Trump on the stump at his Nuremberg style rallies promised to make life better for the downtrodden forgotten masses. Now the line is they will have to endure “some pain”. While his selling out of the post WW11 democratic alliance, charging that Zelensky is a dictator, planning of the removal of two million Palestinians to create a Gaza- a - Largo while negotiating a peace in the Ukraine/Russian war without Ukraine may not affect the day to day life of his MAGA electorate, axing their health care just might. Thus his desire to satisfy his billionaire donors with a massive tax cut will also clash with the needs of the majority of his bizarre coalition.
In line with Trump’s objective to cut 1.5 trillion dollars from the current USA government spending to partly fund his over 4. 5 trillion dollars tax cut for corporations and billionaires, 900 million dollars needs to be cut from Medicaid and the Affordable Care Act which provide medical insurance for 125 million Americans. Ironically those mostly impacted are from the red states that put Trump and by extension Musk into the WhiteHouse. The chaos that this will cause is typical of all the Trump “policies” that simply haven’t been thought through.
The chances of the resulting health care axing being prevented by Trump’s cabinet are remote. They are a collection of ignorant nonentities whose only characteristics are that they are card carrying members of the Trump cult and shine on TV. The Secretary of Health Robert Kennedy Jnr., was unable at his confirmation hearings to differentiate between Medicaid, a program generally for the poor and Medicare, which is for senior citizens.
Jay H. Ell has blogged on the crushing impact of Red States’ policies on abortion where the maternal death rate is exponentially higher than the blue states. For example, nearly 50 percent of counties in Texas are “maternity deserts” . The latter’s already limited obstetrician workforce stands to loose another third of their number in the near future and their residency training programs are already impacted negatively by the draconian “anti abortion” laws following the overturn of Roe v Wade by the right wing Conservative Supreme Court . (Blog: "Trump,Texas and Women’s Health” December 22, 2024).
The impact of the projected cuts on Medicaid will be devastating for health care particularly in the rural areas of the red states.
IMPACT OF PROJECTED BUDGET CUTS ON RURAL HOSPITALS
Rural hospitals serve a section of the community who have a lower income. A substantial portion of the hospitals' income is derived from the payments from Medicaid or the Affordable Care Act. These hospitals would end up bearing the brunt of the now uninsured, who they are legislatively mandated to treat in their Emergency Rooms.
According to a Health Care Advisory Firm, Chartis, 432 rural hospitals would be vulnerable to being closed should the proposed budget cuts come through. For practical purposed the states that are most impacted are the red Trump states. All in all 38 states are at risk for rural hospital closure.
The states with the highest number of hospital closures are Texas, (48), Kansas, (46), Mississippi, (28), Oklahoma, (23) and Georgia, (22). All States that helped put Trump in the WhiteHouse.
The states at risk for over 41 percent of their rural hospital closures are Arkansas, Florida, Kansas, Mississippi and Tennessee. Those that stand to lose between 31 to 40 percent of rural hospitals are Georgia, Missouri, Oklahoma, South Carolina and Texas, while those at risk for 25 - 30 percent are North Carolina, Alabama and South Dakota.
Thus all 14 States that stand to lose more than 25 percent of their rural hospitals voted for Trump for President.
Three Blue States, New Mexico, Illinois and Maryland are at risk to lose 21 - 25 percent of hospitals together with red states Louisiana, Wyoming and Nebraska. Kentucky and Ohio make up those who have up to a 20 percent projected loss of their rural hospitals. Of the 22 States that can lose over 20 percent of their rural hospitals 19 are in those that voted for Trump
There are another 16 states thirteen of which 13 are red that can lose up to 20 percent of their rural hospital care.
Of a total of thirty - eight states that are projected to have rural hospital closures as a result of Medicaid being slashed 32 are MAGA.
SERVICES THAT MEDICAID PROVIDE
Medicaid provides a welter of services especially to those below the poverty level and varying percentages above it, depending on the individual States' formulae. The agency supports care of all sorts, primary, preventive, dental, prescription drugs, hospital and emergency visits, the elderly, children, those with disabilities, those on the autism spectrum, provides transport to medical facilities and nurse visits and on and on. Forty percent of the deliveries of babies in the USA are funded by Medicaid.
Medicaid and the Affordable Care Act are closely intertwined. Under the latter Act those uninsured can be put on Medicaid with the Federal Government bearing 90 percent of the costs. Just axing that provision would produce billions of dollars Likewise insisting that those eligible for Medicaid must work will eliminate a large portion of the infirm and disabled.
Discarding the extra provisions of the current services such as nurse visits or putting a per capita maximum per patient or lowering the already low payments for providers will also crash the program and produce the billions “savings” as desired. Any of these approaches will also have the effect of downing the rural hospitals as outlined.
Obviously whatever the method used to neuter this highly successful government program the rationale will be to “eliminate fraud, waste and abuse”. Improper payments in fact have been researched to be 5 percent which is similar to private insurance, Also the increase in cost per patient has been far lower for Medicaid patients than private insurance patients over the past few years.
This attack on Medicaid should be seen together with the slashing of research programs and physicians in various institutions such as the National Institute of Health and The Center for Disease Control. Also research grants at Universities will not be paid at the current rates possibly halting these endeavors. The latter with cuts in the National Science Foundation will result in the medical advances being drastically slowed down. The Foundation has been involved in imaging and public health research.
AT THE END OF THE DAY
Health care is central to the slash and burn approach Trump 2 is adopting with Elon Musk being the battering ram. Cynically it has been mooted that if Trump has finally to pay what he owes Eugene Carrol and the State of New York only Musk can lay his hands on the close to a billion dollars.
Ironically it is the Red states by far who are going to bear the burden of these cuts to health care. Even three of the States where Universities are hardest hit by the reduction in grants are Alabama, Pennsylvania and North Carolina which were won by Trump in 2024.
The good news is that any budget package is tough to pass in The House of Representatives as the Republicans have only a three seat majority. Ultimately only Congress controls, “the purse”.
Robert Kennedy Jnr., the new Secretary of Health, a vaccine denier and a conspiracy theorist is unlikely to help the chaos that Musk and Trump are may unleash.
The staff protecting the nuclear facilities and the scientists monitoring the bird flu were unceremoniously fired as part of the wholesale thoughtless slaughter of thousands of Federal employees engineered by Musk. Needless to say there is a desperate attempt to trace them - made difficult by the removal of every trace of their existence. Very efficient is the Department of Government Efficiency.
Why if Elon Musk is going to save the country with two trillion dollars of "waste fraud and abuse" does Trump need to increase the budget deficit in this cycle by 4 trillion dollars? The answer is the tax cuts for the billionaires and the corporations stupid!
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