Friends, sharing a recording of the live discussion I had with health care policy expert Charles Gaba from earlier today. I asked Charles to return to our community to talk about what to expect now that the big ugly has passed. While this is a wide-ranging discussion, Charles makes an important point that needs to be heard in the family right now - that Americans will feel the cuts and the damage being done to our health care long before the midterm elections next year.
Charles has just released a new analysis on the impacts of the budget bill, drawn largely from the work of the KFF, that finds “more than half of the health care related provisions will be fully or partially implemented before November 3rd, 2026.” Of greatest significance is the ending of the expanded ACA subsidies at the end of this year, something that will impact the price and access to care for tens of millions of Americans.
As we discuss it is important to recognize the totality of Trump’s assault our health care, as it goes far beyond cutting Medicaid:
Enormous cuts to medical research, weakening of our entire bio-medical research eco-system. These cuts and disruptions are already being felt now.
Dramatic undermining of the nation’s vaccine regime and other elements of our public health care system. Will become a far bigger issue when back to school that starts next month.
The dramatic weakening of the ACA and the private, individual insurance market. This begins in a few months and will impact tens of millions of Americans.
While the deep cuts into Medicaid begin mostly in 2027, all actors in our health care system will start taking the incredible loss of money from the system into account now. Layoffs, downsizing, closures have already begun.
Two final points. As we discuss the weakening of the ACA will give Americans far less leverage against their employers, and make it far harder for people to start their own businesses or become self-employed contractors. We have heard this from the Trump regime this week - best way to get health insurance is to “get a job.” It is no coincidence in my mind that the period of greatest new business formation in recent American history came at the same time we made health care more affordable. Easier to take risks, start new ventures if you know that health care will be there for you and your family no matter what. That era is ending.
As we discuss towards the end of our conversation what remains so hard to really understand is how the Trump regime became so comfortable with policies that will cause people to die. It began with the vaporization of USAID and the decision to let now an estimated 15m of the poorest people in the world, including 5m children, die. And now here, in the US, the Trump team is pursuing this across the board assault on our public health that will inevitably make the American people far less healthy, drive up costs and cause many, many people to die here, too. In an ugly time this is very ugly stuff and it is why we need to keep working as hard as we possibly can to fight all of this in days ahead.
So get to this informative conversation when you can. Like, subscribe and share with others, and let’s keep working hard all - Simon
Charles Gaba Bio
Health care policy analyst Charles Gaba is the founder of ACASignups.net, which has been live-tracking Obamacare enrollments since the exchanges launched in October 2013. His work has been cited by major publications from the Washington Post and Forbes to the New York Times as being the most reliable source available for up-to-date, accurate ACA enrollment data in the country.
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