5 ms·

CA, NY Attorneys General sue to resume federal funding of Medicaid, FEMA, PEPFAR

70 points by basementcat 2y ago

ceejayoz 2y ago
I really thought they'd take a little longer than week two to fuck with big programs like Medicaid. I guess we're speed running this thing. That's healthcare for 85M people and half the births in the country.
- jfengel 2y ago
  They've been working on this for years. They weren't prepared in 2017; they never expected to have this much power. This time they knew what they were getting, and had all the ducks lined up in a row. And it's still just getting started.
  - morkalork 2y ago
    They've definitely learned a lesson from last time where they lost their majority in the midterms.
    - bluGill 2y ago
      "they" will lose their majority far sooner than that. Everyone up for election in the midterm (the entire house) is going to be worried that if they don't defect not they will be voted out. Of course they are balancing that against those who vote against them for defecting. Still I expect to see defections happen in a couple months.
      - jfengel 2y ago
        I don't expect to see very many defections. This is what the voters asked for. I don't see the voters changing their minds. Nor do I see any of them developing a conscience. If they do, there is a very good chance that they will lose a primary challenge. The legislature may change hands just because it's closely balanced and things do tend to swing a bit. It's not so much about voters switching, as about small amounts of turnout making a big difference. So as far as I can tell, expect to see more of exactly what we were told was going to happen.
        swivelmaster 2y ago
        I don't think we'll see defections per se, but we will see some "retiring to spend more time with the family" or "looking for new opportunities in the private sector."
      - ceejayoz 2y ago
        > Still I expect to see defections happen in a couple months. I don't. Trump just pardoned 1,500 people for attacking Congress. Who's gonna defect when it means a noose outside your office with zero consequences?
        morkalork 2y ago
        There's also been explicit threats that the doge man will bankroll contenders to primary anyone who defects.
        bluGill 2y ago
        the incumbant has a big advantage and so it isn't hard to beat that. Besides the reason they will defect is fear of loss - those who defect are likely aware that they won't get reelected if they don't. They might lose a primary but if whoever wins support trump they are unlikely to win. That is the whole point of defecting - if you don't you lose for sure.
jfengel 2y ago
I really wish I could say, "Let it happen and show people what they voted for". But that's abominable. So what we're going to get instead is adversarial: horrors are called for, everybody else has to fight to minimize them, and so only some horrifying things happen. And for a lot of people, as long as those horrors don't affect them directly, they'll say that everything worked the way it was supposed to. So, adversarial is what it's going to be, then. Onward.
- TechRemarker 2y ago
  Unfortunately, "letting it happen" other than of course many people potentially suffering or dying, it presumably wouldn't have much of an affect on voters, as it would simply be spun that it's somehow the previous Administrations fault, or the other parties fault etc. Thankfully we still have the courts, even as more bias judges get seated.
  - jprete 2y ago
    I don't think anyone would not give the new administration credit or blame after they came out of the gate wrecking-ball style.
    - ceejayoz 2y ago
      The Daily Show's Jordan Klepper had a sad clip of a Trump supporter demanding to know where President Obama was during Katrina, and that he should be investigated for his failures. (The answer, of course, is "he was a state Senator in Illinois at the time".)
      - Freedom2 2y ago
        I'm on the fence about this kind of talk, to be honest. I ask myself sometimes, is it fair to demean those who have been let down by the state they were educated in? I know that generally Americans are uninspired and under educated, but a lot of that comes from systematic and cultural issues rather than it being a fault of the person itself.
msie 2y ago
Trump has no humanity.
Applejinx 2y ago
In terms of game theory, I'm very interested to see where this ends up. It's difficult to know what constitutes standing under the circumnstances: certainly if the system of government isn't wildly changed, this makes sense. If it is wildly changed, what to? And in light of that, do the attorneys general have any role in what might not be entirely a legal question?
blackeyeblitzar 2y ago
[flagged]
- deleted 2y ago
  [deleted]
- Fauntleroy 2y ago
  Are you really trying to equate the importance of healthcare and gun ownership?
- ceejayoz 2y ago
  > California leaders also took no issue when the prior federal administration pressured tech companies to censor speech on their behalf, which was a massive violation of first amendment rights. Even this SCOTUS knows that's a bullshit assertion. https://www.scotusblog.com/2024/06/justices-side-with-biden-over-governments-influence-on-social-media-content-moderation/ https://www.scotusblog.com/2024/06/justices-side-with-biden-...
dgfitz 2y ago
Sincere and probably very naive question: won't this put a squeeze on insurance companies?
- ceejayoz 2y ago
  No. Medicaid is the insurer.
  - nradov 2y ago
    Well yes and no. Many state Medicaid agencies outsource at least some of their plans to commercial insurers. Sometimes there is a degree of risk sharing between the entities. https://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx https://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.a...
- adamcblodgett 2y ago
  It will put the squeeze on the doctors and medical facilities. There are reports already that doctors can't access the payment portal for the work that they're doing.
- dragonwriter 2y ago
  > Sincere and probably very naive question: won't this put a squeeze on insurance companies? To the extent that many state Medicaid plans rely to some degree on private insurance providers as the direct insurers, and those private insurers receive monthly capitation payments from the state, possibly, though for Medicaid specifically the direct impact would be to the states, who are the direct recipients of the federal dollars as reimbursement for the federal share of the joint state-federal program. But Medicaid is typically a very large portion of state spending, and the federal share of Medicaid costs varies by state and subprogram but is at least 50% -- so if reimbursement stops it produces a cash flow problem very quickly.
MPSFounder 2y ago
It amazes me how much the bottom and middle class are infatuated with Trump. I recall seeing him in NYC with a look of disgust when he passed by doormen. The guy never said hello, and grew up with a sense of entitlement that is truly mesmerizing. The guy ripped off students with a scam college a la Andrew Tate. Yet, I saw an older gentleman just this morning wearing a white MAGA hat, and driving an old rusted truck. I am dumbfounded really. He is denying funding for these programs while siphoning our taxes into his golf resorts. Utterly disgraceful, yet half the country wanted him. I wish I could understand the delusion people go through. Mental gymnastics that is worthy of graduate studies. I now understand how people can live under Stalinist and Nazi regimes. The ridiculous becomes mundane
- shafyy 2y ago
  People in power spend a lot of money and effort for propaganda so that middle and lower class people think what they do is actually good for them. "I can become rich too, and then I also don't want to pay taxes and yield power with impunity" Also, they keep working class folks occupied with work and just poor enough, so that working class people don't have time to engage in politics, don't have time too think too much about the future, and mainly worry about paying this month's rent and feeding their families. So, I don't blame the people, I blame the system that working exactly as designed. Question is, how can we change this system?
- SpicyLemonZest 2y ago
  I really encourage people to look at it from the opposite angle. What does that older gentleman dislike so much about the status quo that he’d rather engage in strenuous mental gymnastics than accept it? I don’t claim to have the one true answer, but I bet you can identify a couple plausible ones.
  - MPSFounder 2y ago
    I agree with your sentiment. It is just hard for me to comprehend how a billionaire who's shown time and time again he cares little for normal folks, can have such an impact on their perception. His cabinet was filled with billionaires with country club membership. This is easily accessible info. Normal folks would rather elect those who deny them entry to that club, because of how they feel about the status quo. Not sure how this is the answer. I bet if their social security was cut in half, they would see it as a force of good because Trump said so. Amazing really. If that's not a cult of personality, I don't know what is
legitster 2y ago
https://www.whitehouse.gov/fact-sheets/2025/01/923/ https://www.whitehouse.gov/fact-sheets/2025/01/923/ > Q: Is this a freeze on all Federal financial assistance? > A: No, the pause does not apply across-the-board. It is expressly limited to programs, projects, and activities implicated by the President’s Executive Orders, such as ending DEI, the green new deal, and funding nongovernmental organizations that undermine the national interest. This administration is playing Calvinball. What funding does or does not qualify is being completely made up on the spot. But before you dismiss it as bluster and sabre rattling, the administration is already dealing out retribution for those who "don't comply": https://www.npr.org/sections/goats-and-soda/2025/01/27/nx-s1-5276382/trump-usaid-leave-executive-order https://www.npr.org/sections/goats-and-soda/2025/01/27/nx-s1... As an extra layer on dumbness, because the administration is stupid like a fox, they get to walk back anything they want to. They could decide next week that FEMA was never actually cancelled, and they will walk up to a podium and accuse everyone of overreacting and the news for lying. Despite the fact that they controlled the narrative the entire time.
Karrot_Kream 2y ago
[flagged]
- msie 2y ago
  What Trump does affects EVERYBODY. It cannot be ignored.
  - Karrot_Kream 2y ago
    Okay so is your view that I need to view it on every single English language site with user-submitted content?
    - ceejayoz 2y ago
      My view is that there are 30 slots on the HN home page, and a scroll bar.
    - morkalork 2y ago
      I look forward to the insightful analysis here that sites like reddit don't have because they're all in crisis meltdown mode.
    - SpicyLemonZest 2y ago
      I think you’re going to, and if you’d prefer not to you’re taking up the complaint with the wrong people. I’m far from an “everything is politics” guy, but it would be very HN-worthy if the government paused all emergency funding for some other reason, and it doesn’t become less so because it’s happening as part of a political program.
- kevingadd 2y ago
  Federal funding freezes probably have a real tangible impact on the day to day of YC readers since research programs often rely on federal funding. Cybersecurity programs and government agency security are also impacted by freezes and targeted "DEI" purges. I've also personally had someone confirm this particular rumor for me: https://bsky.app/profile/molly.wiki/post/3lgr5oarums2c https://bsky.app/profile/molly.wiki/post/3lgr5oarums2c You can decide how you feel about outsiders strolling into federal agencies and hooking up random hardware to the network. It makes me nervous! A compromise of critical government infrastructure could destabilize the economy and could jeopardize most of our jobs.
bayareabadboy 2y ago
Politics aside, it’s pretty incredible that 85M people are on Medicaid. Feel like something is gonna give in our health care system. This doesn’t seem sustainable.
- ceejayoz 2y ago
  More people on Medicaid (which the ACA added ~10M to) is, fiscally, a good thing. It's probably the closest we'll come to a public option for a while. https://www.cbpp.org/research/correcting-seven-myths-about-medicaid https://www.cbpp.org/research/correcting-seven-myths-about-m... > Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status. For example, adults on Medicaid cost about 22 percent less than if they were covered by private insurance, Urban Institute research shows. > Over the past 30 years, Medicaid costs per beneficiary have essentially tracked costs in the health care system as a whole, public and private. In fact, costs per beneficiary grew more slowly for Medicaid than for private insurance between 1987 and 2017, and are expected to continue growing more slowly than for private insurance in coming years, according to the Medicaid and CHIP Payment and Access Commission.
- taeric 2y ago
  Medicaid is reportedly well run, though? Yes, it is a big number, but it has not been the source of any budget problems. Quite the contrary, it has been a good lever in controlling health care costs.
- nradov 2y ago
  Right, healthcare costs have been growing faster than overall inflation for many years and the industry now constitutes 17.6% of GDP. If it goes much higher it's going to start displacing more essential industries. So obviously costs will eventually be cut somehow. That will probably be some combination of care rationing, provider wage cuts, and prescription drug price fixing. Regardless of whether anyone thinks those measures are good ideas or not, the math is inescapable. My guess is that the crisis will come when large self-insured employers refuse to continue absorbing most of the annual cost increases for employee health plans. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical https://www.cms.gov/data-research/statistics-trends-and-repo...
toomuchtodo 2y ago
IAS statement: PEPFAR freeze threatens millions of lives - https://www.iasociety.org/ias-statement/pepfar-freeze-threatens-millions-lives https://www.iasociety.org/ias-statement/pepfar-freeze-threat... - 25 January 2025

70 points by basementcat 2y ago

I really thought they'd take a little longer than week two to fuck with big programs like Medicaid. I guess we're speed running this thing. That's healthcare for 85M people and half the births in the country.

jfengel 2y ago
They've been working on this for years. They weren't prepared in 2017; they never expected to have this much power. This time they knew what they were getting, and had all the ducks lined up in a row. And it's still just getting started.
- morkalork 2y ago
  They've definitely learned a lesson from last time where they lost their majority in the midterms.
  - bluGill 2y ago
    "they" will lose their majority far sooner than that. Everyone up for election in the midterm (the entire house) is going to be worried that if they don't defect not they will be voted out. Of course they are balancing that against those who vote against them for defecting. Still I expect to see defections happen in a couple months.
    - jfengel 2y ago
      I don't expect to see very many defections. This is what the voters asked for. I don't see the voters changing their minds. Nor do I see any of them developing a conscience. If they do, there is a very good chance that they will lose a primary challenge. The legislature may change hands just because it's closely balanced and things do tend to swing a bit. It's not so much about voters switching, as about small amounts of turnout making a big difference. So as far as I can tell, expect to see more of exactly what we were told was going to happen.
      - swivelmaster 2y ago
        I don't think we'll see defections per se, but we will see some "retiring to spend more time with the family" or "looking for new opportunities in the private sector."
    - ceejayoz 2y ago
      > Still I expect to see defections happen in a couple months. I don't. Trump just pardoned 1,500 people for attacking Congress. Who's gonna defect when it means a noose outside your office with zero consequences?
      - morkalork 2y ago
        There's also been explicit threats that the doge man will bankroll contenders to primary anyone who defects.
        bluGill 2y ago
        the incumbant has a big advantage and so it isn't hard to beat that. Besides the reason they will defect is fear of loss - those who defect are likely aware that they won't get reelected if they don't. They might lose a primary but if whoever wins support trump they are unlikely to win. That is the whole point of defecting - if you don't you lose for sure.

jfengel 2y ago

I really wish I could say, "Let it happen and show people what they voted for". But that's abominable. So what we're going to get instead is adversarial: horrors are called for, everybody else has to fight to minimize them, and so only some horrifying things happen. And for a lot of people, as long as those horrors don't affect them directly, they'll say that everything worked the way it was supposed to. So, adversarial is what it's going to be, then. Onward.

TechRemarker 2y ago
Unfortunately, "letting it happen" other than of course many people potentially suffering or dying, it presumably wouldn't have much of an affect on voters, as it would simply be spun that it's somehow the previous Administrations fault, or the other parties fault etc. Thankfully we still have the courts, even as more bias judges get seated.
- jprete 2y ago
  I don't think anyone would not give the new administration credit or blame after they came out of the gate wrecking-ball style.
  - ceejayoz 2y ago
    The Daily Show's Jordan Klepper had a sad clip of a Trump supporter demanding to know where President Obama was during Katrina, and that he should be investigated for his failures. (The answer, of course, is "he was a state Senator in Illinois at the time".)
    - Freedom2 2y ago
      I'm on the fence about this kind of talk, to be honest. I ask myself sometimes, is it fair to demean those who have been let down by the state they were educated in? I know that generally Americans are uninspired and under educated, but a lot of that comes from systematic and cultural issues rather than it being a fault of the person itself.

msie 2y ago

Trump has no humanity.

Applejinx 2y ago

In terms of game theory, I'm very interested to see where this ends up. It's difficult to know what constitutes standing under the circumnstances: certainly if the system of government isn't wildly changed, this makes sense. If it is wildly changed, what to? And in light of that, do the attorneys general have any role in what might not be entirely a legal question?

blackeyeblitzar 2y ago

[flagged]

deleted 2y ago
[deleted]
Fauntleroy 2y ago
Are you really trying to equate the importance of healthcare and gun ownership?
ceejayoz 2y ago
> California leaders also took no issue when the prior federal administration pressured tech companies to censor speech on their behalf, which was a massive violation of first amendment rights. Even this SCOTUS knows that's a bullshit assertion. https://www.scotusblog.com/2024/06/justices-side-with-biden-over-governments-influence-on-social-media-content-moderation/ https://www.scotusblog.com/2024/06/justices-side-with-biden-...

dgfitz 2y ago

Sincere and probably very naive question: won't this put a squeeze on insurance companies?

ceejayoz 2y ago
No. Medicaid is the insurer.
- nradov 2y ago
  Well yes and no. Many state Medicaid agencies outsource at least some of their plans to commercial insurers. Sometimes there is a degree of risk sharing between the entities. https://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx https://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.a...
adamcblodgett 2y ago
It will put the squeeze on the doctors and medical facilities. There are reports already that doctors can't access the payment portal for the work that they're doing.
dragonwriter 2y ago
> Sincere and probably very naive question: won't this put a squeeze on insurance companies? To the extent that many state Medicaid plans rely to some degree on private insurance providers as the direct insurers, and those private insurers receive monthly capitation payments from the state, possibly, though for Medicaid specifically the direct impact would be to the states, who are the direct recipients of the federal dollars as reimbursement for the federal share of the joint state-federal program. But Medicaid is typically a very large portion of state spending, and the federal share of Medicaid costs varies by state and subprogram but is at least 50% -- so if reimbursement stops it produces a cash flow problem very quickly.

MPSFounder 2y ago

It amazes me how much the bottom and middle class are infatuated with Trump. I recall seeing him in NYC with a look of disgust when he passed by doormen. The guy never said hello, and grew up with a sense of entitlement that is truly mesmerizing. The guy ripped off students with a scam college a la Andrew Tate. Yet, I saw an older gentleman just this morning wearing a white MAGA hat, and driving an old rusted truck. I am dumbfounded really. He is denying funding for these programs while siphoning our taxes into his golf resorts. Utterly disgraceful, yet half the country wanted him. I wish I could understand the delusion people go through. Mental gymnastics that is worthy of graduate studies. I now understand how people can live under Stalinist and Nazi regimes. The ridiculous becomes mundane

shafyy 2y ago
People in power spend a lot of money and effort for propaganda so that middle and lower class people think what they do is actually good for them. "I can become rich too, and then I also don't want to pay taxes and yield power with impunity" Also, they keep working class folks occupied with work and just poor enough, so that working class people don't have time to engage in politics, don't have time too think too much about the future, and mainly worry about paying this month's rent and feeding their families. So, I don't blame the people, I blame the system that working exactly as designed. Question is, how can we change this system?
SpicyLemonZest 2y ago
I really encourage people to look at it from the opposite angle. What does that older gentleman dislike so much about the status quo that he’d rather engage in strenuous mental gymnastics than accept it? I don’t claim to have the one true answer, but I bet you can identify a couple plausible ones.
- MPSFounder 2y ago
  I agree with your sentiment. It is just hard for me to comprehend how a billionaire who's shown time and time again he cares little for normal folks, can have such an impact on their perception. His cabinet was filled with billionaires with country club membership. This is easily accessible info. Normal folks would rather elect those who deny them entry to that club, because of how they feel about the status quo. Not sure how this is the answer. I bet if their social security was cut in half, they would see it as a force of good because Trump said so. Amazing really. If that's not a cult of personality, I don't know what is

legitster 2y ago

https://www.whitehouse.gov/fact-sheets/2025/01/923/ https://www.whitehouse.gov/fact-sheets/2025/01/923/ > Q: Is this a freeze on all Federal financial assistance? > A: No, the pause does not apply across-the-board. It is expressly limited to programs, projects, and activities implicated by the President’s Executive Orders, such as ending DEI, the green new deal, and funding nongovernmental organizations that undermine the national interest. This administration is playing Calvinball. What funding does or does not qualify is being completely made up on the spot. But before you dismiss it as bluster and sabre rattling, the administration is already dealing out retribution for those who "don't comply": https://www.npr.org/sections/goats-and-soda/2025/01/27/nx-s1-5276382/trump-usaid-leave-executive-order https://www.npr.org/sections/goats-and-soda/2025/01/27/nx-s1... As an extra layer on dumbness, because the administration is stupid like a fox, they get to walk back anything they want to. They could decide next week that FEMA was never actually cancelled, and they will walk up to a podium and accuse everyone of overreacting and the news for lying. Despite the fact that they controlled the narrative the entire time.

Karrot_Kream 2y ago

[flagged]

msie 2y ago
What Trump does affects EVERYBODY. It cannot be ignored.
- Karrot_Kream 2y ago
  Okay so is your view that I need to view it on every single English language site with user-submitted content?
  - ceejayoz 2y ago
    My view is that there are 30 slots on the HN home page, and a scroll bar.
  - morkalork 2y ago
    I look forward to the insightful analysis here that sites like reddit don't have because they're all in crisis meltdown mode.
  - SpicyLemonZest 2y ago
    I think you’re going to, and if you’d prefer not to you’re taking up the complaint with the wrong people. I’m far from an “everything is politics” guy, but it would be very HN-worthy if the government paused all emergency funding for some other reason, and it doesn’t become less so because it’s happening as part of a political program.
kevingadd 2y ago
Federal funding freezes probably have a real tangible impact on the day to day of YC readers since research programs often rely on federal funding. Cybersecurity programs and government agency security are also impacted by freezes and targeted "DEI" purges. I've also personally had someone confirm this particular rumor for me: https://bsky.app/profile/molly.wiki/post/3lgr5oarums2c https://bsky.app/profile/molly.wiki/post/3lgr5oarums2c You can decide how you feel about outsiders strolling into federal agencies and hooking up random hardware to the network. It makes me nervous! A compromise of critical government infrastructure could destabilize the economy and could jeopardize most of our jobs.

bayareabadboy 2y ago

Politics aside, it’s pretty incredible that 85M people are on Medicaid. Feel like something is gonna give in our health care system. This doesn’t seem sustainable.

ceejayoz 2y ago
More people on Medicaid (which the ACA added ~10M to) is, fiscally, a good thing. It's probably the closest we'll come to a public option for a while. https://www.cbpp.org/research/correcting-seven-myths-about-medicaid https://www.cbpp.org/research/correcting-seven-myths-about-m... > Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status. For example, adults on Medicaid cost about 22 percent less than if they were covered by private insurance, Urban Institute research shows. > Over the past 30 years, Medicaid costs per beneficiary have essentially tracked costs in the health care system as a whole, public and private. In fact, costs per beneficiary grew more slowly for Medicaid than for private insurance between 1987 and 2017, and are expected to continue growing more slowly than for private insurance in coming years, according to the Medicaid and CHIP Payment and Access Commission.
taeric 2y ago
Medicaid is reportedly well run, though? Yes, it is a big number, but it has not been the source of any budget problems. Quite the contrary, it has been a good lever in controlling health care costs.
nradov 2y ago
Right, healthcare costs have been growing faster than overall inflation for many years and the industry now constitutes 17.6% of GDP. If it goes much higher it's going to start displacing more essential industries. So obviously costs will eventually be cut somehow. That will probably be some combination of care rationing, provider wage cuts, and prescription drug price fixing. Regardless of whether anyone thinks those measures are good ideas or not, the math is inescapable. My guess is that the crisis will come when large self-insured employers refuse to continue absorbing most of the annual cost increases for employee health plans. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical https://www.cms.gov/data-research/statistics-trends-and-repo...

toomuchtodo 2y ago

IAS statement: PEPFAR freeze threatens millions of lives - https://www.iasociety.org/ias-statement/pepfar-freeze-threatens-millions-lives https://www.iasociety.org/ias-statement/pepfar-freeze-threat... - 25 January 2025