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    Share how the ongoing US government shutdown could affect your access to food or health insurance

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    More than 40 million Americans will stop receiving food stamps on 1 November, as the US government shutdown enters its fifth week.The Department of Agriculture says the Supplemental Nutrition Assistance Program (Snap) will be suspended until Congress reopens the government. While the Trump administration argues the department does not have the legal authority to use a $5bn contingency fund to continue the aid, Democrats disagree, and two dozen states have sued the government to force the program to continue.Meanwhile, Democrats are also refusing to vote to end the shutdown because health insurance costs are set to go up dramatically as insurers prepare for a lapse in subsidies. Senate Democrats are demanding that any short-term government funding deal include an extension of the enhanced subsidies for Affordable Care Act plans, while Trump and the Republicans have said they will not negotiate until the government is back up and running. Extending the subsidies would require $350bn in federal spending over the coming decade.We’d like to hear from Americans who are about to lose Snap food assistance due to the shutdown, as well as from people whose healthcare may become unaffordable due to rising premiums. Have you received any notices or paperwork that your insurance will change soon? Tell us. More

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      Democrats use new tactic to highlight Trump’s gutting of Medicaid: billboards in the rural US

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      The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.”In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Donald Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, a senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization.“That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”In response to criticism, Republicans added a $50bn “rural health transformation fund” just before passage of the OBBBA. The fund is expected to cover about one-third of the losses rural areas will face, and about 70% of the losses for the four hospitals where Democrats now have nearby billboards. The rural health fund provides money through 2030, while the Medicaid cuts are not time-bound.That is already becoming a political football, as Democrats argued in a letter that the money is a “slush fund” already promised to key Republican Congress members.“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal,” wrote 16 Democratic senators in a letter to Dr Mehmet Oz, Trump’s head of Medicare and Medicaid.View image in fullscreen“In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims.”Rural hospitals have been under financial strain for more than a decade. Since 2010, 153 rural hospitals have closed or lost the inpatient services which partly define a hospital, according to the University of North Carolina Sheps Center for Health Services Research.“In states across the country, hospitals are either closing their doors or cutting critical services, and it’s Trump’s own voters who will suffer the most,” said the DNC chair, Ken Martin, in a statement announcing the billboards.The OBBBA is expected to further exacerbate those financial strains. A recent analysis by the Urban Institute found rural hospitals are likely to see an $87bn loss in the next 10 years.“We’re expecting rural hospitals to close as a result – we’ve already started to see some hospitals like, ‘OK, how are we going to survive?’” said Third Way’s Kendall.skip past newsletter promotionafter newsletter promotionA June analysis by the Sheps Center found that 338 rural hospitals, including dozens in states such as Louisiana, Kentucky and Oklahoma, could close as a result of the OBBBA. There are nearly 1,800 rural hospitals nationally, according to the Kaiser Family Foundation (KFF), a healthcare research non-profit.That perspective was buttressed by the CEO of the National Rural Health Association, Alan Morgan, who in a recent newsletter said 45% of rural hospitals are already operating at a loss.“When you remove $155bn over the next 10 years, it’s going to have an impact,” he said.In the fragmented US healthcare ecosystem, Medicaid is both the largest and poorest payer of healthcare providers. Patients benefit from largely no-cost care, but hospitals complain that Medicaid rates don’t pay for the cost of service, making institutions that disproportionately rely on Medicaid less financially stable. In rural areas, benefit-rich employer health insurance is harder to come by; therefore, more hospitals depend on Medicaid.But even though Medicaid pays less than other insurance programs, some payment is still better than none. Trump’s OBBBA cut of more than $1tn from the program over the coming decade is expected to result in nearly 12 million people losing coverage.When uninsured people get sick, they are more likely to delay care, more likely to use hospital emergency rooms and more likely to struggle to pay their bills. In turn, the institutions that serve them also suffer.“This is what Donald Trump does – screw over the people who are counting on him,” said Martin, the DNC chair. “These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump’s watch.” More

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      Democrats make long-shot effort to stop Trump cuts to Medicaid and Snap

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      House Democrats are making a long-shot attempt to stop Republicans from downsizing federal safety net programs including Medicaid to offset the costs of Donald Trump’s immigration crackdown and tax cuts.The Democratic House minority leader, Hakeem Jeffries, on Tuesday announced that his lawmakers are circulating a petition which, should a majority of the chamber sign on to it, would force a vote on legislation preventing cuts to the Medicaid health insurance program and the Supplemental Nutrition Assistance Program (Snap).Known as a discharge petition, the effort faces long odds in the GOP-led chamber. Republican leaders have recently moved to stop such petitions, and while several Republican lawmakers have expressed concerns about some of the cuts being considered to pay for Trump’s agenda, they still generally support it.“House Republicans are determined to jam a reckless and extreme budget down the throats of the American people that will enact the largest cut to Medicaid and the largest cut to Snap in American history,” Jeffries told reporters.“All we need are four Republicans to do the right thing. Stand up for Medicaid and stand up for Snap, so they can stand up for the American people and we can stop the devastating cuts that Republicans are proposing.”Trump has called on Congress’s Republican majorities to send him what he has dubbed “one big, beautiful bill”, which is expected to extend tax cuts enacted during his first term, pay for the mass deportation of undocumented immigrants and potentially address other campaign promises, such as ending the taxation of tips, overtime and social security payments.The GOP plans to pass the bill using Congress’s reconciliation procedure, which requires only simple majorities in both the House and Senate.Some Republicans have blanched at the possibility of deep cuts to Medicaid and Snap. Under a budget framework that applies to the House, the former program could lose as much as $880bn, while the latter could lose $220bn, both major cuts that are expected to have far-reaching effects.Democrats are hoping to seize on their discontent to attract the small number of Republican signatures needed for their petition to succeed.“All of this poses a question for those House Republicans who like to call themselves moderate,” said Katherine Clark, the Democratic whip of the House of Representatives.“Here’s a chance for you, your friends, your fellow moderates, to show you actually care for your constituents. It only takes a handful of Republicans to stop this, just a few to protect Medicaid and save working families from losing their healthcare and going hungry.”skip past newsletter promotionafter newsletter promotionDischarge petitions rarely gather enough signatures, and when they do, House Republican leadership moves forcefully to render them moot.Last month, a small number of Republicans signed on with Democrats to a petition that forced a vote on a measure to allow new parents to vote by proxy in the House. Republican leaders inserted language into a must-pass procedural motion to stop the petition, prompting several GOP lawmakers to join with Democrats in voting down the motion, after which leadership recessed the chamber early. The matter was later resolved by a compromise between the House speaker, Mike Johnson, and Anna Paulina Luna, the Republican representative who was leading the petition.The discharge petition to protect Snap and Medicaid comes after the Democratic National Committee last week announced plans to hold town halls and rally voters in the districts of four Republican lawmakers, with the goal of encouraging them to vote against the forthcoming reconciliation bill.Seven of 11 House committees have written up their section of the bill, which Johnson said he hopes to pass through the chamber by the 26 May Memorial Day holiday. More

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      Like millions of Americans, I can never leave my spouse. I’ll lose my healthcare | Jessa Crispin

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      OpinionUS healthcareLike millions of Americans, I can never leave my spouse. I’ll lose my healthcareJessa CrispinMy access to doctors is tied to my husband – and his access is tied to his employer. Land of the free indeed Fri 23 Jul 2021 06.17 EDTLast modified on Fri 23 Jul 2021 07.03 EDTIt was around the second dose of fentanyl going into my IV bag that I stopped trying to control how much all of this was going to cost. I had been arguing with every decision the caregivers at the emergency room were making – “Is this Cat scan actually necessary or is there another diagnostic tool?” “Is there a cheaper version of this drug you’re giving me?” – and reminding them repeatedly that I was uninsured, but either the opioids in my bloodstream, or the exhaustion of trying to rest in a room next to a woman who, given the sounds she was making, was clearly transforming into a werewolf, forced me to surrender.Why is a 108-year-old resorting to GoFundMe to pay for home care? | Ross BarkanRead moreI walked out of there four years ago alive, yes. And, as the doctors and nurses kept reminding me, if I had waited another 48 hours to discover I didn’t actually have the magical ability to self-diagnose and self-treat serious problems with Google and herbs, I might have gone septic. But all said and done, I was also walking home to a $12,000 bill, which was approximately half of my annual income as a single woman.It took me several years of hardship, contributions from my friends and the assistance of the hospital’s charity program to pay off the $12,000.Then, last month, it started again. I was at home. I turned my head a little, the whole world started sliding away from me, and I crashed to the floor. I tried to crawl back into bed, insisting, “It’ll pass, it’ll pass.” My husband, on the other hand, was raised in a country with compulsory public health coverage, so his first instinct upon something weird happening isn’t to lie down for 48 hours and see if it goes away. He immediately started plotting the route to a hospital on his phone.I was back, but this time I was married. The whole hospital visit cost us $30, including the prescription. Everything was covered by his insurance. That’s when I realized I can never divorce my husband.The first emergency room visit might have been an anomaly – a freak health problem that the nurse explained as “sometimes these things happen”. The intense vertigo was the result of the deterioration of the condition of my ears. It has been a problem since childhood, one left in “let’s wait and see what happens” condition until a weird virus last year – yes, I was the big idiot who caught a debilitating non-coronavirus virus during a coronavirus pandemic – forced me to a doctor, who discovered significant hearing loss and structural damage that will require lifelong treatment and intervention.As a freelance writer who has tried and failed for years now to get a real job with real benefits, the costs of the surgeries and hearing aids and other treatments the doctor sketched out as part of my future would be suffocating. But almost all of it is covered by my husband’s insurance, making my health and ability to access healthcare dependent on his presence in my life.While I convalesced from the virus last year, I watched the discussion about health insurance take over the Democratic primary debates. I had little hope that the bright, sparkly Medicare for All plan championed by candidates like Bernie Sanders would be made reality. But still I despaired of the excuses other candidates made for why they did not support guaranteed coverage for all. It angered me to see Amy Klobuchar, Pete Buttigieg and the eventual winner, Joe Biden, defend their plans to largely maintain the status quo – a system in which employment and marriage determine access to healthcare – as though they were protecting our “freedom” to “choose” coverage that was right for us.The coercions built into American social welfare programs limit freedom, not preserve it. People who are not financially independent are forced to maintain ties with family members who might be abusive or violent unless they want to relinquish their housing, healthcare or other forms of support. And as outlined by Melinda Cooper’s Family Values: Between Neoliberalism and the New Social Conservatism, the dismantling of protections like food and financial aid in the 80s and 90s had the express purpose of increasing familial obligations in the name of “duty” and “responsibility”. Single parents seeking public support for their children’s wellbeing now had to first seek assistance through their partners, no matter how fraught or harmful those relationships might be. While politicians spoke of “strengthening families” and repairing the social fabric, one of the consequences of these policy changes was to limit the ability for people to make the basic decisions required to live the lives of their choosing, unless they had the money that in this country is our substitute for freedom.It’s not just unhealthy families we are stuck in: a Gallup poll revealed that one in six Americans stay in jobs they want to leave because they can’t afford to lose their health benefits. Politicians on both sides claim to support innovation and entrepreneurship, but the cost of healthcare is a huge barrier for many, and something that could be easily resolved with a public option. It’s almost as if we believe people who are sick, unlucky or not blessed by inherited resources deserve to have their choices constrained and stay trapped in perilous circumstances. (That last part is a joke. We Americans definitely believe this.)We have a Democrat-led Congress and a Democratic president, yet there is no public option or significant overhaul of our broken health insurance system on the horizon. As a result, when my husband got offered his dream job at an emerging non-profit startup, one so new that when the offer was made they could not yet offer health benefits, he hesitated. There would be a gap in coverage, of indeterminate length, and there was still that $12,000 emergency room visit in recent memory.In the end, simply by luck, the startup found a way to enroll employees in a health program that left us with only a one-month gap in coverage. I am lucky to be married to someone I like, who I am not afraid of, who I do not want to leave. This hasn’t always been the case for women in my family, or even myself in my 20s. For now, and for the foreseeable future, my access to doctors is tied to my partner, and his to his employer. Land of the free indeed.
      Jessa Crispin is a Guardian US columnist
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