Charles Gaba's blog

A couple of days ago I took a look at the letter sent by the Congressional Budget Office (CBO) to Democratic ranking committee members which broke out the ~16 million Americans expected to lose healthcare coverage via the #MAGAMurderBill passed by House Republicans, assuming they also fail to extend the IRA tax credits beyond the end of 2025.

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.

via the Maryland Health Benefit Exchange:

BALTIMORE (June 3, 2025) – The federal budget reconciliation bill passed by the House earlier this month will have significant consequences for the Affordable Care Act in Maryland, if it becomes law as is. For the nearly 250,000 Marylanders who buy health insurance through Maryland Health Connection this bill will increase premium costs, and create unnecessary, inefficient barriers to enrollment.

“For many of those enrolled in Maryland Health Connection, this proposed bill will drive up prices and increase the barriers to quality health insurance,” said Michele Eberle, executive director of Maryland Health Benefit Exchange. “Maryland Health Connection has increased enrollment by 40% in the last four years, because people who know how important health insurance is have found it affordable.”

Increases costs for enrollees

The Congressional Budget Office has published several projections about how many people would lose healthcare coverage and/or become uninsured (these aren't the same thing) under various versions of the #OneBigUglyBill Act passed by House Republicans, which is currently beginning its next phase over on the Senate side of the Capitol.

Their most recent projection put the total at around 11.7 million when you include some technical weirdness which I'm a little vague about...plus another 3.8 million if you include their projection from December 2024 regarding the impact of the upgraded ACA subsidies included in the Inflation Reduction Act being allowed to expire at the end of this year. This placed the grand total at around 15.5 million...except they more recently sent a letter to the House Energy & Commerce Committee which bumped this estimate up a bit more, putting the combined total at 15.9 million.

I joined Simon Rosenberg of Hopium Chronicles yesterday to discuss the House GOP budget bill (aka the #MAGAMassacreBill) and the Trump Regime's all-out assault on the U.S. healthcare system.

You can watch/listen to it here, on YouTube, Apple Podcasts or Spotify.

via NY State of Health:

• Republican-Passed Bill Would Gut New York’s Healthcare System 
• Estimated Loss of $13.5 Billion Every Year, Devastating Our Healthcare System 
• 1.5 Million New Yorkers To Lose Healthcare Coverage and Become Uninsured; Over $3 Billion in Losses for New York’s Hospitals

• New Visualization of Impacts by Congressional District Here and Detailed Analysis Available Here

Governor Kathy Hochul today was joined by the Democratic Leader of the U.S. House of Representatives Congressman Hakeem Jeffries and leaders in the health care and labor sectors to sound the alarm on the detrimental effects of several healthcare provisions already passed by the House of Representatives in the Republican budget reconciliation bill. These provisions collectively amount to an annual loss of nearly $13.5 billion for New Yorkers and our healthcare sector, jeopardizing healthcare access for millions of New Yorkers and threatening the state’s hospitals and healthcare providers. 

“Republicans in Washington have made it abundantly clear that they are determined to dismantle the social safety net that millions of New Yorkers rely on to secure their basic necessities,” Governor Hochul said. “They are specifically targeting essential and life-saving programs such as Medicaid and food stamps with the consequence that everyday Americans will bear the brunt of this attack. I am committed to utilizing litigation and other appropriate tools to safeguard and protect New Yorkers.” 

The Musk/Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

January 2025 Key Findings

Medicaid and CHIP Enrollment

• In January 2025, 78.8 million individuals were enrolled in Medicaid and CHIP.
  • 71.4 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.4 million adults were enrolled in Medicaid, and there were 37.4 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

The Centers for Medicare & Medicaid Services just published updated enrollment data for Medicare, adding February 2025 to the data archive.

So far, after a 2-month initial delay, the Musk/Trump Regime has been posting updated Medicare enrollment data roughly once per month. We'll see if that continues.

Whether the data posted since January 20, 2025 is accurate or not, I can't say for certain, but at least they're updating it...and so far, at least, I don't see anything in their monthly reports which is setting off any obvious red flags.

In any event, according to the latest report, as of February 2025:

Over the past month or so, as Congressional Republicans have pulled out all the stops in their attempt to ram through their budget bill which would gut Medicaid and ACA exchange enrollment (along with SNAP and numerous other desperately-needed social aid programs), you may have noticed that they keep using an oddly specific talking point:

Mike Johnson: Medicaid Is Not for 29-Year-Old Males Sitting on Their Couches Playing Video Games

--CNN, February 27, 2025

Mike Johnson on Medicaid: "What we've talked about is returning work requirements ... you return the dignity of work to young men who need to be out working instead of playing video games all day. We have a lot of fraud, waste, and abuse in Medicaid."

Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is even more extreme).

There's so many awful things included in the bill, many of which are of course healthcare-related, and it would take hundreds of blog entries to discuss them all...but I want to focus on one in particular.

I joined Jennifer Taub on her podcast to discuss the House GOP budget bill (aka the #MAGAMassacreBill) and the Trump Regime's all-out assault on the U.S. healthcare system.

You can watch it on YouTube.