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    Why healthcare spending was at the center of the US government shutdown battle

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    The federal government shut down on Wednesday in part, due to a battle between Democrats and Republicans over healthcare spending.Democrats had said that they would not vote for legislation to keep the government open unless Donald Trump and Republicans, who hold the majority in Congress, agreed to reverse cuts to Medicaid and extend subsidies for Affordable Care Act plans. That did not respire in either of the votes in the Senate on Tuesday.In June, the US president approved legislation he calls his “big, beautiful bill”, which the Congressional Budget Office estimated would reduce federal Medicaid spending by $793bn and increase the number of uninsured people by 7.8 million.The savings in federal Medicaid spending will largely come from the implementation of the new requirements, which include completing 80 hours of work or community service activities per month, or meeting exemption criteria.The law also means that the premium tax credits implemented during the Covid-19 pandemic for insurance purchased through the Health Insurance Marketplace will expire at the end of 2025. That would make coverage more expensive and lead to 3.1 million more people without health insurance, according to the CBO.skip past newsletter promotionafter newsletter promotion“We are not going to support a partisan Republican spending bill that continues to gut the healthcare of everyday Americans,” Jeffries said following a negotiation with Trump and Republican leaders on Monday.Meanwhile, Trump doubled down during an Oval Office press conference on Tuesday that if the parties can’t reach an agreement, “we can do things during the shutdown that are irreversible, that are bad for them,” Trump said while speaking to reporters in the Oval Office on Tuesday afternoon. “Like cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”He did not mention Medicaid or the Affordable Care Act but said: “We can do things medically and other ways, including benefits.”Still, there could be an opening for negotiation in coming weeks. The Senate majority leader, John Thune, said on the Senate floor on Tuesday that the Democrats should vote to keep the government open until 21 November and that he would be happy to fix the “ACA credit issue” before the credits expire at the end of the year. More

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      Now’s the time for Democrats to hammer Trump on the economy | Lloyd Green

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      “Economic Growth Shatters Expectations as President Trump Fuels America’s Golden Age,” the White House announced on Wednesday. But within 48 hours, the data told a very different story, giving the Democrats a badly needed opening if they can muster the competence and focus to seize upon it.On Thursday, the US commerce department announced that inflation had ticked up to 2.6%. A day later, the labor department reported that unemployment had risen to 4.2% in July, and that the US had actually gained 258,000 fewer jobs than previously reported.From the looks of things, Donald Trump and his tariffs are damaging the economy. Suddenly, things aren’t looking so hot.Rather than copping to a screw-up, however, the president immediately laid blame elsewhere. In a barrage of posts on social media, he lambasted Jerome Powell, the chair of the Federal Reserve, attacked his intelligence and again threatened his tenure at the Fed.The president trashed Powell, who he appointed, as “a stubborn MORON”. Adding insult to injury, Trump brayed: “IF HE CONTINUES TO REFUSE, THE BOARD SHOULD ASSUME CONTROL, AND DO WHAT EVERYONE KNOWS HAS TO BE DONE!”But things didn’t end there. The tantrum continued unabated.Hours later, Trump grabbed another page from the strongman playbook and fired Erika McEntarfer, the head of the Bureau of Labor Statistics. He suggested that she had cooked the books and was essentially giving aid and comfort to Joe Biden, the man who first appointed her.As we know, there is reality and then there is Trump’s version of reality.At Friday’s final bell, the Dow had dropped more than 540 points and the Nasdaq was down 2.24%. The ghost of Trump’s so-called “liberation day” had returned to haunt the markets, giving the Democrats ample material to work with.Already, the One Big Beautiful Bill Act places Trump and the Republicans at odds with their base and with swing voters. According to a Wall Street Journal poll, 70% of the US believes the act benefits the rich. Beyond that, the tax plan is underwater with the public, 42-52, and is disfavored by a majority of independents.Practically speaking, the Congressional Budget Office projected in June that nearly 8 million people would lose their insurance under the Trump-backed bill. For the current iteration of the GOP, that’s a problem. These days, Republican voters tilt working class. Many of them break economically liberal and socially conservative.This why House Republicans danced around the issue of coming Medicaid cuts. They stand to harm their own voters. And they know it.Take Mike Lawler, a representative from New York’s Hudson Valley. More than 200,000 of his constituents receive Medicaid benefits. Town halls in his district have become rowdy events, with the police hauling out a constituent.Lawler claims to have “fought extensively to make sure that there were not draconian changes to Medicaid”.“At the end of the day, this is about strengthening the program,” Lawler added. Uh, that’s why he needed the cops.More than 64 Republican House members represent districts where Medicaid rates exceed the national average, according to CNN. In those seats, five incumbents won last November by five points or fewer.But the GOP’s problems don’t end with Medicaid. These days, social security, the most sacrosanct legacy of the New Deal, may be in the crosshairs of Team Trump.On Wednesday, Scott Bessent, the treasury secretary, acknowledged the so-called “Trump accounts” created for kids by the One Big Beautiful Bill Act were actually a “back door for privatizing social security”.The accounts are designed as a vehicle for Americans to build and accumulate wealth as soon as they are born. Under the new law, newborns will be eligible to receive $1,000 from Uncle Sam.“Social security is a defined benefit plan paid out,” Bessent explained. “To the extent that if all of a sudden these accounts grow, and you have in the hundreds of thousands of dollars for your retirement, then that’s a gamechanger.”As a candidate and then again in office, Trump had pledged to leave social security untouched. Now that pledge is in doubt.In 2024, the Republicans made the economic failures of the Biden-Harris administration central to their campaigns. The Trump-Vance campaign raked the Democrats over the coals over inflation. In politics, turnabout is fair play. It is time for the Democrats to show that they actually care about the average voter.

      Lloyd Green is an attorney in New York and served in the US Department of Justice from 1990 to 1992 More

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      Judge orders Trump administration to continue Medicaid funding to Planned Parenthood

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      The Trump administration must continue reimbursing Planned Parenthood clinics for Medicaid-funded services, a federal judge ruled on Monday, in an escalating legal war between the reproductive health giant and the White House over Republican efforts to “defund” Planned Parenthood.Days after Donald Trump signed his sweeping tax bill, Planned Parenthood sued over a provision in the bill that ended Medicaid payments for one year to abortion providers that received more than $800,000 from Medicaid in 2023, such as Planned Parenthood. The new court order, from US district judge Indira Talwani in Boston, will protect Medicaid funding for all Planned Parenthood clinics nationwide while litigation in the case continues.The order also replaces and expands a previous edict handed down by Talwani, which initially granted a preliminary injunction specifically blocking the government from cutting Medicaid payments only to Planned Parenthood affiliates that did not provide abortions or did not receive at least $800,000 in Medicaid reimbursements in a given year.“Patients are likely to suffer adverse health consequences where care is disrupted or unavailable,” Talwani wrote in her Monday order.“In particular, restricting members’ ability to provide healthcare services threatens an increase in unintended pregnancies and attendant complications because of reduced access to effective contraceptives, and an increase in undiagnosed and untreated STIs.”More than 80 million people rely on Medicaid, the US government’s insurance program for low-income people.It is already illegal to use Medicaid to pay for most abortions, but Planned Parenthood clinics – which treat a disproportionate number of people who use Medicaid – rely on the program to reimburse it for services such as birth control, STI tests and cancer screenings.In its lawsuit, Planned Parenthood had argued that it would be at risk of closing nearly 200 clinics in 24 states if it is cut off from Medicaid funds. These closures would probably be felt most strongly in blue states, since they are home to larger numbers of people who use Medicaid. A Planned Parenthood affiliate in California has already been forced to close five clinics as a result of the “defunding” provision.Planned Parenthood estimated that, in all, more than 1 million patients could lose care.“We will keep fighting this cruel law so that everyone can get birth control, STI testing and treatment, cancer screenings and other critical healthcare, no matter their insurance,” the Planned Parenthood Federation of America’s president and CEO, Alexis McGill Johnson, said in a statement after the Monday ruling.Planned Parenthood is battling overwhelming political and economic headwinds. Even if it prevails against the Trump administration, its affiliates could still be removed from Medicaid in red states, thanks to a June decision by the US supreme court in favor of South Carolina in a case involving the state’s attempt to kick Planned Parenthood out of its Medicaid program.  On Monday, the state of Missouri also sued the Planned Parenthood Federation of America – the mothership organization that knits together Planned Parenthood’s network of regional affiliates – over accusations that the organization downplayed the medical risks of a common abortion pill, mifepristone, “to cut costs and boost revenue”. The lawsuit, which asks for more than $1m in damages, is part of an ongoing campaign by anti-abortion activists to cut off access to mifepristone.More than 100 studies, conducted across dozens of countries and over more than three decades, have concluded that mifepristone is a safe way to end a pregnancy.The Associated Press contributed reporting 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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      ‘Morally Offensive and Fiscally Reckless’: 3 Writers on Trump’s Big Gamble

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      Frank Bruni, a contributing Opinion writer, hosted a written online conversation with Nate Silver, the author of “On the Edge: The Art of Risking Everything” and the newsletter Silver Bulletin, and Lis Smith, a Democratic communications strategist and author of the memoir “Any Given Tuesday: A Political Love Story,” to discuss the aftermath of the passage of President Trump’s One Big, Beautiful Bill.Frank Bruni: Let’s start with that megabill, the bigness of which made the consequences of its enactment hard to digest quickly. Now that we’ve had time to, er, chew it over, I’m wondering if you think Democrats are right to say — to hope — that it gives them a whole new traction in next year’s midterms.I mean, the most significant Medicaid cuts kick in after that point. Could Trump and other Republicans avoid paying a price for them in 2026? Or did they get much too cute in constructing the legislation and building in that delay and create the possibility of disaster for themselves in both 2026 and 2028, when the bill’s effect on Medicaid, as well as on other parts of the safety net, will have taken hold?Lis Smith: If history is any guide, Republicans will pay a price for these cuts in the midterms. In 2010, Democrats got destroyed for passing Obamacare, even though it would be years until it was fully implemented. In 2018, Republicans were punished just for trying to gut it. Voters don’t like politicians messing with their health care. They have been pretty consistent in sending that message.I’d argue that Democrats have an even more potent message in 2026 — it’s not just that Republicans are messing with health care, it’s that they are cutting it to fund tax cuts for the richest Americans.Nate Silver: What I wonder about is Democrats’ ability to sustain focus on any given issue. At the risk of overextrapolating from my home turf in New York, Zohran Mamdani just won a massive upset in the Democratic mayoral primary by focusing on affordability. And a message on the Big, Beautiful Bill could play into that. But the Democratic base is often more engaged by culture war issues, or by messages that are about Trump specifically — and Trump isn’t on the ballot in 2026 — rather than Republicans broadly. The polls suggest that the Big, Beautiful Bill is extremely unpopular, but a lot of those negative views are 1) among people who are extremely politically engaged and already a core Democratic constituency, or 2) snap opinions among the disengaged that are subject to change. Democrats will need to ensure that voters are still thinking about the bill next November, and tying it to actual or potential changes that affect them directly and adversely.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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      Vance Tries to Sell the Benefits of Trump’s Megabill but Ignores the Costs

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      In a visit to Pennsylvania, Vice President JD Vance stressed tax cuts and savings accounts for newborns, with no mention of trims to Medicaid and nutritional assistance programs many Trump voters rely on.Vice President JD Vance traveled to a crucial swing state on Wednesday to sell the Trump administration’s signature domestic policy legislation as a victory for working American families, despite concerns even among some Republicans over its cuts to the safety net in service of benefiting the rich.In what amounted to an attempted brand relaunch of legislation that Democrats have framed as an attack on the middle class, Mr. Vance traveled to a machine shop in eastern Pennsylvania to spotlight provisions in the package that would cut taxes, preserve overtime pay and create $1,000 savings accounts for newborns. Left unmentioned by Mr. Vance were the cuts to Medicaid and the nutritional assistance programs that many of Mr. Trump’s own supporters rely on.“I think this will be transformational for the American people,” Mr. Vance said in front of signs that read “No tax on tips” and “America is back.” The vice president appealed to those in attendance to help the administration sell the package ahead of next year’s midterm elections, arguing that it would benefit Americans like those working in the manufacturing facility serving as his backdrop.“We’re going to invest in American workers and American families every single day,” Mr. Vance added. “That’s my solemn promise to every single person in this room.”Selling the bill is likely to be an uphill climb, particularly after Republicans provided Democrats a series of sound bites expressing concern over how Medicaid cuts would hurt their constituents. While polls show the bill is broadly unpopular, it is difficult to say how much it will influence voters in future elections. Still, six out of 10 Americans find the package unpopular, according to a recent CNN poll. Roughly 58 percent of Americans said Mr. Trump had gone too far in cutting federal programs.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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      Schumer Says Trump Bill Boosts Democrats’ Hopes in 2026 Midterm Elections

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      The top Senate Democrat said the law would lead to widespread pain for voters, imperiling Republicans who supported it and allowing his party more openings to contest control of the Senate.Senator Chuck Schumer, Democrat of New York and the minority leader, said Thursday that the passage of President Trump’s domestic policy agenda had boosted Democrats’ hopes of claiming the Senate majority in the 2026 midterm elections, handing them a winning economic message as they seek to contest an expanded map of states around the country.“The three issues we’re going to most campaign on: costs, jobs, and health care,” Mr. Schumer said in an interview at the Democratic Senatorial Campaign Committee headquarters, across the street from the Capitol. “Those affect average people and every state.”He argued that the sweeping law to extend tax cuts and slash social safety net programs would hurt not just those who rely on Medicaid — which will be cut by nearly $1 trillion — but by a broad swath of Americans. “It’s going to raise insurance costs even if you don’t have Medicaid,” he said. “Your electricity costs will go up by 10 percent. Even not poor people, it goes across the board. And it’s hitting at the same time that your costs are going up because of tariffs.”As they search for ways to connect with voters ahead of the midterm elections, House and Senate Democrats have been poring over polling and research that shows their likely best bet is focusing on the Republicans’ cuts to health care and food assistance programs for working people in order to help pay for tax cuts that provide the biggest benefits to the wealthy.A recent poll conducted by Blue Rose Research on behalf of the Senate Majority PAC, an outside group aligned with Democrats, found that 50 percent of voters said they were less likely to support their representative in the upcoming election if he or she had voted for the bill. That number included 49 percent of swing voters and 17 percent of voters who supported Mr. Trump in the 2024 election.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’s big beautiful betrayal – podcast

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      On 4 July – as Americans celebrated their country’s independence – Donald Trump signed into law his sweeping tax and spending bill.Trump’s ‘Big Beautiful Bill’, as he and fellow Republicans call it, is a sprawling piece of legislation covering everything from tax cuts to border walls to repealing environmental protections, the Guardian US’s chief reporter, Ed Pilkington, explains.But for a president who normally rules by executive order, the act perhaps tells us better than anything so far what he wants to achieve in office. ‘It enshrines what Trump wants to do in his second term,’ says Pilkington.Most controversially, it includes enormous tax breaks for the country’s super-wealthy, while making swingeing cuts to social welfare programmes used by its poor. More than 10 million US citizens are expected to lose access to Medicaid – despite Trump’s continued insistence since coming into office that he would not touch the service.So, asks Michael Safi, why is Trump doing it? And will it cost him the support of the millions of poorer Americans, who came out to vote for him last year? More

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      Planned Parenthood sues Trump administration over funding cuts in big bill

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      Planned Parenthood sued the Trump administration on Monday over a provision in Donald Trump’s sweeping domestic policy bill that would strip funding from health centers operated by the reproductive healthcare and abortion provider.In a complaint filed in Boston federal court, Planned Parenthood said the provision was unconstitutional, and its clear purpose is to prevent its nearly 600 health centers from receiving Medicaid reimbursements.Planned Parenthood said that would have “catastrophic consequences”, given that the health centers serve more than 1 million patients annually through Medicaid, the US government’s insurance program for low-income people. More than 80 million people use Medicaid.“The true design of the Defund Provision is simply to express disapproval of, attack, and punish Planned Parenthood, which plays a particularly prominent role in the public debate over abortion,” Planned Parenthood said in its lawsuit.The lawsuit continued: “Stripping away this patient volume and reimbursements for care provided will result in the elimination of services, laying off staff and health center closures. The public health consequences for Medicaid patients and non-Medicaid patients alike will be dire and compounding.”The organization has estimated that the defunding could force roughly 200 Planned Parenthood clinics to shutter. Blue states, which are home to more people on Medicaid, would probably see a disproportionate number of closures.Since it is illegal to use Medicaid to pay for most abortions, Planned Parenthood clinics rely on the insurance program to reimburse them for providing services like birth control, STI tests and cancer screenings. But if blue-state clinics are forced to close, people will no longer be able to seek abortions at those clinics – a possibility that has led some abortion rights supporters, including Planned Parenthood, to call the Trump bill’s provision a “backdoor abortion ban”. Planned Parenthood provides an estimated 38% of US abortions.“We’re facing a reality of the impact on shutting down almost half of abortion-providing health centers,” Alexis McGill Johnson, Planned Parenthood Federation of Americas’s CEO, told the Guardian last week. “It does feel existential. Not just for Planned Parenthood, but for communities that are relying on access to this care.”Planned Parenthood’s lawsuit asks the courts to declare the Trump bill’s provision unconstitutional on numerous grounds, or to at least preserve Medicaid funding for Planned Parenthood clinics that do not provide abortions. The reproductive health giant suggests in the lawsuit that Congress did not understand its structure when it passed the provision. The Planned Parenthood technically consists of a mothership group, Planned Parenthood Federation of America, and nearly 50 regional affiliate groups that operate as independent entities.Medicaid is overseen by the Centers for Medicare & Medicaid Services, part of the US Department of Health and Human Services. That agency did not immediately respond to requests for comment.Planned Parenthood is being buffeted by intense financial headwinds. This spring, the Trump administration froze tens of millions of dollars earmarked for family planning providers who participate in Title X, the nation’s largest family planning program. Although several of those providers have since had their funding restored, a Planned Parenthood spokesperson said last week their affiliates had not received funding.The US supreme court also ruled in late June in favor of South Carolina in a case involving the state’s attempt to kick Planned Parenthood out of its state Medicaid reimbursement program. Red states may see that ruling as a blessing to their own efforts to defund Planned Parenthood.Even if Planned Parenthood’s Monday lawsuit succeeds, the organization will probably have to grapple with the consequences of that supreme court ruling for years to come. More