Big Beautiful Bill

[Pudortu]

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I read that the Senate just passed this so likely this will soon become law after it gets back to the House. I've also read that it will throw off about 11 million people off of Medicaid.

Not trying to be political about this at all, but we will most likely be affected by that. Do you all suspect volumes will trend up or maybe (heaven forbid) down with these patients avoiding the ED? Will our pay take a hit? What are your all's thoughts on this.

 

[Janders]

Shifts some millions of people from a poor paying Medicaid product to a non-paying self pay uninsured status.

I don’t think this helps most of us…

 

[AlmostAnMD]

Probably some long term uptick in volume as their clinic options disappear and shift towards acute care vs chronic disease management, but we already know this population is a high ED utilizer (part their fault, part medicaid has limited clinic options since PP docs don't want to deal with it).

The bigger impact will be on your profit margins. Medicaid doesn't pay well, but it DOES pay, and now millions will go to ED for care that your group will essentially pay for.

 

[HemorrhagicShock]

Yea the big hit here will be on margins.

Depending on how you make your bread, this could be disastrous for many EM groups.

Not to mention the alarming number of rural, low-resourced, underserved, and/or critical access hospitals that would close as a result.

I wonder if this will affect the locums market if these are places that traditionally relied on out-of-town ER docs to staff their shops.

Less locums positions and lower locums rates for sure.

 

[emergentmd]

There might be a drop but medicaid pays very little. I could see a net positive if people being off medicaid would push them finding a job and getting insured.

My gut says this will be a net positive with more getting off the government payroll and getting jobs.

 

[Apollyon]

There might be a drop but medicaid pays very little. I could see a net positive if people being off medicaid would push them finding a job and getting insured.

My gut says this will be a net positive with more getting off the government payroll and getting jobs.

People that would use the ED liberally are unlikely to get a job to obtain health insurance. At least, that's my guess.

 

[AlmostAnMD]

There might be a drop but medicaid pays very little. I could see a net positive if people being off medicaid would push them finding a job and getting insured.

My gut says this will be a net positive with more getting off the government payroll and getting jobs.

Doubt you have time for the whole segment, but does go into detail why work requirements have failed when implemented.

It's an idea that sounds good on paper but it's never been administered well

 

[calvnandhobbs68]

Also have fun with all those people SW in the ED realizes should be eligible for Medicaid and tries to sign up to avoid no payment but now won't be eligible because your ED visit is 31 days after they actually get on Medicaid.

"Currently, states must cover Medicaid benefits retroactively for three months before an eligible individual signs up for coverage. The Senate and House bills would reduce that to one month."

Comparing the Medicaid cuts in House and Senate "big, beautiful bill"

Senate and House Republicans would each cut Medicaid spending significantly, and there are some differences between the two bills.

www.cbsnews.com

 

[AlmostAnMD]

Also have fun with all those people SW in the ED realizes should be eligible for Medicaid and tries to sign up to avoid no payment but now won't be eligible because your ED visit is 31 days after they actually get on Medicaid.

"Currently, states must cover Medicaid benefits retroactively for three months before an eligible individual signs up for coverage. The Senate and House bills would reduce that to one month."

Comparing the Medicaid cuts in House and Senate "big, beautiful bill"

Senate and House Republicans would each cut Medicaid spending significantly, and there are some differences between the two bills.

www.cbsnews.com

rofl

I actually didn't even hear about that part

what a dick move

Curious how healthcare overall will change in the future....this feels like the groundwork of single payer 10-15 years from now imo

 

[WhatJobDoIPick]

The trend is overall downwards for EM and medicine.

To the lurking students: Further reason why no one should go into a field where the bulk of your "customers" are on the government dole.

You'll probably still match EM though because "it's the only field for me."

 

[Emapp20177]

No matter who is in office, we get f'd.

• 2020: -6% (emergency medicine, CMS Medicare Physician Fee Schedule)
• 2021: -2% (emergency medicine, after Congressional mitigation from 6%)
• 2022: -4.48% (Medicare conversion factor reduction)
• 2023: -2% (Medicare physician payment reduction)
• 2024: -1.25% (Medicare physician payment reduction)
• 2025: -2.83% (Medicare physician payment reduction)

Cumulative effective pay cut counting for inflation (2020–2025): -34.23%

Maybe something new will help, who knows.

 

[CliveStaples]

A cut to medicaid (whether through work restrictions or via a cut to the provider tax which is used to calculate federal funding of state medicaid) is bad for the ED because it is bad for hospitals, too.

Yes, it's bad to have uninsured people because EMTALA dictates we have to see them anyway.

But a lot of groups are dependent on hospital subsidies, particularly in rural areas. Medicaid cuts will tighten these hospital's budgets, or close them entirely. Also bad for our field.

 

[HemorrhagicShock]

The trend is overall downwards for EM and medicine.

To the lurking students: Further reason why no one should go into a field where the bulk of your "customers" are on the government dole.

You'll probably still match EM though because "it's the only field for me."

I am mostly quoting this post so I can write the following in bold:

MEDICAL STUDENTS, PLEASE LISTEN TO THIS GUY, DO NOT GO INTO EM

Trust me, it's not the "only field" for you.

Try anesthesiology, radiology, PMR, dermatology, plastic surgery, ENT, orthopedics, neurosurgery, cardiology

Do not waste your training, intellect, and abilities on EM. It's an IMG field at best.

 

[Janders]

There might be a drop but medicaid pays very little. I could see a net positive if people being off medicaid would push them finding a job and getting insured.

My gut says this will be a net positive with more getting off the government payroll and getting jobs.

Your optimism is charming

 

[Pinner Doc]

I read that the Senate just passed this so likely this will soon become law after it gets back to the House. I've also read that it will throw off about 11 million people off of Medicaid.

Not trying to be political about this at all, but we will most likely be affected by that. Do you all suspect volumes will trend up or maybe (heaven forbid) down with these patients avoiding the ED? Will our pay take a hit? What are your all's thoughts on this.

I work in Vermont and as a rural state, I worry many of our hospitals will close.

 

[Pinner Doc]

There might be a drop but medicaid pays very little. I could see a net positive if people being off medicaid would push them finding a job and getting insured.

My gut says this will be a net positive with more getting off the government payroll and getting jobs.

Except only 8% of Medicaid recipients are unemployed without exemptions.

 

[EctopicFetus]

No matter who is in office, we get f'd.

• 2020: -6% (emergency medicine, CMS Medicare Physician Fee Schedule)
• 2021: -2% (emergency medicine, after Congressional mitigation from 6%)
• 2022: -4.48% (Medicare conversion factor reduction)
• 2023: -2% (Medicare physician payment reduction)
• 2024: -1.25% (Medicare physician payment reduction)
• 2025: -2.83% (Medicare physician payment reduction)

Cumulative effective pay cut counting for inflation (2020–2025): -34.23%

Maybe something new will help, who knows.

We didnt go down 30% on the conversion factor and we did get minimal increases in the RVU payment. Was $36.08 now is 32.35.. we are down just under $4.. but we arent down 30%. nothing to brag about.. but not as horrific as you mentioned.

Most of the pain will be in the blue states aka htose who epxnaded medicaid.

 

[gruemd]

In good news, or rather "good" because it is good for me personally and not because I think it is actually good for my fellow countrymen or the nation as a whole, extension of tax cuts was also baked in, including extending the QBI deduction. I'm about to switch to a 1099 job from W2 later this year so that could be a real boon as I understand it. Anyone who is already 1099 and taking advantage of that deduction, please chime in. In fact if there's anyone finance nerdy who wants to talk 1099 deductions/advice in general, hit me up, I have questions!

 

[RustedFox]

In good news, or rather "good" because it is good for me personally and not because I think it is actually good for my fellow countrymen or the nation as a whole, extension of tax cuts was also baked in, including extending the QBI deduction. I'm about to switch to a 1099 job from W2 later this year so that could be a real boon as I understand it. Anyone who is already 1099 and taking advantage of that deduction, please chime in. In fact if there's anyone finance nerdy who wants to talk 1099 deductions/advice in general, hit me up, I have questions!

Explain this like I'm five.
I have some W2 options that I'm looking at as well .

 

[Pudortu]

In good news, or rather "good" because it is good for me personally and not because I think it is actually good for my fellow countrymen or the nation as a whole, extension of tax cuts was also baked in, including extending the QBI deduction. I'm about to switch to a 1099 job from W2 later this year so that could be a real boon as I understand it. Anyone who is already 1099 and taking advantage of that deduction, please chime in. In fact if there's anyone finance nerdy who wants to talk 1099 deductions/advice in general, hit me up, I have questions!

I thought we couldn’t do QBI because we are part of a specific trade. That’s my understanding and also that most of us are phased out. Maybe I need to revisit this also.

 

[cyanide12345678]

Shifts some millions of people from a poor paying Medicaid product to a non-paying self pay uninsured status.

I don’t think this helps most of us…

My rural ERs also have a fairly heavy Medicaid population. There’s a list of hospitals floating around in tik tok for hospitals at risk of closing, both my rural hospitals are on that list.

Being a part of a 24 hospital system might help weather the storm though.

 

[Pudortu]

My rural ERs also have a fairly heavy Medicaid population. There’s a list of hospitals floating around in tik tok for hospitals at risk of closing, both my rural hospitals are on that list.

Being a part of a 24 hospital system might help weather the storm though.

Do you have that list by any chance?

 

[cyanide12345678]

Do you have that list by any chance?

Just the list for Indiana. I work at 2 of them 🤣

 

[calvnandhobbs68]

In good news, or rather "good" because it is good for me personally and not because I think it is actually good for my fellow countrymen or the nation as a whole, extension of tax cuts was also baked in, including extending the QBI deduction. I'm about to switch to a 1099 job from W2 later this year so that could be a real boon as I understand it. Anyone who is already 1099 and taking advantage of that deduction, please chime in. In fact if there's anyone finance nerdy who wants to talk 1099 deductions/advice in general, hit me up, I have questions!

Yes this bill is probably good for me personally. Not so great for most of the country lol.

Yes you can use the pass through deduction but you’ll have to meet the income limits for QBI. You’ll most likely hit it if married filing jointly, the limit for single is pretty low. Limits are a little higher for 2025 I believe but I need to go look them up for my return next year.

Keep in mind self employment tax, self employed health insurance premium deduction, employer contributions to a solo 401K, etc bring QBI down.

Instructions for Form 8995-A (2024) | Internal Revenue Service

www.irs.gov

Exception 1: If your 2024 taxable income before the QBI deduction isn’t more than $383,900 if married filing jointly, and $191,950 for all other returns, your SSTB is treated as a qualified trade or business, and thus may generate income eligible for the QBI deduction.

 

[gruemd]

Note: I am not an accountant and am a relative noob at this subject, and I haven't even switched over to 1099 yet.

But from what I understand, yes to what C&H said above, and if I'm reading it right, I think that cap is actually going to be lifted by 50k for married filing jointly.

 

[Brigade4Radiant]

The sad thing is that the closure of a lot of these rural emergency departments and hospitals will destroy the economies in a lot of these places.

 

[RustedFox]

Note: I am not an accountant and am a relative noob at this subject, and I haven't even switched over to 1099 yet.

But from what I understand, yes to what C&H said above, and if I'm reading it right, I think that cap is actually going to be lifted by 50k for married filing jointly.

Lifted by 50k to a maximum of what?
This could be game-changing for me.

 

[EctopicFetus]

The sad thing is that the closure of a lot of these rural emergency departments and hospitals will destroy the economies in a lot of these places.

I am sure i am in the minority but i truly dont care. I dont see why we need these EDs. People choose to live in the boonies. having access to craptastic (often) care is part of the deal. Having no care IMO is better than crappy care. If the cities want to subsidize these hospitals go for it.

When I live in a big city I pay a lot in taxes. I deal with traffic etc etc. Why should my tax dollars subsidize these rural hospitals. Why is that the case? I cant think of a good answer.

 

[calvnandhobbs68]

Lifted by 50k to a maximum of what?
This could be game-changing for me.

Not aware of this 50K increase thing with the new bill but the income limits go up every year, I've been 1099 for the last 4 years.

Here's a calculator for this year:

199A Calculator 2025

 

[JacobMcCandles]

I am sure i am in the minority but i truly dont care. I dont see why we need these EDs. People choose to live in the boonies. having access to craptastic (often) care is part of the deal. Having no care IMO is better than crappy care. If the cities want to subsidize these hospitals go for it.

When I live in a big city I pay a lot in taxes. I deal with traffic etc etc. Why should my tax dollars subsidize these rural hospitals. Why is that the case? I cant think of a good answer.

There’s a reason most of these hospitals are already in a bad spot financially.

 

[TooMuchResearch]

I am sure i am in the minority but i truly dont care. I dont see why we need these EDs. People choose to live in the boonies. having access to craptastic (often) care is part of the deal. Having no care IMO is better than crappy care. If the cities want to subsidize these hospitals go for it.

When I live in a big city I pay a lot in taxes. I deal with traffic etc etc. Why should my tax dollars subsidize these rural hospitals. Why is that the case? I cant think of a good answer.

Because when I work there and can keep the patients there for admission or hold them in the ED for a day until there is a bed elsewhere, I decompress our overburdened city hospitals. Our other hospitals simply can't absorb the patient volume. My rural place see around 16-30 patients per day now. We're not too rural.

 

[Pinner Doc]

Because when I work there and can keep the patients there for admission or hold them in the ED for a day until there is a bed elsewhere, I decompress our overburdened city hospitals. Our other hospitals simply can't absorb the patient volume. My rural place see around 16-30 patients per day now. We're not too rural.

This. The university of Vermont is already farming out inpatients to smaller hospitals across the state because it has “no room at the inn.”

How myopic to think that closure of multiple small hospitals across the country won’t affect larger more urban shops. You think you have ED boarders now?

 

[Pinner Doc]

I am sure i am in the minority but i truly dont care. I dont see why we need these EDs. People choose to live in the boonies.

Maybe I have the benefit of perspective, having lived and trained across the country, including upstate New York, North Carolina, New York City, Salt Lake City, Seattle, now Vermont. But the people who live in these boonies are the ones growing our food. They provide critical services to this country and deserve healthcare, despite the fact that the nature of their work requires they live in wide open spaces.

It may also surprise you that many of these hospitals subject to closure aren’t, in fact, in the boonies. The shop I just left before fellowship is in our state capital. A surprising number of hospitals are heavily dependent on revenue that will be slashed.

 

[HemeOncHopeful19]

Maybe I have the benefit of perspective, having lived and trained across the country, including upstate New York, North Carolina, New York City, Salt Lake City, Seattle, now Vermont. But the people who live in these boonies are the ones growing our food. They provide critical services to this country and deserve healthcare, despite the fact that the nature of their work requires they live in wide open spaces.

It may also surprise you that many of these hospitals subject to closure aren’t, in fact, in the boonies. The shop I just left before fellowship is in our state capital. A surprising number of hospitals are heavily dependent on revenue that will be slashed.

Agree with your first paragraph but I don’t see why these hospitals can’t take a haircut in admin instead of simply closing.

I’ll never forget where I trained we had two complete floors of the hospital that used to be patient rooms in the 1990s that had been converted into offices for various nurse administrators and other miscellaneous administrative positions.

 

[EctopicFetus]

Because when I work there and can keep the patients there for admission or hold them in the ED for a day until there is a bed elsewhere, I decompress our overburdened city hospitals. Our other hospitals simply can't absorb the patient volume. My rural place see around 16-30 patients per day now. We're not too rural.

All depends. I work some at rural sites. Daily volumes range from 8 to 70. If they cant hack it financially the city should pony up, the state can pony up. It is incredibly inefficient use of money. While you say the hospitals cant absorb the volume this may be location dependent. Some of the issues are literal physical space issues. Some are staffing issues. Staffing 2 RNs to cover and ED seeing 0.5pph is highly inefficient. Same for sticking a doc out there. It’s a waste of resources. Again, I know this isn’t popular.

 

[EctopicFetus]

Maybe I have the benefit of perspective, having lived and trained across the country, including upstate New York, North Carolina, New York City, Salt Lake City, Seattle, now Vermont. But the people who live in these boonies are the ones growing our food. They provide critical services to this country and deserve healthcare, despite the fact that the nature of their work requires they live in wide open spaces.

It may also surprise you that many of these hospitals subject to closure aren’t, in fact, in the boonies. The shop I just left before fellowship is in our state capital. A surprising number of hospitals are heavily dependent on revenue that will be slashed.

I have also lived and worked across the country, SE, NE, SW, Midwest. I am not talking about hospitals subject to closure. My aim (if you will) are low volume sites. I am not poking at busy hospitals who have financial strain. My point is the low volume hospitals in the sticks should be closed. I am aware of the rural life. My wife’s family are all Ohio farmers. All I am saying is many of those hospitals suck, provide substandard care are a total financial drain. The cost of care for one of these patients at some of these rural hospitals/ CAH is insane.

 

[TooMuchResearch]

All depends. I work some at rural sites. Daily volumes range from 8 to 70. If they cant hack it financially the city should pony up, the state can pony up. It is incredibly inefficient use of money. While you say the hospitals cant absorb the volume this may be location dependent. Some of the issues are literal physical space issues. Some are staffing issues. Staffing 2 RNs to cover and ED seeing 0.5pph is highly inefficient. Same for sticking a doc out there. It’s a waste of resources. Again, I know this isn’t popular.

In my location, we definitely can't absorb volume in the city. My group staffs most of the hospitals that receive these patients and I know people at the other places. When I'm in the city seeing people out of rotating chairs (i.e. see and return to triage for dispo unless unstable), I definitely don't have capacity to safely take another 35+ patients per day. Maybe some of these places could consolidate but definitely couldn't close them all, at least where I live. I also am biased in that I really prefer working these single coverage places : )

 

[WhatJobDoIPick]

The fact of the matter is, most ER presentations are not ER appropriate.

Even most abdominal pain could be an outpatient workup.

It is a convenience department for people who are unwilling to see their primary in 2 weeks or wait 2 hours to see if whatever sensation they are experiencing in their body is improving.

 

[calvnandhobbs68]

The fact of the matter is, most ER presentations are not ER appropriate.

Even most abdominal pain could be an outpatient workup.

It is a convenience department for people who are unwilling to see their primary in 2 weeks or wait 2 hours to see if whatever sensation they are experiencing in their body is improving.

Yeah but if they ain't got health insurance where are these people gonna end up? And then you're gonna be paid 0 dollars.
There is no "you should go see your PCP for this" if they can't see a PCP.

At least if you have Medicaid, it might take forever to see anyone but you can get some sort of primary care (NP/PA level at an FQHC, county clinics, etc) in most places.

ACA and the resultant medicaid expansion has been in place 15 years at this point and are pretty baked into financial assumptions for hospitals...not sure any of them have modeled out what 11.8 million people getting kicked off health insurance within 8 years would look like.

 

[AlmostAnMD]

Yeah but if they ain't got health insurance where are these people gonna end up? And then you're gonna be paid 0 dollars.
There is no "you should go see your PCP for this" if they can't see a PCP.

At least if you have Medicaid, it might take forever to see anyone but you can get some sort of primary care (NP/PA level at least) in most places.

That part is definitely true. There aren't enough free clinics in the world to absorb all the people kicked off of medicaid. Their sole avenue of care will be the ED, and it will be free care, and you'll be just as liable for a mistake as if they were paying

bad situation for all

 

[WhatJobDoIPick]

Yeah but if they ain't got health insurance where are these people gonna end up? And then you're gonna be paid 0 dollars.
There is no "you should go see your PCP for this" if they can't see a PCP.

At least if you have Medicaid, it might take forever to see anyone but you can get some sort of primary care (NP/PA level at an FQHC, county clinics, etc) in most places.

ACA and the resultant medicaid expansion has been in place 15 years at this point and are pretty baked into financial assumptions for hospitals...not sure any of them have modeled out what 11.8 million people getting kicked off health insurance within 8 years would look like.

There are lots of free clinics, usually associated with academic centers. People just don't wanna wait.

I'm not arguing in favor of Medicaid scale back. But if you're gonna do it, you need to scrap EMTALA and medmal. The combination of the three is the major reason why EM is trash.

We all know EMTALA and medmal aren't changing in an appreciable way. All the more reason to save aggressively and get out

 

[ScepticSkeksis]

One of the news articles effectively said: "If we remove all of the people scamming medicaid/SNAP, that will hurt the grocery stores and doctors who provide services to those people." It was a very interesting take on the issue...

I for one am happy to take a pay cut if it means we get rid of able-bodied people and illegal aliens scamming the system

Everyone is eventually going to have to take huge cuts in benefits (Boomers I'm looking at you) if we get to Argentina.

 

[calvnandhobbs68]

One of the news articles effectively said: "If we remove all of the people scamming medicaid/SNAP, that will hurt the grocery stores and doctors who provide services to those people." It was a very interesting take on the issue...

I for one am happy to take a pay cut if it means we get rid of able-bodied people and illegal aliens scamming the system

Everyone is eventually going to have to take huge cuts in benefits (Boomers I'm looking at you) if we get to Argentina.

"Interesting" in what way?

It's been shown time and time again that there's no widespread problems with patients "scamming" the system. The largest perpetrators of government insurance fraud are....drumroll...."providers" of various stripes doing billing fraud.

Stop watching Faux news bud, there's no widespread issue with "illegal aliens scamming the system". They aren't eligible for medicaid in the first place.

5 Key Facts About Immigrants and Medicaid | KFF

Confusion persists about immigrants’ eligibility for federal programs, with about half or more of U.S. adults and immigrants adults saying they are unsure or incorrectly believe that most immigrants to the U.S. are eligible to enroll in federal health insurance programs, including Medicaid, as...

www.kff.org

More than 2/3 of Medicaid receipents ALREADY work:

Nearly two-thirds of Medicaid beneficiaries already work: KFF

Most adults on Medicaid are employed, suggesting few beneficiaries wouldn’t meet a work requirement policy being considered by Republicans in Congress.

www.healthcaredive.com

What this does is just throw a bunch of administrative barriers up hoping people will miss deadlines to file their work hours or forget to re-verify their eligibility every 6 months or don't file for medicaid coverage within 30 days for retroactive payments to hospitals/ER/etc.

 

[AlmostAnMD]

What this does is just throw a bunch of administrative barriers up hoping people will miss deadlines to file their work hours or forget to re-verify their eligibility every 6 months or don't file for medicaid coverage within 30 days for retroactive payments to hospitals/ER/etc.

The more I look into this, the more I see that's a feature, not a bug. The goal is to make it so difficult to keep medicaid people just give up and lose coverage. Lawmakers, of course, won't GAF because when they show up at your door for treatment, they don't pay for it---hospital/you eat the cost. Saving money! lol

 

[TooMuchResearch]

The fact of the matter is, most ER presentations are not ER appropriate.

Even most abdominal pain could be an outpatient workup.

It is a convenience department for people who are unwilling to see their primary in 2 weeks or wait 2 hours to see if whatever sensation they are experiencing in their body is improving.

But it isn't. I know places that apparently need pre-auths on outpatient CT for acute problems, thus all go to the ED.

Clinics are over booked, PCPs see too many patients per day. Urgent care has limited capability. There isn't anywhere else to get high quality acute care.

 

[AlmostAnMD]

But it isn't. I know places that apparently need pre-auths on outpatient CT for acute problems, thus all go to the ED.

Clinics are over booked, PCPs see too many patients per day. Urgent care has limited capability. There isn't anywhere else to get high quality acute care.

Good point.

I had some mystery abdominal pain that I saw my PCP for (peace of mind? seen too much cancer).

With my ultra delux premium choice insurance it took two weeks to get the CT. Why NOT just go to the ED?

 

[Jabbed]

But it isn't. I know places that apparently need pre-auths on outpatient CT for acute problems, thus all go to the ED.

Clinics are over booked, PCPs see too many patients per day. Urgent care has limited capability. There isn't anywhere else to get high quality acute care.

Too bad the Big Beautiful Bill doesn’t provide a tax break for the inevitable charity care that we will all be providing..

 

[ScepticSkeksis]

"Interesting" in what way?

It's been shown time and time again that there's no widespread problems with patients "scamming" the system. The largest perpetrators of government insurance fraud are....drumroll...."providers" of various stripes doing billing fraud.

Stop watching Faux news bud, there's no widespread issue with "illegal aliens scamming the system". They aren't eligible for medicaid in the first place.

5 Key Facts About Immigrants and Medicaid | KFF

Confusion persists about immigrants’ eligibility for federal programs, with about half or more of U.S. adults and immigrants adults saying they are unsure or incorrectly believe that most immigrants to the U.S. are eligible to enroll in federal health insurance programs, including Medicaid, as...

www.kff.org

More than 2/3 of Medicaid receipents ALREADY work:

Nearly two-thirds of Medicaid beneficiaries already work: KFF

Most adults on Medicaid are employed, suggesting few beneficiaries wouldn’t meet a work requirement policy being considered by Republicans in Congress.

www.healthcaredive.com

What this does is just throw a bunch of administrative barriers up hoping people will miss deadlines to file their work hours or forget to re-verify their eligibility every 6 months or don't file for medicaid coverage within 30 days for retroactive payments to hospitals/ER/etc.

It was "interesting" in that they were saying fraud (even if hypothetical) is okay because it supports businesses and doctors.

There are 1.9 million illegals on medicaid. I'd say that's pretty widespread. I'm not sure of the numbers of able-bodied, but I don't think it's unreasaonble to have a work requirement if you are able to work. Here are the numbers from AI:

• One estimate from 2022 indicates that out of 37.2 million working-age adults (Medicaid recipients who are not elderly, parents, or disabled), 13.9 million are considered able-bodied adults without dependents (ABAWDs).
• Another source from March 2023 estimated that out of nearly 100 million Medicaid enrollees, approximately 40 million are able-bodied adults.
• A recent analysis classified only a small percentage of the total nonworking Medicaid population ages 18-64 (about 15.8%) as able-bodied, representing a mere 8% of the total Medicaid population.

Let's say that's even half correct and only 14 million able-bodied people are on Medicaid, it's a huge waste of money and should be curtailed.

 

[calvnandhobbs68]

It was "interesting" in that they were saying fraud (even if hypothetical) is okay because it supports businesses and doctors.

There are 1.9 million illegals on medicaid. I'd say that's pretty widespread. I'm not sure of the numbers of able-bodied, but I don't think it's unreasaonble to have a work requirement if you are able to work. Here are the numbers from AI:

• One estimate from 2022 indicates that out of 37.2 million working-age adults (Medicaid recipients who are not elderly, parents, or disabled), 13.9 million are considered able-bodied adults without dependents (ABAWDs).
• Another source from March 2023 estimated that out of nearly 100 million Medicaid enrollees, approximately 40 million are able-bodied adults.
• A recent analysis classified only a small percentage of the total nonworking Medicaid population ages 18-64 (about 15.8%) as able-bodied, representing a mere 8% of the total Medicaid population.

Let's say that's even half correct and only 14 million able-bodied people are on Medicaid, it's a huge waste of money and should be curtailed.

Are you just having trouble understanding this bud? The majority of those able bodies adults ALREADY WORK. This isn't an argument about "number of able bodied adults on medicaid". It's a matter of what the work requirement hopes to accomplish, which is essentially just trying to kick people off with red tape. Never mind the fact that it's completely possible to have a full time job that doesn't offer health insurance.

Where'd you pull the 1.9 million number from your butt? Oh wait no it's Trump's butt.

Factchecking The White House “Mythbuster” on Medicaid Cuts and Immigrants

On June 2, 2025, The White House posted a “Mythbuster” fact sheet in defense of the House-passed reconciliation bill. However, the sheet is full of inaccuracies and advances more myths than facts—t…

ccf.georgetown.edu

 

[ScepticSkeksis]

I sense a lot of anger in you Calvin,


I had AI drill down further into it:

• • About 13.9 million Medicaid recipients are able-bodied adults without dependents(often called ABAWDs).
  • Of those, 8.1 million (58%) worked at least 80 hours in a given month.
  • That leaves roughly 4 million ABAWDs who are persistently enrolled in Medicaid and work fewer than 80 hours per month—about 29% of ABAWDs, or 5% of all Medicaid recipients.

So 4 million. If I get time I'll research the number of "disabled" people under 50 who get medicaid.

Also the 1.9 million:

• More than 1.9 million people are enrolled in state-funded coverage programs for immigrants in several states and the District of Columbia, based on partial enrollment data from 11 of 14 states and DC.

Not sure what Trump had to do with that number.