It can seem like Trump is having a lot of successes lately. Some who may not be fans might nevertheless be impressed by these successes. Knowing how to respond, both honestly and accurately, to people with that impression is important.

Trump does deserve some credit, which will be defined, but for those who follow the news carefully we know that almost every success is really crap under the hood. There’s no need to dig into a lot of that but to give one example, the bill he got through Congress includes work requirements for Medicaid. Some people will like that requirement, and at a very superficial level it makes sense, but we know from states that have required that in the past what it mostly does is lead to a lot of people losing coverage who are low-income working people who should qualify but get snagged in the red tape. Something that could seem good on the surface turns out to be damaging to the country.

For fans, though, or for those with only a superficial awareness, the picture would look very different. Wow, he bombed Iran and gave them “what for” for trying to build nukes. Sneaking across the border is way, way down. He got that big bill passed that has some nice tax breaks, like no tax on tips, and has some savings like work requirements for Medicaid. The Supreme Court has agreed with him on a number of things like ending Birthright Citizenship and sending immigrant criminals to tough prisons in smaller countries. He got NATO to cave on spending more on their own defense. This guy is making things happen!

Yes, he is making things happen, and that’s part of where he deserves credit, but of course most of the above items have a different or darker side to them. The Supreme Court wins are equivocal. Iran was an act of war on a country that wasn’t warring on us, and will likely create terrible international messes in the future. Et cetera. So most of the successes are the appearance of success. That’s a lesson progressives could note. Creating the appearance of success can be bad if deceptive, but it can also be a useful tool if used in a productive way to create momentum for real success on positive goals.

More broadly he is showing that bold leadership can accomplish a lot. Of course it’s harder when you’re sticking closer to the rules, unlike say firing all the FBI leadership you don’t like and replacing them with inexperienced loyalists so it can become your tool to harass opponents, but still, Democrats could have accomplished much more in years past with more of this boldness, and then maybe people wouldn’t be so frustrated as to vote for an insurrectionist. Even mild amounts of breaking the rules, and then let the system push back, but you’ve made your point, can be good.

Trump has succeeded at a couple of things. Undocumented immigration is way down. Of course it was accomplished by an inhumane way of going at it, but clearly it could have been reduced before with more humane methods. We need immigrants, but it would be good to have that happen in a more planned and coordinated way as far as possible. (There’s also a lot of history of GOP obstruction but too much to cover here.) NATO, though, is a mostly clean success, getting the partners to agree to spend more. It was needed and he got that done.

But for anyone you know who is a fence-sitter impressed with successes, really, almost all are not. They are hollow (Supreme Court has yet to truly decide on birthright citizenship), or negative (the big bill is going to damage the lower half, help the topmost, and rack up debt), or false (groceries have not generally gone down) or for show (rounding up non-criminal, hard-working immigrants and shipping them to distant harsh prisons). At the same time, acknowledge the true successes. Also that Democrats have long needed a positive version of such boldness. Something like a modern FDR. Nothing else has gotten that message through the thick heads of the leadership. If we’re lucky, perhaps before long that will happen, and the message will have come from the destructive actions of one with careless boldness.

---

“FREEDOM OF THE PRESS IS NOT JUST IMPORTANT TO DEMOCRACY, IT IS DEMOCRACY.” – Walter Cronkite. CLICK HERE to donate in support of our free and independent voice.

The post Trump’s String of Successes appeared first on DCReport.org.

These are dark times but I will continue to tell the stories you need to hear in a clear (and usually profane) voice. If I entertain/anger/inform you, preferably all three, please consider becoming a supporting subscriber today for only $5 a month or just $50 a year.

☠️This Subscription Kills Fascists☠️

Republicans passed their bill of nightmares and things are going to get so much worse which means we’re all going to get so much angrier. And louder. And there is going to be so many more of us in the streets.

Stephen Miller thinks he has his army of Nazis now? America knows how to deal with Nazis. That story ends with a lot of body bags filled with “the Master Race.”

Lots to catch up on this week, so grab your history books and let’s review how it all ended the LAST time for the Nazi regime…

Monday: Republicans passed their bill of horrors, but for a party claiming elections don’t matter anymore, they sure aren’t acting like it…

Tuesday: ICE agents are making a choice to be lawless and violent. There’s a light at the end of that tunnel and it shines through a rope.

Wednesday: Mr. Trump, I PROMISE that publicly humiliating the world’s richest man who is also an unstable junkie with delusions of grandeur and follows an insane religion will not have negative consequences for you. Honest!!!

Thursday: The Republicans on the Supreme Court push America further down the road of fascism.

Also Thursday! The June jobs report came out and it was…suspicious. We had thoughts about that.

Friday: July 4th - Took the day off. Did I celebrate? Nope because fuck fascism. Took my girls to buy manga and CDs instead.

5 Things I Found Interesting This Week

1. Trump is Bringing Back Enslavement - WTF did he mean by "owners?" He meant exactly what you're afraid he did by Tia Levings at What The Fundamentalist?!

2. 2026 looks apocalyptic for Republicans - While it's very early, Republicans look doomed during the midterms. by The Fascism Heckler at A mocking a day, keeps the Fascism away

3. Taking away your citizenship by Joyce Vance at Civil Discourse with Joyce Vance

4. When Does the Fucking Winning Start, MAGA? - Hating Everything Instead of Thriving Has to Be Damn Exhausting by The Mouthy Renegade Writer at You Have the Right to Remain Mouthy

5. CBS becomes a quisling of journalism - The network folds to Trump, joining other outlets betraying the free press. by Mark Jacobs at Stop The Presses

"Unleash market forces" has been a rallying cry of both the right and some nominally on the left for the past twenty-some years. The free market and private operators do everything better! Competition drives improvement! 

It's an okay argument for toasters. It's a terrible argument for education.

The free market does not foster superior quality; the free market fosters superior marketing. And as we've learned in the more recent past, the free market also fosters enshittification-- the business of trying to make more money by actively making the product worse (see: Google, Facebook, and any new product that requires you to subscribe to get the use of basic features). 

We know what competition drives in an education market-- a competition to capture the students who give you the most marketable "success" for the lowest cost. The most successful school is not one that has some great new pedagogical miracle, but the one that does the best job of keeping high-testing students ("Look at our numbers! We must be great!") and getting rid of the high-cost, low-scoring students. Or, if that's your jam, the success is the one that keeps away all those terrible LGBTQ and heathen non-believer students. The kind of school that lets parents select a school in tune with their 19th century values.

The market, we are repeatedly told, distinguishes between good schools and bad ones. But what does the free market do really, really well?

The free market distinguished between people who have money and people who don't.

This is what school choice is about, particularly the brand being pushed by the current regime.

"You know what I like about the free market," says Pat Gotbucks. "I can buy a Lexus. In fact, not only can I buy a Lexus, but if you can't, that's not my problem. I can buy really nice clothes, and if you can't, that's not my problem. Why can't everything work like that? Including health care and education?"

It's an ideology that believes in a layered society, in a world in which some people are better and some people are lesser. Betters are supposed to be in charge and enjoy wealth and the fruits of society's labor. Lessers are supposed to serve, make do with society's crumbs, and be happy about it. To try to mess with that by making the Betters give the Lessers help, by trying to elevate the Lessers with social safety nets or DEI programs-- that's an offense against God and man.

Why do so many voters ignore major issues in favor of tiny issues that barely affect anyone? Because the rich getting richer is part of the natural order of things, and trans girls playing girls sports is not.

What will the free market do for education? It will restore the natural order. It will mean that Pat Gotbucks can put their own kids in the very best schools and assert that what happens to poor kids or brown kids of Black kids or anybody else's kids is not Pat's problem. If Pat wants a benevolent tax dodge, Pat can contribute to a voucher program, confident that thanks to restrictive and discriminatory private school policies, Pat's dollars will not help educate Those People's Children. 

Pat's kids get to sit around a Harkness table at Philips Exeter, and the children of meat widgets get a micro-school, or some half-bakes AI tutor, and that's as it should be, because after all, it's their destiny to do society's grunt work and support their Betters. 

One of the huge challenges in this country has always been, since the first day a European set foot on the North American continent, that many folks simply don't believe that it is self-evident that all people are created equal. They believe that some people are better than others--more valuable, more important, more deserving of wealth, more entitled to rule. Consequently, they don't particularly believe in democracy, either, (and if they do, it's in some modified form in which only certain Real Americans should have a vote).

The argument for the many layers of status may be "merit" or achievement or race or "culture" or, God help us, genetics. But the bottom line is that some folks really are better than others, and that's an important and real part of life and trying to fix it or compensate for it is just wrong. For these folks, an education system designed to elevate certain people is just wrong, and a system that gives lots of educational opportunities to people whose proper destiny is flipping burgers or tightening bolts is just wasteful. 

For these folks, what the free market in education means is that people get the kind of education that is appropriate for their place in life, and that the system should be a multi-tiered system in which families get the education appropriate to their status in society. And it is not an incidental feature of such a system that the wealthy do not have to help finance education for Other Peoples' Children.  

It's an ideology that exists in opposition to what we say we are about as a nation and in fact announces itself with convoluted attempts to explain away the foundational ideas of this country. Public education is just one piece of the foundation, but it's an important one. 

This week, schools across the country were supposed to receive billions of dollars in aid. It was approved and designated by Congress. 

But the day before the money was supposed to go out, the Education Department, in one of its special unsigned emails, told states, "Nah, we don't want to."

The five targeted programs:

Title I-C for migrant education ($375 million)
Title II-A for professional development ($2.2 billion)
Title III-A for English-learner services ($890 million)
Title IV-A for academic enrichment ($1.3 billion)
Title IV-B for before- and after-school programs ($1.4 billion)

I was five years old when I came to understand my family’s close connection to the 4^th of July. My brother Frank and I were visiting my great grandmother, Mary Walker Randolph, and my great aunts Agnes and Mary Walker, at Wild Acres, the place they had bought in Charlottesville for my great grandmother to live out her last years. It was a little house on a creek in the woods just outside of town, with a long, straight drive off one of the local blacktops that ran out of town into the countryside.

At night, you could carry a folding lawn chair and walk to the end of their gravel drive and sit and watch a drive-in movie that showed on a screen across a field. The image on the screen was tiny in the distance – you could see the characters moving in the picture, but you couldn’t make out their faces, and of course, you couldn’t hear what they were saying. But for Frank and me, it was a thrill. We felt like we were stealing a ticket to the movie, while around us fireflies blinked and tree branches swayed and whispered in the darkness.

My great grandmother’s room was at the back of the house, overlooking a small field that ran down to the creek. Robert, their handyman, had dammed up the creek to create a hog wallow for the three or four pigs they kept in a pen outside a little outbuilding behind the house. Robert would let the pigs out during the day, and they would wander down to the creek to cool off from the stifling heat of a Virginia July, the month my grandparents drove us down from their house in Washington D.C. to visit my grandmother’s sisters and mother at Wild Acres. When the pigs had finished wallowing in the creek and the water had run clear, Frank and I would put on our swimming suits and play in the dammed-up area, turning over rocks looking for crayfish and watching minnows flash their silvery sides in the sun as we chased them.

When we walked back up the hill to the house, my great aunt Mary Walker, who we called Miss Moo, would run a tub, make sure we washed ourselves clean, and then dress us in Bermuda shorts and white collared shirts and take us to the back bedroom to visit Gran, as our great grandmother was called. She was born in 1866 at Edgehill, the Randolph family plantation that was at the bottom of the Monticello mountain, less than a mile up Louisa Road from Shadwell, the birthplace of Thomas Jefferson, to whom most of the Randolphs who populated Edgehill after Jefferson died were related. Gran was the great-great granddaughter of Thomas Jefferson Randolph, Jefferson’s first grandson, born to his daughter Martha and Thomas Mann Randolph, governor of Virginia from 1819 to 1822. Their eldest son, Thomas, inherited Edgehill from his father and mother. Born in 1792, Thomas and his mother, Martha, lived at Monticello and took care of Jefferson and ran the house and plantation during the last years of his life.

So, when Frank and I walked into the back bedroom in our clean shorts and our pressed shirts and shined shoes, we were visiting a woman who had spent the first nine years of her life living in the house at Edgehill with a man who had spent his early adulthood living at Monticello and caring for his grandfather, the man who wrote the Declaration of Independence. In fact, when my brother and I were in that room with our great grandmother, there was only one dead person, Thomas Jefferson Randolph, between Gran and us and Jefferson himself. Our country begins its 250^th year today, but as a nation, and especially as a democracy, we are in our infancy.

During our visits to Wild Acres, our great aunts would drive us up to Monticello in the morning to play, picking us up later in the afternoon. We spent the day free to explore the upstairs rooms in the house and play in the underground former slave quarters behind the house which were called “the Dependencies.” One summer on the 4^th of July, the day of Jefferson’s death in 1826, we were dressed once again in our shorts and little suit jackets and driven up to the graveyard where we lay a wreath on the grave of the man who by now we understood was our sixth great grandfather.

I have written about some of this before, and I’m telling these stories again to illustrate the kind of privilege Frank and I were born into just because we were Truscotts descended through the Randolphs from the third President of the United States. That day we laid the wreath on Jefferson’s grave is the only 4^th of July I can remember that our family treated as a special day. Our grandfather the famous general, our grandmother and great aunts and great uncles, all of whom had old Virginia accents that sounded British with a southern lilt, our connection to Monticello, the fact that we buried our great aunts and uncles in the Monticello graveyard, and then we buried our parents and our aunt Mary, and then we buried our brother Frank and our Uncle James – all of this was taken for granted. It was just who we were, the family we came from, the legacy we inherited by birth. That our legacy and we ourselves were thus part of American history was not lost on us. It just was what it was.

I have tried to use our family’s legacy for good. I invited our cousins from the Hemings family to the Monticello reunion for four years, trying to get the white side of the Jefferson family to accept our cousins descended from the union of Jefferson and his slave, Sally Hemings. It didn’t work. My brother and sisters and I and just one of our white cousins were the only ones to accept our Hemings cousins into the family when it came to a vote in 2002. We tried. Now it’s up to our children, and their children, to carry on the legacy of our family’s connection to the descendants of Thomas Jefferson and Sally Hemings. I don’t know if the two sides of the Jefferson family will ever come together, but I know that Truscott descendants will hold true to the legacy we laid down in the early part of this century.

My son, Lucian V, and my youngest daughter, Violet, spent two weeks at Monticello during the summers of 2017 and 2018, Lucian as an intern working in the gardens and Violet attending the Monticello day camp. In 2018, we were at Monticello on the 4^th of July, and they both worked at the naturalization ceremony that is held on the West lawn every year, handing out bottled water and seating families who had come to witness their relatives being sworn in as U.S. citizens. Monticello felt like a world apart on that 4^th of July. The ugliness of anti-immigrant sentiment and gangs of masked thugs were not yet running amok in towns and cities and factories and even schools and churches, rounding up immigrants and putting them in cages.

Another yearly naturalization ceremony was held at Monticello today, far away at the top of the mountain amongst the flowers and trees and beauty of that place and its history. But I will not celebrate this 4^th of July, commemorating the Declaration of Independence. I will not be proud of our history until the legacy of hate Donald Trump is attempting to force upon this country has been defeated and cast into ignominy.

I am proud of who I am, but I hate what this country has become. I swear I will endeavor to make good of the name and history I was bequeathed by my birth.

Give a gift subscription

Leave a comment

Share