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Woolhandler is a primary care physician at Cambridge Hospital and associate professor at Harvard Medical School who has studied and written about the Massachusetts healthcare plan.
She said today: "As Washington politicians climb on-board a
Massachusetts-style health reform, Massachusetts healthcare sinks.
"Congress seems poised to include an individual mandate in health
reform, copying Massachusetts. Here, beating your wife, communicating a
terrorist threat and being uninsured all carry $1,000 fines.
"The 2006 Massachusetts reform halved the state's already low
uninsurance rate -- mostly by expanding Medicaid and similar programs
at great public expense.
"But reform hasn't made care affordable for middle class families,
or for the public treasury. A middle income uninsured 56-year-old is
now forced to lay out at least $4,800 for a policy with a $2,000
deductible before it pays for any care, and 20 percent co-payments
after that. Overpriced, skimpy coverage like this left one in six
Massachusetts residents unable to pay their medical bills last year.
Among INSURED residents in the state, 18 percent say they skipped care
because they couldn't afford it.
"Meanwhile, health costs continue to rise; our state Senate is
planning to drop 28,000 people from the insurance rolls, and public
hospitals and clinics have suffered draconian cuts as the governor
diverts their funding to shore up the reform. The state just cut the
budget of Boston Medical Center, the state's largest safety net
provider, by $180 million. Cuts to Cambridge Health Alliance, the
second largest safety net provider, have forced closure of half of its
psychiatric services and six of its community clinics.
"Massachusetts' experience prefigures the ugly reality of the
reform plans on the table in Washington. Searching for the $100-$150
billion extra they'd need each year just to cover the uninsured,
Congress threatens to tax health benefits for those who are currently
insured, effectively increasing the price. And they'd drain Medicare
and Medicaid funds from safety net hospitals, anticipating a sharp drop
in those unable to pay for care -- a drop that never really
materialized in Massachusetts."
Woolhandler testified before the Health Subcommittee of the House Energy and Commerce Committee on June 24 in Washington.
A nationwide consortium, the Institute for Public Accuracy (IPA) represents an unprecedented effort to bring other voices to the mass-media table often dominated by a few major think tanks. IPA works to broaden public discourse in mainstream media, while building communication with alternative media outlets and grassroots activists.
"For no real reason at all, hungry people are set to lose food while tax cheats get a free pass."
Progressive economists and advocates warned that the tentative debt ceiling agreement reached Saturday by the White House and Republican leaders would needlessly gash nutrition aid, rental assistance, education programs, and more—all while making it easier for the wealthy to avoid taxes.
The deal, which now must win the support of both chambers of Congress, reportedly includes two years of caps on non-military federal spending, sparing a Pentagon budget replete with staggering waste and abuse.
The Associated Pressreported that the deal "would hold spending flat for 2024 and increase it by 1% for 2025," not keeping pace with inflation.
The agreement would also impose new work requirements on some recipients of Supplemental Nutrition Assistance Program (SNAP) benefits and Temporary Assistance for Needy Families (TANF) while scaling back recently approved IRS funding, a gift to rich tax cheats.
In exchange for the spending cuts and work requirements, Republican leaders have agreed to lift the debt ceiling until January 1, 2025—a tradeoff that House Speaker Kevin McCarthy (R-Calif.) is pitching as a victory to his caucus, which includes far-right members who have demanded more aggressive austerity.
President Joe Biden, for his part, called the deal "a compromise, which means not everyone gets what they want."
"After inflation eats its share, flat funding will result in fewer households accessing rental assistance, fewer kids in Head Start, and fewer services for seniors."
Lindsay Owens, executive director of the Groundwork Collaborative, said in a statement Saturday night that "this is a punishing deal made worse only by the fact that there was no reason for President Biden to negotiate with Speaker McCarthy over whether or not the United States government should pay its bills," alluding to the president's executive authority.
"After inflation eats its share, flat funding will result in fewer households accessing rental assistance, fewer kids in Head Start, and fewer services for seniors," said Owens. "The deal represents the worst of conservative budget ideology; it cuts investments in workers and families, adds onerous and wasteful new hurdles for families in need of support, and protects the wealthiest Americans and biggest corporations from paying their fair share in taxes."
The agreement comes days before the U.S. is, according to the Treasury Department, set to run out of money to pay its obligations, imperiling Social Security, Medicare, and Medicaid payments and potentially hurling the entire global economy into chaos.
House Republicans have leveraged those alarming possibilities to secure painful federal spending cuts and aid program changes that could leave more people hungry, sick, and unable to afford housing, critics said.
"For no real reason at all, hungry people are set to lose food while tax cheats get a free pass," wrote Angela Hanks, chief of programs at Demos.
While legislative text has not yet been released, the deal would reportedly impose work requirements on adult SNAP recipients without dependents up to the age of 54, increasing the current age limit of 49. Policy analysts and anti-hunger activists have long decried SNAP time limits and work requirements as cruel and ineffective at boosting employment. (Most adult SNAP recipients already work.)
"The SNAP changes are nominally extending work requirements to ages 50 to 54. In reality, especially as the new rule is implemented, this is just an indiscriminate cull of a bunch of 50- to 54-year-olds from SNAP who won't realize there are new forms they need to fill out," said Matt Bruenig, founder of the People's Policy Project.
Diane Yentel, president and CEO of the National Low Income Housing Coalition, wrote on Twitter that the agreement is "cruel and shortsighted," pointing to the work requirements and real-term cuts to rental assistance "during an already worsening homelessness crisis."
"House Rs held our nation's lowest-income people hostage in exchange for lifting the debt ceiling," Yentel continued. "The debt ceiling 'deal' could lead to tens of thousands of families losing rental assistance... Expanding ineffective work requirements and putting time limits on food assistance adds salt to the wound, further harming some of the lowest-income and most marginalized people in our country."
The White House and Republican leaders also reportedly agreed to some permitting reforms that climate groups have slammed as a boon for the fossil fuel industry. According toThe New York Times, the agreement "includes measures meant to speed environmental reviews of certain energy projects," though the scope of the changes is not yet clear.
And while the deal doesn't appear to include a repeal of Biden's student debt cancellation plan—which is currently before the U.S. Supreme Court—it does contain a provision that would cement the end of the student loan repayment pause, drawing fury from debt relief campaigners.
\u201cResuming student debt payments will crush working families and is simply bad policy\u2014but agreeing to codify the pause\u2019s end into law before the Supreme Court decides on broad-scale relief is criminal.\u201d— The Debt Collective \ud83d\udfe5 (@The Debt Collective \ud83d\udfe5) 1685241461
The deal must now get through Congress, a difficult task given likely opposition from progressive lawmakers who oppose attacks on aid programs and Republicans who want steeper cuts.
As the Times reported, "Lawmakers in the House Freedom Caucus were privately pillorying the deal on Saturday night, and the Congressional Progressive Caucus had already begun to fume about it even before negotiators finalized the agreement."
Amy Hanauer, executive director of the Institute on Taxation and Economic Policy, said Sunday that "it's a relief to see that congressional leaders and the president have come to an agreement to raise the debt limit and avert an economic disaster."
"But by instituting work requirements for critical assistance programs and rescinding important funding to crack down on wealthy tax cheats, this deal will rig the economy even more in favor of the most well-off Americans while failing to fix the real structural problems that led to the current debt crisis in the first place," said Hanauer. "The deal avoids the elephant in the room: it includes no new revenues even though tax cuts of the past few decades were a primary driver of deficit growth."
"And next up, many Republican lawmakers want to double down on tax cuts by pushing through many more tax cuts that would most help wealthy families and corporations," Hanauer added. "They should do the opposite."
"The GOP claims doing so is necessary in the interest of $11 billion in deficit reduction. But at the same time, they have doubled down on tax cuts skewed to the rich and special interests."
The Biden White House late Friday accused Republicans of attempting to "take food out of the mouths of hungry Americans" by imposing new work requirements on recipients of federal nutrition assistance, a public rebuke of the GOP that came as negotiators worked to finalize a debt ceiling agreement.
Additional work requirements appear to be among the final sticking points in the time-sensitive talks, with the GOP insisting on their inclusion in any agreement to raise the debt limit.
In a statement Friday night, White House spokesperson Andrew Bates said the GOP's proposed work requirements for the Supplemental Nutrition Assistance Program (SNAP) are "designed to tie the most vulnerable up in bureaucratic paperwork" and "have shown no benefit for bringing more people into the workforce."
"The GOP claims doing so is necessary in the interest of $11 billion in deficit reduction," said Bates. "But at the same time, they have doubled down on tax cuts skewed to the rich and special interests that would add $3.5 trillion to our debt."
House Republicans have demanded new work requirements for recipients of SNAP, Medicaid, and Temporary Assistance for Needy Families (TANF)—many of whom already work.
Asked Friday whether the GOP would be willing to drop its push for work requirements, Rep. Garret Graves (R-La.)—the party's lead negotiator—said, "Hell no."
"Hell no," he repeated. "Not a chance."
The White House has spoken out against new work requirements for SNAP and Medicaid, but it's unclear whether it opposes fresh work mandates for TANF, which replaced the more generous Aid to Families With Dependent Children program under the Clinton welfare reform law that Biden supported as a senator.
Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, welcomed the White House's statement against SNAP work requirements, which analysts say could strip food aid from millions of people amid a worsening hunger crisis.
"The president is calling out MAGA GOP hypocrisy of refusing to raise the debt ceiling so the economy doesn't crash simply to take food from hungry people," Jayapal tweeted Saturday. "When you count admin[istrative] costs of bureaucratic red tape, this would produce ZERO savings. Isn't and has never been about saving money."
The White House issued its statement amid growing progressive concerns over the concessions the Biden administration has reportedly granted to GOP hostage-takers.
On Friday, watchdogs, Democratic lawmakers, and policy analysts responded with outrage to reports that the Biden White House is leaning toward accepting Republicans' demand for IRS funding cuts—a giveaway to rich tax cheats.
Progressives have also voiced alarm over reports that the emerging debt ceiling deal includes a two-year cap on non-military federal spending, which would result in cuts to key domestic programs.
"Any deal is a disaster since most government departments and agencies are currently severely underfunded," warned Jeff Hauser, executive director of the Revolving Door Project.
"We knew this was coming," wrote one policy expert. "But we still treat these burdens like they're unavoidable natural disasters."
With a green light from the federal government, states across the U.S. have thrown hundreds of thousands of low-income people off Medicaid in recent weeks—and many have lost coverage because they failed to navigate bureaucratic mazes, not because they were no longer eligible.
More than a dozen states, including Florida and other Republican-led states that have refused to expand Medicaid under the Affordable Care Act, have begun removing people from Medicaid as part of the "unwinding" of a pandemic-era federal policy that temporarily barred governments from kicking people off the program.
In a bipartisan deal late last year, Congress agreed to cut off the pandemic protections, giving states 12 months to redetermine who is eligible for the healthcare program that covers tens of millions of Americans.
The process differs in each state, but Medicaid enrollees are typically required to complete paperwork verifying their income, address, disability status, and other factors used to determine eligibility for the program.
While some states have undertaken public outreach campaigns to ensure Medicaid recipients understand what they need to do to continue receiving benefits, most enrollees across the country "were not aware that states are now permitted to resume disenrolling people from the Medicaid program," according to new survey data from the Kaiser Family Foundation (KFF).
As a result, The New York Timesreported Friday, "many people lost coverage for procedural reasons, such as when Medicaid recipients did not return paperwork to verify their eligibility or could not be located."
"The large number of terminations on procedural grounds suggests that many people may be losing their coverage even though they are still qualified for it," the newspaper added. "Many of those who have been dropped have been children."
Early data released by the state of Florida, for example, shows that more than 205,000 people in the state lost coverage for procedural reasons after April eligibility checks.
"We knew this was coming. But we still treat these burdens like they're unavoidable natural disasters," said Pamela Herd, a professor of public policy at Georgetown University. "We need to be much more explicit about these failures because we're making a choice to allow this."
Joan Alker, executive director of the Georgetown Center for Children and Families, said she is "very worried about Florida."
"We've heard the call center's overwhelmed, the notices are very confusing in Florida—they're very hard to understand," said Alker.
In a recent letter to Republican Gov. Ron DeSantis, a 2024 presidential candidate, more than 50 advocacy groups demanded a Medicaid redetermination pause, pointing to "reports of Floridians being disenrolled from Medicaid without having received notice" from the state's Department of Children and Families (DCF).
"One of these individuals is a 7-year-old boy in remission from Leukemia who is now unable to access follow-up—and potentially lifesaving—treatments," the groups wrote. "Families with children have been erroneously terminated, and parents are having trouble reaching the DCF call center for help with this process. Additionally, unclear notices and lack of information on how to appeal contribute to more confusion."
"We are deeply concerned about those with serious, acute, and chronic conditions who will continue to lose access to their lifesaving treatments during this time, along with people who risk substantial medical debt, or even bankruptcy, as a result of coverage loss," the groups added.
\u201cWhat if instead we just gave everyone health insurance coverage??!! \nhttps://t.co/hSOQKYU7JY\u201d— Ady Barkan (@Ady Barkan) 1685130002
The Times highlighted the situation in Arkansas, which is led by Republican Gov. Sarah Huckabee Sanders—a supporter of Medicaid work requirements and other attacks on the program. (Work requirements were briefly tried in Arkansas in 2018 and 2019, with disastrous consequences.)
"In Arkansas, more than 1.1 million people—over a third of the state's residents—were on Medicaid at the end of March ," the Times noted Friday. "In April, the first month that states could begin removing people from the program, about 73,000 people lost coverage, including about 27,000 children 17 and under."
An Arkansas law requires the state to complete its Medicaid eligibility reviews in six months instead of 12.
In a Wall Street Journalop-ed earlier this month, Sanders wrote that her state is booting people from Medicaid at "the fastest pace in the nation" and claimed those being removed are "ineligible participants"—ignoring evidence that many being stripped of coverage were technically still eligible.
The U.S. Health and Human Services Department has estimated that upwards of 15 million people nationwide could lose Medicaid coverage during the redetermination process.
"This is such an enormous policy failure—profoundly cruel and will contribute to furthering inequities," Dr. Cecília Tomori, a public health scholar at Johns Hopkins University, wrote Friday.
While some who lose Medicaid will be able to access insurance through an employer or the Affordable Care Act marketplaces, KFF found that more than four in ten people with Medicaid as their only source of healthcare "say they wouldn't know where to look for other coverage or would be uninsured" if they were removed from the program.
"This is about to happen to a lot of people," warned Larry Levitt, KFF's executive vice president for health policy.
The Times pointed to the case of 54-year-old Arizona resident Debra Miller, who "lost Medicaid coverage in April after her roughly $25,000 annual salary as a Burger King cook left her ineligible."
"Ms. Miller, a single mother with diabetes and hypothyroidism, worked with an insurance counselor at North Country HealthCare, a network of federally funded health clinics, to enroll in a marketplace plan with a roughly $70 monthly premium," the Times reported.
Miller told the newspaper that the new plan is a "struggle" both because of the new monthly payment and because it doesn't include the vision coverage she needs and now may not be able to afford.
The Congressional Budget Office estimated earlier this week that states' Medicaid eligibility checks will likely leave 6.2 million people without any insurance at all.