Big Beautiful Bill: Implications for Pain...
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implications?
a lot fewer medicare patients.
a lot fewer medicaid patients.
a local system has stated the effect of the bill will be somewhere between $0 and $700 million. all new construction at present is on hold.
www.peoplespolicyproject.org
yes, 3.9 million people, a lot but not the flex you think it is.
a lot fewer medicare patients.
a lot fewer medicaid patients.
a local system has stated the effect of the bill will be somewhere between $0 and $700 million. all new construction at present is on hold.
you do realize this is 1% of the US population, right?
Is There Really an Epidemic of Workless Medicaid Recipients?
A deep dive into the Survey of Income and Program Participation.
yes, 3.9 million people, a lot but not the flex you think it is.
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Medicaid in my area is my best payor. Pays on par with Medicare, plus specialty access incentives and tobacco tax incentives for documenting smoking cessation counseling. It will be very bad for me financially since CA with no doubt have to cut who qualifies for coverage and cut reimbursement levels.
i like the "idea" of requiring work for medicaid. but i guess there is a a issue with reporting and how this will be tracked etc. sounds like another unfunded mandate. also, when these patients dont "qualify" by not working: then what? we still pay for them when they go to the ER or have cancer or have a heart attack.
LOL
Implications - I can bonus depreciate my G Wagon 100% now.
But I might make less with all these medicare cuts.
iloveharvard
Full Member
It is a BIG BEAUTIFUL idea to make sure that the lazy people shouldn't receive Medicaid, so that we will have more money to support disabled people.
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This insane liberal argument - "if people don't do x, then we have to support them anyway so why not just support them now?"
You really have 2 options: either support everyone - cradle to grave with socialist programs OR people recognize that if they don't stand on their own and exercise self responsibility, they (not everyone else) are screwed.
They aren’t screwed- they will show up to the ER with even more severe pathologies that at least could have been somewhat curbed by some degree of preventative care. I’m also interested in seeing how much more funding will be required to verify employment/school/etc and if there actually is any savings.
iloveharvard
Full Member
Even if there actually is no savings, it is still a good thing not to support laziness.
If you earn income you’re not going to qualify for Medicaid
My patients’ special needs adult child had their social security benefit increased to $900/month so they are no longer eligible for Medicaid. I guess half their income is going to go towards getting a Medicare supplemental because their brain is still full of tumors
Hyperalgesia doesnt understand the concept of preventative care saving money for the government. Oh you denied them medicaid? Good, now deal with not being paid anything but still being forced to take care of patients.
Its amusingly sad that the same conservatives who praise the name of the Lord will try at every opportunity to screw over the hungry and the sick even more..
well.... we DO have to support them. unless you are ok with mass homelessness, starvation, and literally kids dying in the streets.
again, i support the program, but do you think that eligibility for medicaid will encourage people to work? that this will decrease unemployment? no. this is simply a cost-cutting measure.
i actually believe that their lives would be better if they worked. more money, more happiness, less federal dependence, greater sense of accomplishment. but a good chunk of the population isnt built that way.
a more just way to handle medicaid is to basically have a tiered system where medicaid patients preferentially get treated by sh$tty providers. physician extenders, longer wait times, generic drugs only. id be fine with that
This is the same catastrophizing that you and others do with Trump.
If someone in America starves and dies on the street, it's not because the government didn't save them.
ASIPP saying potential physician payments might decrease up to 6% in light of the potential increases tied to inflation (MEI). as a private practice doc, this could hurt. Was hoping there was going to be more of a focus on improving our payment system with the current administration but looks like I'm pretty wrong sadly.
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Not looking forwards to our civilization devolving into third world country ethos
But from a practical standpoint, keeping people fed and off the streets has benefits towards lowering the crime rate.
The house bill does have a doctor payment fix. Something like 2.5% in 2026 then some crazy low number of 0.25% yearly increase some how tied to inflation rate. I thought it was good they at least are trying to link automatic increases to inflation even if a pittance.
Before our healthcare system was enveloped by government programs, insurance companies, EMTALA, and the AMA, community hospitals provided care for the indigent, supported by charity.
Now it's inconceivable for many people that our society could even function without all these programs. And they still think we need more. Obamacare wasn't enough right?
Ultimately none of this matters while people are legally entitled to life-saving medical care. You can save a few pennies by cutting preventive care, childhood vaccine coverage, etc, but ultimately when someone shows up in the ER with an occluded LAD or renal failure with hyperkalemia, the hospital has to treat them, costing hundreds of thousands. If they’re uninsured the hospital has to eat the cost, and so increasing the number of uninsured means that hospitals have to be subsidized in some way to compensate for that free care, whether by the government or by overcharging those who can afford to pay.
So if you really want to advocate for libertarian solutions to fix the mess that is the hospital payment system, you’ve got to have the balls to go for the really libertarian solution: if the wallet biopsy is negative, the patient can be discharged to the street regardless of current condition. Bonus: it will help reduce the homeless population because they’ll die instead.
So if you really want to advocate for libertarian solutions to fix the mess that is the hospital payment system, you’ve got to have the balls to go for the really libertarian solution: if the wallet biopsy is negative, the patient can be discharged to the street regardless of current condition. Bonus: it will help reduce the homeless population because they’ll die instead.
They tried required work for Medicaid already, in Arkansas. It worked out pretty much how you would expect.
I would just leave it to the states. If we feel compelled to provide federal funding, so be it.
EMTALA should be state law.
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True in TX, but state dependent.
Interestingly, my kid qualified for Medicaid in TX during residency and the services they covered were exceptional. In home care, respite, developmental services. Perhaps age 18 is when they can go to hell administratively?
Most of my Iowa Medicaid are simple, hard working, blue collar folk that are normal, functional and not destitute or really poor. Folks from the other side of the state border are the stereotype of Medicaid patients, at least the half that actually slow up for their appointments.
Texas voted not to expand Medicaid and it looks like Iowa did, so there are probably a lot of differences in how they are treated. After COVID there was a huge disenrollment period where people and children lost coverage for missing paperwork. It looks like Iowa just implemented work requirements. Will be interesting to see how that pans out. I’m not really sure what kind of jobs my disabled patients are fit for at this point.
people also died before age 68.
you dont need to worry as much about Medicare or Medicaid costs if you kill off most of the population 10 years younger.
this work requirement is a distraction and an attempt to ultimately get rid of medicaid. the number of people of working abled people who have no dependents is low comparatively. i posted stats on a separate thread.
The real implication for all of us is fewer patients and lower reimbursement for those of us who take Medicaid, and far, far more patients clamoring for us to certify that they are too disabled to work.
you realize that this would significantly increase state healthcare costs, mostly in red states or significantly increase death rates in these states.
if EMTALA is state law, my guess is that the states that would most likely not enact EMTALA would be red states. the states with the most insured percentage wise are Texas, Ok, Ga, Miss, Fla. the states with the most number of uninsured people are Tx, Ca, Fla Ga, NC.
community hospitals have very thin margins. there arent many C-suite executives making a boatload in BFE.
if the medicaid cuts go thru, a bunch of these hospitals will close, and the bigger hospitals will be forced to absorb them. this gives the hospital more leverage and bargaining power.
the cheapest way to pay for medical care is to actually EXPAND medicaid, not cut it.
It sounds like you guys have a lot of lbp patients that can’t work and subsequently require Medicaid/Medicare. Personally I think most people with chronic pain can find gainful employment somewhere. They may not like their job or the pay, but most can do it. It’s not our job to pay for these people’s benefits
Personally I worked for 2 yrs with severe neck pain. It was quite disabling but I still went to work and reluctantly put on my lead every day
Personally I worked for 2 yrs with severe neck pain. It was quite disabling but I still went to work and reluctantly put on my lead every day
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Right, making several hundred thousand dollars a year. I imagine if you offered even half that amount of money to people on medicaid you would find many, many willing to work.
If you subdivide and tackle healthcare issues separately, you could solve a lot of the issues.
For routine preventative care, a clinic at Walmart could handle vaccines and most hypertension and DM management. $20 copay for every visit, zero insurance needed. State/federal/charity covers the cost.
i agree that hospitals are incredibly inefficient. cant make changes, have to deal with unions, tons of paperwork for federal insurances, cant get or keep good workers, OR is inefficient, SPD sucks, inadequate mental health care, PCPs lose money, etc.
but those services are essential. feels like we are headed towards an existential crisis if this bill goes thru. the end result being single payer, unfortunately for all
Back in hypothetical world, I would again subdivide situations, some of which don't belong in the hospital at all, and address them more efficiently without any insurance or federal govt involvement.
In the real world, you're catastrophizing again. How is this gonna destroy us? Is your practice so dependent on able-bodied people abusing Medicaid?
That's why you must tell your Congressman to support HR 2191...Physician Led and Rural Access to Quality Care Act. Together we can make a difference in patient's lives.
IN THE HOUSE OF REPRESENTATIVES
March 18, 2025
Mr. Griffith (for himself, Mr. Hern of Oklahoma, Mr. Vicente Gonzalez of Texas, Mr. Joyce of Pennsylvania, Mr. Correa, Mr. Balderson, Mr. Valadao, Mr. Pfluger, Mr. Dunn of Florida, Mr. Davis of North Carolina, Mr. Yakym, Mr. Weber of Texas, Mrs. Miller-Meeks, and Mr. Austin Scott of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. Short title.
This Act may be cited as the “Physician Led and Rural Access to Quality Care Act”.
SEC. 2. Revising certain physician self-referral exemptions relating to physician-owned hospitals.
(a) In general.—Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is amended—
(1) in subsection (d)—
(A) in paragraph (2)(C), by inserting “(other than a covered rural hospital (as defined in subsection (h)))” after “a hospital”; and
(B) in paragraph (3)(D), by inserting “in the case of a hospital other than a covered rural hospital (as defined in subsection (h)),” before “the hospital”; and
(2) in subsection (h), by adding at the end the following new paragraph:
“(8) COVERED RURAL HOSPITAL.—The term ‘covered rural hospital’ means a hospital that—
“(A) is located in a rural area (as defined in section 1886(d)(2)(D)); and
“(B) as of the date that such hospital enrolls under this title, is located more than a 35-mile drive (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) from a hospital or a critical access hospital.”.
(b) Allowing for expansion of existing physician-Owned hospitals.—Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is amended—
(1) in paragraph (1)(B), by striking “in paragraph (3)” and inserting “in paragraph (3) or (7)”; and
(2) by adding at the end the following new paragraph:
“(7) SUNSET OF EXPANSION PROHIBITION.—The requirement described in paragraph (1)(B) shall not apply beginning on the date of the enactment of this paragraph.”.
you provide no answers. if the states have to spend the money, then what is the difference?
i just laid out how the medicaid cuts would play out. see post 29
that would be a band aid to a 9 inch laceration. its a start, but not enough
the stats show time and again that 92% of medicaid recipients are working or have a documented disability or reason that they are not working (caregiver, disability, student). worst case scenario 8% of medicaid recipients, and most likely 1% of medicaid recipients are working adults without dependents and no reasons to not work. the number of people that anti medicaid proponents state are exaggerated.
who are you going to hire to do this $20 copay per visit? which doctor would be willing to see a patient for $20? or even a noctor? PCPs are woefully underpaid. will you as a pain physician be willing to see a patient for that? and which walmart are you going to get to give up their precious retail space for a medical clinic that is not going to generate enough income towards cleaning, maintenance, lights, etc?
which republican will you get to go along with paying for the state or federal costs, irrespective of local, state or federal office?
suppose you do hire someone to do this. who is going to pay for the medication without medicaid? do you think these patients who qualify for medicaid will afford $50 per month for metformin, atenolol and lisinopril, let alone something like losartan ($100) or jardiance ($600)?
the cut off to get medicaid is roughly $2900 per individual. average rent is $1300. average food costs per american is $350. average utility costs is $430. that adds up to $2080. average transportation costs is supposed to be $819. and you expect out of the $1 per month left over to live on that the medicaid recipient will pay $50 to get medications?
the majority of the medicaid patients i see are working. the ones that are not have mostly been declared disabled...
The difference is that states balance their budgets, have different cultures, priorities and ideas. Some states might experiment with more libertarian concepts and others fully socialized.
Why do you care so much what happens in Arkansas?
we care because they are Americans too.
why do you care what happens in california? seems like orange man just HAS to quell these protests with the marines and national guard.
it simply wont work with individual state-based health care. you would need to trash both medicaid and medicare and then you would have health tourism.
as much as id like to ignore some parts of the country, i actually care about the people living there
Improve the healthcare system in your own state. Make it sustainable and with a high satisfaction and lead by example.
and what happens to those from Arkansas? or those from Iowa? or Georgia? or Flor oh wait nm about that one.
we are in this together. its called the United States of America, not Geoflorilouisibama or the South US or Pacific NE US or Atlantic States.
we fought a huge war over this, 160 years ago. hundreds of thousands died. many epic battles, and while i love reading and watching videos on the battles, it would have been much better if they had never happened.....
we are in this together. its called the United States of America, not Geoflorilouisibama or the South US or Pacific NE US or Atlantic States.
we fought a huge war over this, 160 years ago. hundreds of thousands died. many epic battles, and while i love reading and watching videos on the battles, it would have been much better if they had never happened.....
Get over yourself. They don't need your elitist help.
All liberals have to do is stop imposing their incompetence on other states.
Regarding California, immigration is one of the few obligations of the federal government. Trump is not gonna allow federal officers to be assaulted and buildings damaged.
Other than that, if LA residents don't mind looting and general mayhem, I have no objection. Please just film it for everyone's enjoyment.
@kstarm @Ducttape @SSdoc33
It’s the bleeding heart liberals that have and will continue to run this country into the ground in debt. Do you guys hear yourselves? You think everyone “deserves” a handout and the bar is apparently so low everyone qualifies. No one deserves anything in this world especially on the backs of our future generations. Let’s cut the fat and start making sure those that need it and deserve it get the help they need. Everyone else needs to be cut off, and sadly that’s a lot despite what you think duct
It’s the bleeding heart liberals that have and will continue to run this country into the ground in debt. Do you guys hear yourselves? You think everyone “deserves” a handout and the bar is apparently so low everyone qualifies. No one deserves anything in this world especially on the backs of our future generations. Let’s cut the fat and start making sure those that need it and deserve it get the help they need. Everyone else needs to be cut off, and sadly that’s a lot despite what you think duct
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Isnt Trumps bill going to increase the debt by $2.4 trillion? sounds like its the conservatives running this country into the ground.
Honestly I don’t believe the estimates. Plus any Republican led bill will result in less spending than any Democratic bill. That’s a fact. Dems wouldn’t cut ****. Just increase entitlements and taxes to make up for the shortfall and then argue they were “saving money” During my working yrs thus far I’ve already given away 2-3 million on wasteful spending. It’s sickening. No idea why anyone in our position would be fine with that
The CBO does a pretty good job of this. Their average absolute error rate for revenue calculations and income calculations over the past 20 years so so has been 6 and 3% respectively. They've very forthright about their data which you can read about here: The Accuracy of CBO’s Budget Projections for Fiscal Year 2024.
The largest swing was a recent 18% error in estimating the income from corporate sources, though this again averages out across all income sources for the above 6% figure.
Even assuming that they have this outlier higher error in both directions, e.g. 18% too aggressive in spending and 18% too low in assumed revenue collected... this is still projecting a 1.98 trillion increase in the deficit over 10 years.
Source:
Their spreadsheet with the calculations, plus my own 18% modifications in both directions below. The far right column is Fiscal years 2025-2034. The non grey columns are the individual annual expectations from 2025 onward. Raw data here: Estimated Budgetary Effects of H.R. 1, the One Big Beautiful Bill Act
Obviously, even using this higher error rate in both directions as above doesn't account for the possibility that the error will be substantially larger. That said, the historical error rate, as above, has been 3-6% on average, even accounting for things like the COVID timeframe.
I feel like anyone arguing that the numbers are simply wrong are saying so more out of political loyalty than any rational thought process.
To be clear, this is not an attack on the GOP. I think Democrats on the whole have a tendency to increase the budget as well. That said, I'm personally rather fiscally conservative and I think that this bill needs a ton of work.
Let's see, the budget spends 60% on SS, medicare, national defense, interest. Medicaid is about 9% of the budget and Trump's bill would cut it down to 7.5%.
Interest on the federal debt is already higher than total federal Medicaid spending. If Trump's bill goes through, interest will be more than double what we spend on Medicaid. Which 'wasteful spending' is making you so sick?
I'm more concerned about my retirement and the consequences of a US default than I am about income tax.
trump's bill is saying this:
i will buy a new fancy house that i cant afford right now, but "might" be able to afford 10 years from now if I make more money.
it didnt work the last time he tried it, and it wont work now. the white house numbers are based on projected future growth, which can in no way be predictable.
how about we cut the DoD? this it the first place we look. also, need to increase the retirement age of SS
