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      Medicaid recipients fear ‘buzzsaw cuts’ for Trump’s agenda: ‘We’re not going to be alive forever’

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      At the age of 62, Marya Parral knows that her, and her husband’s, years of being able to care for their two developmentally disabled sons are numbered, and so they have done everything they can to ensure their children can continue to live independently.For their oldest, Ian, that’s meant placing him in a program on an organic farm that caters to people diagnosed with autism. For Joey, their youngest, who has both autism and Down syndrome, Parral has found a caregiver who can help him deliver newspapers and run errands around their community of Ocean City, New Jersey.Parral said none of this would be affordable without help from Medicaid, the federal government’s insurance program for poor and disabled Americans. But this week, the Republican-controlled House of Representatives approved a budget framework that would make deep cuts to the program, and Parral worries her sons will lose what she has worked so hard to build.“We’re not going to be alive forever. We’re trying to set up a life for them, but that entire life that we’re working so hard to set up for them is dependent on Medicaid,” Parral said. “So it’s really devastating to think about cuts.”Producing a budget is the first step in the Republican-controlled Congress’s drive to enact legislation that will pay for Donald Trump’s priorities. House lawmakers will now spend weeks working to write and pass a bill that is expected to approve $4.5tn in extended tax cuts, as well as funding for Trump’s plan for mass deportations of undocumented immigrants.To pay for it, Republicans are considering a rollback of the federal social safety net, particularly Medicaid, which has nearly 80 million enrollees in all 50 states. The budget plan proposes an $880bn reduction in funding for the insurance over the next 10 years, an amount that experts warn would hollow out the program and have ripple effects across the entire American healthcare system.Megan Cole Brahim, a professor at Boston University School of Public Health and an expert on Medicaid, said the cut was the largest ever proposed, and if enacted would “have far-reaching impacts not just for those who rely on Medicaid, but for entire communities and economies”.“These changes mean millions of Americans – including the low-income, elderly, persons with disabilities, children – will lose health insurance coverage,” she said. “Others may see significant reductions in benefits or limited access to care. The impact on hospitals and health systems will be significant, particularly for safety-net and rural hospitals, which are already on the brink of closure. Patient revenues will fall, uncompensated care will rise. There will be staff layoffs and site closures.”John Driscoll, a healthcare executive and chair of the board of UConn Health in Connecticut, said: “The scale of the buzzsaw cuts to Medicaid would undermine every hospital’s ability to actually support its mission to care for the community, and would be a dangerous cut to the nursing-home infrastructure in the country.”Republican leaders backed the cuts to Medicaid, as well as to similar programs such as one that helps poor Americans afford food, as a way to mollify lawmakers in their party who want the US’s large budget deficit addressed. Still, not everyone is pleased. As the budget was being debated, eight Republican representatives, some of whom Democrats are keen to unseat in next year’s midterm elections, wrote to the House speaker, Mike Johnson, warning that their districts’ large Hispanic populations would be harmed.“Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open,” they said.All eight ultimately voted for the resolution, but the dissent may be a warning sign for the budget’s prospects of enactment, particularly in the House, where the GOP has a mere three-seat majority. It also remains unclear whether Republicans will try to pass all of Trump’s priorities in one bill, or split them into two.The GOP has made clear they want to fully pay for the extension of Trump’s tax cuts, and Elyssa Schmier, vice-president of government relations for advocacy group MomsRising, said Medicaid and social safety programs are the party’s prime targets for cost savings.“If you’re not going to go after, say, the Pentagon budget, if they’re only going to go to some of these big mandatory spending programs, there’s only so many places that Republicans feel that they can go,” she said.In the days since the budget’s approval, Johnson and Trump have scrambled to downplay the possibility of slashing Medicaid, insisting they intend only to root out “fraud, waste and abuse.”“The president said over and over and over: ‘We’re not going to touch social security, Medicare or Medicaid.’ We’ve made the same commitment,” Johnson told CNN in an interview.Democrats have little leverage to stop the budget, which can be passed with simple majorities in both chambers. But the Democratic senator Ruben Gallego warned that gutting the social safety net to extend tax cuts that have mostly benefited the rich will alienate voters who sided with the GOP last November.“It will be on Donald Trump and Republicans, the fact that he’s going to side with the ultra-rich versus the working poor,” said Gallego, who won election to his seat in Arizona even as Trump captured the state’s electoral votes. “Families that are barely making a living, scratching a living, they’re now going to get kicked off healthcare to give tax cuts to the mega-rich.”The proposed cut to Medicaid would remove billions of dollars in funding from congressional districts nationwide that are represented by lawmakers from both parties, according to an analysis by the liberal Center for American Progress.In California’s San Joaquin valley, the Democratic representative Jim Costa’s district would lose the third-largest amount of funding, according to the data, and Medicaid coverage would be imperiled for more than 450,000 residents.“This reckless budget prioritizes the wealthy while devastating those who need help the most,” Costa said. “I voted no because this resolution is bad for our valley and a threat to the wellbeing of the people I represent.” More

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      The Unnecessary Suffering of Women With Obstetric Fistulas

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      One of the most dangerous things a woman can do in much of the world is become pregnant, and the risks caught up with a Kenyan named Alice Wanjiru a decade ago.Then 20 years old and pregnant for the first time, she suffered a childbirth injury called an obstetric fistula, caused by prolonged labor without access to a C-section to end it. This left her with a hole in the tissue between her rectum and her vagina, and for 10 years she endured the humiliation of continually leaking stool through her genital tract.“I could never get fully clean, for there was always some stool left,” she told me. “The other women would say, ‘She is the woman who stinks.’ I would ask God, ‘Why me? Why can’t I be like other women?’”Wanjiru bathed herself several times a day, fasted from morning until evening so there wouldn’t be much in her digestive tract during the day, and always wore a sanitary pad. Doctors misdiagnosed her, sex was a nightmare and her husband abandoned her after harshly accusing her of having poor hygiene.Shamed by the continuous odor, she withdrew from friends and stayed home from church and other gatherings. She endured her shame in solitude, year after year.Perhaps one million or two million women worldwide are enduring fistulas and leak stool or, more commonly, urine through their vaginas. These are typically impoverished women in poor countries where home births are the norm, who couldn’t get to a doctor in time for a needed C-section.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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      Republicans take aim at subsidies that help tens of millions of women

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      As they prepare to take control of the White House and Congress next month, conservatives are eyeing cutbacks to federal programs that help tens of millions of women pay for healthcare, food, housing and transportation.Slashing or overhauling social support programs, long a goal of Republican lawmakers, could be catastrophic for women experiencing poverty. Supporters contend the social safety-net programs are already grossly underfunded.“With this new administration that is coming in … I really am concerned about the lives of women. We are seeing so many policies, so many budget cuts,” said Christian Nunes, president of the National Organization for Women.Republicans say they want to keep campaign promises to cut government spending, and three major programs make easy targets: Medicaid, the joint state/federal health insurance program for people with lower incomes; Temporary Assistance for Needy Families (TANF), a cash-allowance program that replaced welfare; and the Supplemental Nutrition Assistance Program (Snap), widely known as food stamps.While conservatives frame cuts as making government more efficient and even restoring freedom, advocates for and experts on families with little or no income say reducing these programs will throw more people – especially women and children – further into poverty.“It is going to fall heavily on women,” said Elaine Waxman, a senior fellow in the Income and Benefits Policy Center at the Urban Institute, a non-profit research organization.Predicting precisely what Republicans in Congress and the Trump administration will do is difficult. Congressional leaders are close-mouthed about negotiations, and the president-elect has not finished putting together his advisory team. None of the spokespeople contacted for this story returned calls or e-mails.But organizations known to advise top leaders in Congress and the previous Trump administration have laid out fairly detailed roadmaps.Project 2025, the conservative Heritage Foundation’s blueprint for the incoming administration, denies its proposed changes will harm women, saying instead that marriage and “family values” will improve their economic situations. “Marriage, healthy family formation, and delaying sex to prevent pregnancy are virtually ignored in terms of priorities, yet these goals can reverse the cycle of poverty in meaningful ways,” reads the section on proposed changes to TANF and Snap.Numerous other groups that have studied the problem say forcing or even encouraging marriage will not make poverty disappear. And a recent study by a team at the University of South Carolina found that when state laws make it harder for pregnant women to get divorced, they’re more likely to be killed by their partners.Trump has promised not to attack the two most expensive and popular government programs: social security and Medicare. But he and Congress are up against a deadline to extend his 2017 tax reforms, which raised the federal deficit. They’ll have to cut something, and social spending programs, especially the $805bn Medicaid program, are low-hanging fruit for conservatives.Trump repeatedly tried to slash Snap during his last tenure in office: his 2021 budget proposal would have cut the program by more than $180bn – nearly 30% – over 10 years. Conservatives in Congress have continued these efforts and, with majorities in the House and Senate, they may be able to get them through next year.The Republican Study Committee, whose members include about three-quarters of the House Republican caucus, recommends more work requirements for Snap and TANF.“SNAP and our welfare system should embrace that work conveys dignity and self-sustainment and encourage individuals to find gainful employment, not reward them for staying at home,” their plan, released in March, reads.A large body of research questions whether widening work requirements does anything other than force people off benefits without helping them find employment. “I think there is a misperception that people in need of help are not working,” said Mei Powers, chief development and communications officer at Martha’s Table, a non-profit aid organization in Washington DC. “People are a paycheck, a crisis, a broken-down car away from needing services.”Snap currently helps 41 million people buy groceries and other necessities every month. Women accounted for more than 55% of people under 65 receiving Snap benefits in 2022, according to the National Women’s Law Center, a gender justice advocacy group. About one-third of them were women of color, the NWLC said.Among other things, cutting these programs will trap women in dangerous situations, the NWLC said: “SNAP helps survivors of domestic violence and sexual assault establish basic economic security.”TANF, which provides cash assistance, overwhelmingly benefits women. In 2022, 370,000 TANF adult recipients were female and 69,000 were male, according to the Department of Health and Human Services.Perhaps Medicaid is the most tempting target for conservatives because they can use it to undermine the Affordable Care Act, also known as Obamacare. The GOP has been gunning for the ACA since it was signed into law without a single Republican vote in 2010.The federal government shares the cost of Medicaid with states. The ACA aimed to make Medicaid cover more people by offering to pay for virtually all the extra costs. Many Republican-led states resisted for years, but as of November, all but 10 states had expanded coverage to an extra 21 million people, or about a quarter of all Medicaid recipients.Medicaid pays for more than 40% of births in the US, plus it covers new mothers for post-pregnancy-related issues for 60 days. It also pays for medical care for 60% of all nursing home residents, more than 70% of whom are women.According to the health research organization KFF, expanding Medicaid helped improve care for women before and during pregnancy and after they gave birth.But most Republicans in Congress have never approved of this federal spending. Proposed cuts to Medicaid funding, which would save hundreds of billions of dollars, are laid out by the Paragon Health Institute, a conservative health thinktank headed by Brian Blase, a top health adviser to the first Trump administration.Experts predict states would be unable or unwilling to make up the difference. “Facing such drastic reductions in federal Medicaid funding, states will have no choice but to institute truly draconian cuts to eligibility, benefits and provider reimbursement rates,” Edwin Park, research professor at Georgetown University, wrote in an analysis.That would mean women, children, older adults and people with disabilities would lose coverage as facilities closed and providers stopped seeing patients.The effects, says the National Organization for Women, “will be widespread, devastating, and long-lasting”.This story is published in partnership with the Fuller Project, a non-profit newsroom dedicated to the coverage of women’s issues around the world. Sign up for the Fuller Project’s newsletter. More

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      Breaking the Cycle of Childhood Poverty in New York

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      This is part of an Opinion series on The New York Times Communities Fund, which assists nonprofits that provide direct support to people and communities facing hardship. Donate to the fund here. .g-goldbergseriesinfo a { text-decoration: underline; color: inherit; text-decoration-thickness: 1px; text-underline-offset: 2px; } .g-goldbergseriesinfo{ position: relative; display: flex; overflow: hidden; box-sizing: border-box; padding: 1.125rem […] More

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      World Bank Warns of Record Debt Costs for Developing Countries

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      The World Bank warned in a new report that poor countries will be stuck in economic “purgatory” without debt relief.Soaring inflation saddled developing countries with a record $1.4 trillion in debt servicing costs last year, the World Bank said in a report published on Tuesday, detailing the precarious state faced by the world’s most vulnerable economies since the pandemic.As central banks around the world raised interest rates to slow rising prices, poor countries with already high debt burdens saw the interest payments on the money that they owed to creditors balloon. While principal balances held steady at around $951 billion, interest payments jumped by a third, to $406 billion. That has left more countries facing fiscal crises and struggling to avoid default.“These facts imply a metastasizing solvency crisis that continues to be misdiagnosed as a liquidity problem in many of the poorest countries,” Indermit Gill, the World Bank’s chief economist, wrote in the report. “It is easy to kick the can down the road, to provide these countries just enough financing to help them meet their immediate repayment obligations. But that simply extends their purgatory.”More than a dozen sovereign nations defaulted on their debt in the last three years, and more than 30 of the world’s poorest countries have experienced “debt distress,” according to the United Nations. In 2023, Belarus, Ghana, Lebanon, Sri Lanka and Zambia were all in default, according to Fitch Ratings.Global financial institutions such as the World Bank and the International Monetary Fund have been working with international lenders to help developing countries restructure their debt, but the process has been slow and painstaking. China, the world’s largest creditor, has been particularly reluctant to alter the terms of its loans as it grapples with its own economic challenges.The Biden administration has been critical of China’s lending practices. Treasury Secretary Janet L. Yellen described them as “opaque” in an interview with The New York Times in October in which she called for accelerating debt relief. She also raised the idea of helping nations find new sources of borrowing by creating coordinated aid packages for “high-ambition countries” that want to invest in clean energy projects.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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      A Loss and Damage Fund Is Taking Shape at COP Climate Talks

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      The U.N. climate summit in Azerbaijan has cleared the for way aid to flow when lower-income countries are hit.A long-awaited fund designed to help lower-income countries respond to natural disasters is finally taking shape at the U.N. climate conference in Baku, Azerbaijan.Wealthy nations agreed to create the fund at the 2022 climate summit in Sharm el Sheikh, Egypt, after decades of resistance. Last year, a group of nations, including the United States and the European Union, made the first financial commitments.Now, the fund has a leader and is looking to start distributing money within the next year.Ibrahima Cheikh Diong, who has Senegalese and American citizenship and has held roles at financial firms and at development banks, started this month as the inaugural executive director of the initiative, which is formally known as the Fund for Responding to Loss and Damage.At this year’s climate summit, known as COP29, formal agreements were signed that will allow the fund to begin formally receiving the money that has been pledged and to start distributing it soon. The fund is being managed by the United Nations, and the World Bank is serving as a financial trustee.Sweden this month became the latest country to make a pledge, with its $19 million contribution bringing total commitments to around $720 million.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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      ‘A once-in-a-generation change’: Oregon’s biggest city prepares for monumental overhaul of government

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      When voters in Portland, Oregon, head to the polls next month, they will be tasked not only with selecting new leaders, but also the implementation of a monumental overhaul of the city’s government.Two years ago, residents moved to fundamentally alter their local government structure and adopted what experts have described as some of the most “expansive voting reforms” undertaken by a major US city in recent decades. Come November, the city will use ranked-choice voting to elect a mayor and a larger, more representative city council as Portland moves from a commission form of government to one overseen by a city administrator.The shake-up comes after challenging years for Portland in which the city of 630,000 grappled with a declining downtown, rising homelessness, a fentanyl crisis, growing public drug use and the continued economic impacts of the pandemic years.While some news coverage has portrayed the shift as Portlanders rejecting the city’s historically progressive values, those involved with the project counter that residents are embracing democratic reforms that will lead to a more equitable government better equipped to solve the city’s problems.“It was really clear that this system was, as operated, very inequitable,” said Jenny Lee, managing director of Building Power for Communities of Color, a non-profit that was a key proponent of the effort.“And the challenges in governing are going to be felt the most by those who already have been marginalized in our political system.”Now the city waits to see what the “once-in-a-generation” change will mean for its future.Since 1913, Portland has used a commission form of government. The commission consisted of five people elected citywide and who were responsible for passing policies and also acting as administrators in charge of city departments.The system was briefly popular in other major US cities, but then largely abandoned, said Richard Clucas, a political science professor at Portland State University.“Most cities who adopted that form of government realized there were problems with it,” he said. “Someone may be good as a legislator but it doesn’t make them good as an administrator.”View image in fullscreenAnd Portland’s system had long failed to adequately represent different demographics in the city, Lee said. The city’s elected officials historically have been white men from more affluent areas where residents are more likely to have a higher income and own their homes, according to the Sightline Institute. In 2017, only two people of color had ever been elected to the city council.Under the charter system, simple decisions – such as where to put a bike lane – were politicized, said Shoshanah Oppenheim, the charter transition project manager.“It was based on the political tide,” said Oppenheim, who is also a senior adviser in the city administrator’s office.For more than a century, Portlanders rejected attempts to reform the commission system, but that changed when the 10-year review of the city charter coincided with upheaval and challenges of the pandemic years.The pandemic exacerbated the existing limitations of the city’s form of government, according to a report from Harvard’s Ash Center for Democratic Governance and Innovation chronicling Portland’s reforms.Meanwhile, Portland was the site of widespread racial justice protests and an ensuing federal crackdown, the city’s economic recovery from the pandemic was slow, and residents grew increasingly disillusioned with their leaders’ ability to make meaningful progress tackling homelessness and drug abuse.Those challenges created an opportunity to have meaningful conversations about elections and government, Lee said.Clucas echoed that sentiment: “I think the public was looking and happy to take on some sort of change.”skip past newsletter promotionafter newsletter promotionCommunity leaders had spent years educating themselves about electoral reform, and saw an opportunity to create change in the city, the report stated.With support from community organizations and local activists, the commission brought a measure before voters that would make key changes to the city’s system, allowing voters to rank local candidates in order of preference, expand the city council from five to 12 representatives elected from four newly created districts, and move to a system of government overseen by a professional city administrator.Despite criticism about the complexity of the measure and opposition from political leaders and the business community, 58% of voters approved the package of reforms proposed by the commission.Although the timing coincided with major changes and social issues, Lee said the reforms were not reactionary and instead an example of Portland being willing to try new things, which ties into Oregon’s long history of democratic reforms aimed at making government more participatory.“It was a message about change, but it was definitely a hopeful one,” she said. “It was always about these changes will make our government more effective and equitable.”The city has spent the last two years preparing for a project unlike anything Portland has seen before,Oppenheim said. “We had a really short timeline … It’s been an all-hands-on-deck approach,” she said. “There is no playbook. We are making it up as we go along.”Next month, voters will decided among more than 100 candidates for 12 council seats and 19 candidates for mayor. A recent poll from the Oregonian suggested a once-longshot candidate, whose campaign has focused on ending homelessness, is well positioned to win.In a poll of roughly 300 voters from early October, before election packets were sent out, two-thirds responded that they understood how voting works very well or somewhat well. People tend to understand the system right away given that they rank things every day, Oppenheim said.The city has also developed a voter education program to inform residents about the changes and trained operators on its information line how to explain ranked-choice voting.The hope is that voters will feel the increased power of their vote, Lee said. “Every vote has a lot of power. Your constituents’ voices really matter. Their second- and third-choice rankings actually really matter.”After the election, the other major test comes next year when Portland’s new government takes the reins. “We want to be ready on day one so all the city business can continue,” Oppenheim said.“Portlanders have huge expectations for change and we have a once-in-a-generation opportunity to do things better,” Oppenheim said. “They want a more representative government. We have it in our power to deliver that.” More

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      Trump and Harris Both Like a Child Tax Credit but With Different Aims

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      Kamala Harris’s campaign is pushing a version of the credit intended to fight child poverty, while Donald J. Trump sees the program primarily as a tax cut for people higher up the income scale.Vice President Kamala Harris has made an expanded child tax credit central to her campaign, and former President Donald J. Trump boasts, “I doubled the child tax credit.” With a quick look, voters might think the child-rearing subsidy the rare matter on which the rival candidates agree.It is anything but. The common vocabulary masks profound differences over which parents the government should help and what constitutes fairness for children in a country of great wealth and inequality.Mr. Trump sees the $110 billion program mostly as a tax cut, which as president he increased to $2,000 per child and extended to high-income families. But his policy denies the full benefit to the poorest quarter of children because their parents earn too little and owe no income tax.Ms. Harris would expand the tax cuts and add a large anti-poverty plan, sending checks to millions of parents with low pay or no jobs. That would turn a tax cut into an income guarantee, in a landmark expansion of the safety net.Supporters of the Harris plan say the payments would shrink child poverty. Critics see an expensive welfare scheme that could weaken the willingness to work.“They’re both talking about something called the ‘child tax credit,’ but they’re not at all talking about the same policy,” said Scott Winship of the conservative American Enterprise Institute.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