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    A Road Map for Undoing the Damage of the Big, Awful Bill

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    In the 30 years I have been a part of fiscal policymaking I don’t think I have ever seen a legislative push as impressive as the passage of President Trump’s big, dubious tax and policy bill.Don’t get me wrong: The consequences for health insurance, poverty, climate change and macroeconomic stability, in roughly that order of importance, will be horrendous. The Medicaid and other health care changes would undo about three-quarters of the coverage expansion from President Barack Obama’s Affordable Care Act and Medicaid expansion. The law repeals much of what Joe Biden did for climate change in the Inflation Reduction Act. The tax provisions sustain most of the cuts from Mr. Trump’s first term and add in several others for good measure.But before Democrats — and hopefully some Republicans — even try to fix the damage, they should learn the lessons of how the Republicans got all this done, working against tremendous odds on a much faster timetable than the major legislative accomplishments from Mr. Trump’s three predecessors.The first lesson is that ideas really do matter. This legislation did not happen because the public or lobbyists were clamoring for it. Instead Donald Trump and congressional Republicans wanted it and were willing to overcome public disfavor and opposition from vested interests.Sure, special interests were at play in ways big (preserving workarounds to limits on state and local tax deductions) and small (getting new tax breaks for Alaskan whaling captains). But no major lobbying groups were asking for the broad contours of this legislation. The health care industry, which is expected to lose about half a trillion dollars, and the energy industry, which is losing huge tax breaks and subsidies, put up a fight. Their opposition, like that of other industries, went nowhere. And neither did Elon Musk’s — further evidence that oligarchy is the wrong lens through which to view this political moment.The second lesson is that while ideas matter, expert ideas do not necessarily matter. Past fiscal debates have divided economists and policy wonks. In President Trump’s first term, some economists would write opinion articles or go on TV news programs defending his tax cuts as adding to growth while other economists (including me) would write rebuttals.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Taking From the Poor and Giving to the Rich Is Not Populism

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      “I love the poorly educated,” President Trump declared during the 2016 campaign. His intense support for the “big, beautiful” $4.5 trillion tax-and-spending bill now before Congress shows that he has a unique way of demonstrating his affection.Republicans are on the verge of enacting Trump’s upwardly distributive fiscal policy measure, which has become an extreme test of the loyalty of his more downscale MAGA supporters, who not only oppose the bill but stand to bear the brunt of its negative consequences.In its current form, which is changing by the hour, the measure, known popularly as B.B.B., would provide the upper classes, including Trump’s allies and donor base — corporations and the rich — with tax cuts worth approximately $4.45 trillion over 10 years. The measure would offset the cost with the largest reductions in safety net programs in recent decades, if not all time, for those on the lower tiers of the income distribution.This pared-back social spending would adversely affect a large bloc of rural and exurban Republicans who played a crucial role in putting their party in control of the House and Senate, and Trump in the White House.“You can very safely say,” Bobby Kogan, senior director of federal budget policy at the liberal Center for American Progress, told The Washington Post, that “this is the biggest cut to programs for low-income Americans ever.”Many of the details of the legislation remain in flux as the Senate continues to vote on amendments. If the Senate approves the legislation, the House and the Senate will still have to come to agreement on a final version for the measure to become law.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump May Get His ‘Big Beautiful Bill,’ but the G.O.P. Will Pay a Price

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      And so will many voters.There will be many short- and long-term consequences if Republicans succeed in passing President Trump’s signature policy bill, as they aim to do before the July 4 holiday, David Leonhardt, the director of the Times editorial board, tells the national politics writer Michelle Cottle in this episode of “The Opinions.”Trump May Get His ‘Big Beautiful Bill,’ but the G.O.P. Will Pay a PriceAnd so will many voters.Below is a transcript of an episode of “The Opinions.” We recommend listening to it in its original form for the full effect. You can do so using the player above or on the NYT Audio App, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts.The transcript has been lightly edited for length and clarity.Michelle Cottle: I’m Michelle Cottle and I cover national politics for Times Opinion. So with the July 4 weekend looming, I thought we’d talk about a different kind of fireworks: that is, President Trump’s “big, beautiful bill” and as always, I hope the air quotes there are audible for everybody.But that bill looks like it is on track for passage. From Medicaid cuts to tax breaks for the rich, it is a lot. Thankfully with me to talk about this is David Leonhardt, the fearless director of the New York Times editorial board, who has some very pointed thoughts on the matter. So let’s just get to it. David, welcome.David Leonhardt: Thank you, Michelle. It’s great to be talking with you.Cottle: I’m so excited, but warning to all: We are recording on Monday midday and even as we speak, the Senate is brawling its way through to a final vote. So the situation is fluid and could change the details by the time you all hear this.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Texas Doctor Who Filed $118 Million in Fraudulent Medical Claims Gets 10 Years in Prison

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      Jorge Zamora-Quezada falsely diagnosed patients with a chronic disease and subjected them to unnecessary treatments to help fund his lavish lifestyle, officials said.For nearly 20 years, a Texas doctor falsely diagnosed patients as having a chronic disease, administered unnecessary, toxic treatments and filed more than $118 million in fraudulent health insurance claims to fund his lavish lifestyle, which included a private jet, luxury cars and high-end properties, prosecutors said.The doctor, Jorge Zamora-Quezada, 68, of Mission, Texas, was sentenced to 10 years in prison this week, according to the Justice Department.From 2000 to 2018, he falsely diagnosed patients with rheumatoid arthritis and administered dangerous, medically unnecessary treatments to defraud federal and private health insurance companies, the Justice Department said.Rheumatoid arthritis is a chronic disease that causes a person’s immune system to attack healthy tissue. Some of Mr. Zamora-Quezada’s patients were as young as 13, the Justice Department said.Mr. Zamora-Quezada’s medical license was canceled in 2021, according to Texas Medical Board records.His scheme funded what prosecutors described in court documents as his “lavish and opulent lifestyle,” with properties across the United States and Mexico, as well as a private jet and a Maserati that he used to travel between his offices in the Rio Grande Valley and San Antonio.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump Squeezes His Party on Domestic Policy Bill

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      The president visited the weekly meeting of House Republicans to make the case for the legislation and pressure members of his party to fall into line.President Trump on Tuesday huddled with House Republicans on Capitol Hill to urge them to unify around a wide-ranging bill to deliver his domestic agenda, ratcheting up the pressure for the party to overcome divisions that could sink the package.Joining Republicans at their weekly closed-door meeting, Mr. Trump praised Speaker Mike Johnson, who has been toiling to cobble together the votes to pass what the party has dubbed the One Big Beautiful Bill Act, which they hope to bring to a vote by the end of the week.“I’m his biggest fan — I love this guy,” Mr. Trump said of Mr. Johnson before the meeting. The speaker can afford to lose no more than three votes on the bill if all Democrats oppose it, as expected, and every lawmaker is present and voting.The president made it clear that he saw passage of the measure as a test of loyalty to him, saying he had been a “cheerleader” for the party, and warning that any holdouts “wouldn’t be a Republican much longer.”But he minimized the very real rifts within his party that could derail the measure, saying there were “one or two grandstanders” holding it up.That is not the case. Several Republican factions have expressed concern about the details of the sprawling bill, which would extend the 2017 tax cuts and eliminate taxes on tips and overtime pay; raise spending on the military and immigration enforcement; and cut Medicaid, food stamps, education and subsidies for clean energy to pay for some of it.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump Plan Would Tie Some Drug Prices to What Peer Nations Pay

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      The president announced an executive order aimed at lowering U.S. drug costs, revisiting an idea that was blocked in court during his first term.President Trump will sign an executive order on Monday aimed at lowering some drug prices in the United States by aligning them with what other wealthy countries pay, he said on Truth Social on Sunday evening.The proposal he described, which alone cannot shift federal policy, is what he calls a “most favored nation” pricing model. Mr. Trump did not provide details about which type of insurance the plan would apply to or how many drugs it would target, but he indicated that the United States should pay the lowest price among its peer countries.“Our Country will finally be treated fairly, and our citizens Healthcare Costs will be reduced by numbers never even thought of before,” he wrote in his social media post.Any such plan will most likely be subject to challenges in court, and it is not clear whether it will pass legal muster, especially without action by Congress.In his first term, Mr. Trump tried unsuccessfully to enact a version of this idea for Medicare, the health insurance program that covers 68 million Americans who are over 65 or have disabilities. That plan would have applied only to 50 drugs, administered at clinics and hospitals, that are paid for by Medicare. A federal court blocked it, ruling that the administration had skipped steps in the policymaking process.The pharmaceutical industry bitterly opposes the idea, which would almost certainly cut into its profits, and has been lobbying against it as discussions of the policy have regained steam in Washington in recent weeks. Companies have warned that such a policy would lead them to spend less on research, depriving patients of new medicines.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Why Patients Are Being Forced to Switch to a 2nd-Choice Obesity Drug

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      CVS Caremark decided to stop offering Zepbound in favor of Wegovy for weight loss. It’s the latest example of limits imposed by insurance that disrupt treatments for patients.Tens of thousands of Americans will soon be forced by their health insurance to switch from one popular obesity drug to another that produces less weight loss.It is the latest example of the consequences of secret deals between drugmakers and middlemen, known as pharmacy benefit managers, that are hired by employers to oversee prescription coverage for Americans. Employers pay lower drug prices but their workers are blocked from getting competing treatments, a type of insurance denial that has grown much more common in the past decade.One of the largest benefit managers, CVS Health’s Caremark, made the decision to exclude Zepbound in spite of research that found that it resulted in more weight loss than Wegovy, which will continue to be covered.Those research findings, first announced in December, were confirmed in an article published on Sunday in The New England Journal of Medicine. The study involved a large clinical trial comparing the drugs that was funded by Eli Lilly, the maker of Zepbound. Earlier research not financed by Eli Lilly reached similar conclusions.Ellen Davis, 63, of Huntington, Mass., is one of the patients affected by Caremark’s decision. “It feels like the rug is getting pulled out from under my feet,” she said.After taking Zepbound for a year, she has lost 85 pounds and her health has improved, she said. She retired after working for 34 years at Verizon, which hired Caremark for her drug coverage.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      UnitedHealth’s Move to End Cyberattack Loan Lifeline Upsets Medical Providers

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      The company lent roughly $9 billion to practices affected by a vast cyberattack on its payment systems last year. Medical practices are now suing the health care colossus, saying it is pressuring them to repay funds.Two independent medical practices in Minnesota once hoped to expand operations but have spent the past year struggling to recover from the cyberattack on a vast UnitedHealth Group payment system.Odom Health & Wellness, a sports medicine and rehabilitation outfit, and the Dillman Clinic & Lab, a family medicine practice, are among the thousands of medical offices that experienced sudden financial turmoil last year. The cyberattack against Change Healthcare, a division of United, paralyzed much of the nation’s health-care payment system for months.Change lent billions of dollars to medical practices that were short on cash but has begun demanding repayments.Dillman and Odom are suing United in U.S. District Court in Minneapolis, accusing the corporation of negligence related to the cyberattack and claiming they sustained excessive expenses because of the attack’s fallout.In addition, Odom and Dillman asserted in court filings that the company’s insurance arm, UnitedHealthcare, has in turn been denying claims to cover patient care for being submitted late.Lawmakers viewed the chaos caused by the cyberattack as a result of United’s seemingly insatiable desire to buy up companies like Change, alongside doctors’ practices and pharmacy businesses. The widespread disruption was a reminder of how deeply United’s sprawling subsidiaries had become embedded in the nation’s health care system.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Have you seen examples of health care fraud, waste or abuse? Tell us about it.

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      New York Times reporters are looking into cases of unnecessary and wasteful spending in government health programs.In 2023, companies billed Medicare for hundreds of thousands of urinary catheters that doctors never ordered. The next year, doctors collected billions from the government for pricey bandages that were sometimes unneeded.Medicare waste has wide-reaching consequences. Even if patients do not pay the bills themselves, more spending by the government insurance program can increase future premiums.The New York Times wants to better understand what fraud, waste and abuse looks like in today’s health care system. Are there other instances of wasteful spending we should be investigating? Tell us about them. We are especially interested in cases that involve federal health care programs, like Medicare, Medicaid and Veterans Affairs.We will follow up with you before publishing any part of your response or your name.Help us investigate health care waste, fraud and abuse More