Democrats will mow make Medicaid cuts a midterm election issue. But they face one big question ahead of that: will they shut down the government over extending the ACA tax credits? Premiums will spike and 4.2 million more people will be uninsured (CBO) if the credits lapse.

Levitt, NYT, the facts on the OBBB. Just out:.

With the Scott amendment to the OBBB pulled, the three things that went too far for R’s: defunding Medicaid expansion (Scott); a per capita cap, a block grant. After the OBBB, will not extending the ACA tax credits be the fourth?.

Scott's amendment eliminates enhanced match for expansion, but for new enrollees in 2031, adding savings now to the OBBB but putting pressure on congress to reinstate funding in the future while playing chicken with the expansion population in 40 states.

And Medicaid cuts are only part of the story. Premiums rise by as much as 90% for marketplace enrollees in rural areas if ACA tax credits are not extended by the end of the year, leaving millions uninsured. Another blow to rural health a $25b fund can’t compensate for.

A $25b rural hospital fund is barely a fig leaf compared to massive ten year cuts in Medicaid payments and Medicaid and ACA coverage. But it will sound big to many voters and its cover for some R’s to vote for the bill. Will the media call it like it is?.

My favorite interview I ever did was on Bill Moyers show. A real discussion. Bill wanted to explain, educate, inform. He made the country better.

It’s remarkable how much of the debate about Medicaid cuts is now about hospitals and a rural hospital fund to placate critics and appear to soften the blow, not the millions of people who will lose coverage or find it unaffordable. Some will lose SNAP benefits at the same time.

Inspired by the fitness companies, I would like to now officially lobby the OBBB to make all four of my professional sports tv packages HSA eligible on the grounds of MAHA. If I had an HSA and not a ridiculously expensive PPO I offer KFF employees, including me.

More from Wakely:” “Non-Medicaid expansion states would see especially large enrollment losses with reductions in enrollment ranging between 53% and 64%.” Will momentum build to extend the ACA tax credits after reconciliation?.

BIG attention grabber from Wakely, which says the marketplaces will shrink 47-57% if tax credits expire and reconciliation changes are made.

On the health insurance industry/administration announcement  today about paring back prior authorization. Will they actually do it? The history of voluntary efforts is not good. If they do, will they raise premiums and cost sharing to compensate?.

Many of the Medicaid cuts target expansion states. Many immigration policies target Democratic cities. Cuts and policies advance campaign promises and policy objectives, but are are also being used as political weapons.

Active duty troops in LA diverts attention from: everything in the reconciliation bill including Medicaid cuts, firing the vaccine advisory committee, tariffs, Ukraine and more. NOT suggesting intent, it just does. Possibly it should?.

You might think he was the for profit hospital guy. But he was a leading advocate for access to care and smart health policy, always focused on those less fortunate. Respected by everyone. Not was. Is. No one better in our field.

Our new Tracking Poll. Approximately ten million MAGAs and non MAGA Republicans in the marketplaces, almost half of total enrollment. I will have more to say about this in my column Tuesday.

The great flaw in “decide with your doctor”. The vast majority of practicing docs are not scientists they rely on scientific guidelines. Erode trust in them or take them away and you have 300k primary care docs plus specialists making stuff up.

As more Medicaid and ACA changes pour in tonight from Congress, one thing strikes me as a former state human services secretary. For them or against them, assuming that states will implement so many new policies and programs at once, on time, and as designed is, well, fantasy.

We calculate what is known so far about how the “big beautiful bill” would increase the uninsured in each state:  historically a much bigger focus for Democrats than Republicans:

Republicans have given up on repealing “Obamacare”, but apparently they are still interested in significantly cutting it. Buried in reconciliation, provisions producing at least a 1/3 reduction in marketplace enrollment: