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The Big, Beautiful Bill's Ugly Future for Rural Health Care​

The sacrifices the legislation imposes on struggling communities don't improve the financial health of our nation.


The bill that just passed the Senate means more uncompensated care, and it harms one of the few funding streams states have for keeping struggling hospitals afloat. In the House version, Medicaid spending in rural areas will decline by as much as $119 billion (or 15%) over 10 years, including a loss of $50.4 billion in Medicaid funding for rural hospitals at a time when nearly half have already been operating at a financial loss. The Senate bill's inclusion of a $50 billion rural hospital fund won’t address this shortfall. More closures will be inevitable.


Despite arguments that work requirements for Medicaid get people back to work, when Arkansas tried to apply a similar policy at the state level in 2018, it saw nearly 17,000 lose coverage, with no increase in employment. What did increase in Arkansas? Medical debt, something most Americans fear and that is essentially nonexistent in other advanced countries.
 
So Trump runs off to Iowa to have his celebration rally? Guess the farmers there haven't figured tariffs out yet.
 

Trump's signature policy bill adjusts work requirements for the Supplemental Nutrition Assistance Program, the country's largest nutrition assistance program.

  • In order to keep their benefits under the Senate-passed version of the bill, parents of children aged 14 or older would have to meet work requirements. The bill also bumps the work requirement age up to 64.
  • Currently, SNAP's requirements for able-bodied adults without dependents apply to those between 18 and 54.
  • It could also force some states to shoulder more benefit costs, the rate of which would be set by a state's percent of erroneous payments. Benefits are currently 100% federally funded, though states share administrative costs.
Threat level: Medicaid and food aid cuts could also lead to job losses and hits to state GDPs, Axios' Alex Fitzpatrick writes.

Zoom out: In March 2025, more than 42 million Americans participated in SNAP, according to initial USDA data.

  • The program provides crucial support for families with low-paying jobs, low-income older adults, people with disabilities and others.
  • According to a CBPP analysis of FY 2024 USDA data, more than 62% of SNAP participants are in families with children, and more than 38% are in working families.
  • New Mexico has the largest share participating in SNAP, with some 21% of the population helped by the program, according to preliminary March data.



By the numbers: The bill would reduce nutrition funding, which includes SNAP, by around $186 billion between 2025 and 2034.

  • While analyst's projections have fluctuated as the legislation's provisions are tweaked, analysts have indicated millions of people could be cut from SNAP under the work requirement provisions.
  • CBPP points to a CBO indication that more than 2 million people would be cut from SNAP under the work requirement provision.
  • While the CBPP notes that revised legislation released June 25 slightly modified several SNAP provisions in the reconciliation plan, it still says more than 5 million people live in households at risk of losing at least some food assistance.


Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
 
Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
Let the rich give their taxes breaks back first before we take food out of the poor people's mouths. I'd rather feed a person who might not need it than starve one that does. That's what Jesus would do. I'm betting he didn't means test when he fed the multitude.
 
Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
I don't have the facts in front of me-but I have seen various articles over the years that SNAP benefits lag considerably over the decades when compared to inflation And that was before the considerable inflation of groceries the last year or two
 
Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
It was a one time increase in benefits to accommodate the increase in cost and adjust for inflation. This wasn't an "emergency level" increase. He didn't "expand" the program. They also altered what was covered and by how much. Your post seems to imply people are 1) receiving too much and 2) that people are using the program who should not have access to this aid. Neither case is accurate.


Stacy Dean, who served as deputy undersecretary for USDA’s Food, Nutrition, and Consumer Services from 2021 to 2024, explained to me that her team’s efforts to reform the Thrifty Food Plan were authorized by the 2018 Farm Bill, passed by a Republican Congress and signed by Donald Trump. Section 4002 of the law stated that the Department of Agriculture should “by 2022 and at 5-year intervals thereafter … reevaluate and publish the market baskets of the thrifty food plan based on current food prices, food composition data, consumption patterns, and dietary guidance.”

The team was thus instructed that the Thrifty Food Plan had to reflect how people actually ate (“consumption patterns”) and the foods they actually chose (“food composition data”), rather than assuming that poor Americans subsist largely on giant tubs of yogurt, or oatmeal and beans.
The administration concluded that complying with that instruction meant the total cost of the Thrifty Food Plan could not stay the same. It was not possible to accurately reflect the actual cost of food and notincrease the cost of the plan.
 
Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
Why do you think SNAP was fully funded to begin with? You want SNAP to go down, but that only makes sense if you think the "non-emergency" level was the correct amount. What's the basis for that assumption?

Like most social safety net programs with outsized impact on children, SNAP is a wonderful investment. Kids who are hungry don't learn well in school. They fall behind. They have worse health. Ironically, they can be quite obese because they are having to eat cheap food -- i.e. fried carbohydrates with few vegetables or complete proteins.

Hungry kids are much more likely to turn to criminal behavior when they are older. They have fallen behind in school. Their brain development is often less than ideal.

SNAP is a wonderful investment. We'd be better off with more than less. So why is it again that you think SNAP funding should be reduced?

Giving that much money to ICE is probably the single most destructive US policy this century at least, and probably you can go a lot further back. Spending money to reduce your productive capacity is nuts. It's akin to building missiles and using them to blow up major cities. As between ICE and SNAP -- I mean just to articulate the choice is to answer the question. If we are cutting SNAP to make room for ICE, that is a trillion dollar mistake. Probably, over the long-term, I would guess a 14 figure mistake -- i.e. more than $10T.
 
CBS tried to help their girl Kamala by selecting editing their interview by trying to promote that she had intelligent thoughts on why she had thoughts on the Israeli/Hamas conflict.
If you could sue a news outlet for making a candidate sound better, Kamala would own Fox News. The editing they have done for Trump would make CBS blush.
 
CBS tried to help their girl Kamala by selecting editing their interview by trying to promote that she had intelligent thoughts on why she had thoughts on the Israeli/Hamas conflict.
Explain how that leads to civil or criminal liability.

CBS could have given her a script to read, and edited afterwards if she screwed up the script, and put in all sorts of extra AI footage making her seem like a world historical genius . . . and they would have done nothing actionable.

The only reason this lawsuit settled was that CBS' billionaire owners wanted to sell it, and Trump could block that. It was use of government power to achieve a result that could not have been reached by lawful means.

I'm back to thinking you are not a lawyer. No lawyer could know so little about the law.
 
Explain how that leads to civil or criminal liability.

CBS could have given her a script to read, and edited afterwards if she screwed up the script, and put in all sorts of extra AI footage making her seem like a world historical genius . . . and they would have done nothing actionable.

The only reason this lawsuit settled was that CBS' billionaire owners wanted to sell it, and Trump could block that. It was use of government power to achieve a result that could not have been reached by lawful means.

I'm back to thinking you are not a lawyer. No lawyer could know so little about the law.
I would love to compare that interview to any live unedited interview with Trump.
 
The Senate version of the budget bill includes provisions impacting parents of children under 14, particularly in relation to Medicaid and the Child Tax Credit. The bill would exempt parents of children under 14 from certain work requirements to maintain Medicaid eligibility.
Additionally, it would increase the Child Tax Credit to $2,200 per child, but with potential limitations on its benefit for lower-income families.

Medicaid and Work Requirements:
The bill would require able-bodied adults, including parents, to work 80 hours per month to maintain Medicaid eligibility, but parents of children under 14 would be exempt.


This exemption for parents of young children is a point of contention, with some arguing it is necessary for childcare reasons and others criticizing it for potentially creating a disincentive to work.

Child Tax Credit:
The bill would increase the Child Tax Credit from $2,000 to $2,200 per child.
However, it would also impose stricter requirements, potentially limiting the full benefit for lower-income families.
One key change is the requirement that both parents must have a Social Security number for their child to be eligible for the full credit, which could exclude some families.
Personal exemptions would have been $6000/person if not killed by the 2017 Tax Bill - which Reverse Robin Hood'ed capital flux from working and middle class to billionaires.
 
Shouldn’t we at some point try to return spending on SNAP to non-emergency levels, with some adjustment for inflation?

Biden greatly expanded the program as a part of our recovery plan. When can we ask for that back? As is, the cuts in this plan only claw back about half of what it was increased by Biden ( was 300 billion over 10, now 150 over 10).
Why are you more concerned with 150 billion in food for poor children than four trillion in tax cuts for people who don’t need them?
 
Explain how that leads to civil or criminal liability.

CBS could have given her a script to read, and edited afterwards if she screwed up the script, and put in all sorts of extra AI footage making her seem like a world historical genius . . . and they would have done nothing actionable.

The only reason this lawsuit settled was that CBS' billionaire owners wanted to sell it, and Trump could block that. It was use of government power to achieve a result that could not have been reached by lawful means.

I'm back to thinking you are not a lawyer. No lawyer could know so little about the law.
At least not a litigator. Thats for sure
 

A study by the University of North Carolina, commissioned by Senate Democrats, found that 338 rural hospitals will be at risk of closing thanks to the GOP bill. But it’s not just rural hospitals already feeling the pinch. Two of San Diego, California’s largest medical providers announced layoffs in the last week. UC San Diego Health is laying off 230 workers and cited “mounting financial pressures” as a result of “federal impacts to health care,” including poor reimbursement rates for Medicare and Medicaid, in a memo seen by the San Diego Union Tribune.

Sharp Healthcare, San Diego County’s biggest provider, also announced it was laying off 315 employees who will work through early September. Executives at Sharp are also taking pay cuts, with CEO Chris Howard asking the board to cut his pay by 25%, according to the San Diego Union Tribune.

Bea Grause, president of the Healthcare Association of New York State told the Times Union that hospitals are going to feel this. “It’s a fiscal pandemic,” Grause said. “Medicaid is an important funder for all hospitals, and so it will financially hurt almost every hospital across the state of New York—and hospitals are central to the economy of each community. That’s what the average New Yorker should be concerned about.”

Many Americans probably don’t even know they’re on Medicaid, given the fact that each state administers its own program and has a different name for it. In California it’s called Medi-Cal, in Massachusetts it’s called MassHealth, and in New Jersey it’s called NJ FamilyCare. But people also don’t seem to understand that Medicaid helps hospitals pay for things that help everyone more broadly and pulling the rug out from under them will have ripple effects.

The Congressional Budget Office estimates 11.8 million people will lose Medicaid coverage between now and 2034, according to the Washington Post, but the bill also abolishes other subsidies for the Affordable Care Act that the CBO estimates will dump another 4.2 million people. Another 1 million on top of that will lose their coverage because of other health provisions in the bill, bringing the grand total to somewhere around 17 million people over the next decade.

When people lose their health insurance it doesn’t mean that they’re not going to need help. As Sen. Catherine Cortez Masto, a Democrat from Nevada, pointed out during a virtual roundtable this week, these cuts will “devastate health care in Nevada,” and people will go to the ER after they get sick enough.

“More people now are going to be showing up in our emergency rooms with acute care because they now have lost the health care that they need to even provide preventative care for them,” Cortez Masto said, according to the Nevada Current.
 
Many Americans probably don’t even know they’re on Medicaid, given the fact that each state administers its own program and has a different name for it. In California it’s called Medi-Cal, in Massachusetts it’s called MassHealth, and in New Jersey it’s called NJ FamilyCare. But people also don’t seem to understand that Medicaid helps hospitals pay for things that help everyone more broadly and pulling the rug out from under them will have ripple effects.

That many Americans probably don't even know they're on Medicaid............is an important point and may explain why some don't realize they are going to be hurt.
 
Explain how that leads to civil or criminal liability.

CBS could have given her a script to read, and edited afterwards if she screwed up the script, and put in all sorts of extra AI footage making her seem like a world historical genius . . . and they would have done nothing actionable.

The only reason this lawsuit settled was that CBS' billionaire owners wanted to sell it, and Trump could block that. It was use of government power to achieve a result that could not have been reached by lawful means.

I'm back to thinking you are not a lawyer. No lawyer could know so little
No one but you said criminal liability.
 
No one but you said criminal liability.
I said civil or criminal -- meaning that I don't think there would be any liability at all. Thought I'd cover my bases. Now, please explain how there can be liability for broadcasting an interview. You have two challenges. First, finding a cause of action. Second, overcoming the obvious First Amendment protections.

As I said, CBS could have never had Kamala in the studio, created an interview out of thin air with AI and broadcast it and there would be no liability. Certainly not to Trump. Care to explain why I'm wrong?
 
I said civil or criminal -- meaning that I don't think there would be any liability at all. Thought I'd cover my bases. Now, please explain how there can be liability for broadcasting an interview anywhere in the world. You have two challenges. First, finding a cause of action. Second, overcoming the obvious First Amendment protections.

As I said, CBS could have never had Kamala in the studio, created an interview out of thin air with AI and broadcast it and there would be no liability. Certainly not to Trump. Care to explain why I'm wrong?
Suit based upon election interference - CBS fraudulently editing the interview which was intended to help the Democratic candidate to the detriment to Trump. If it was so baseless why didn’t CBS file a 12b6 motion and dispose of it and move for Rule 11 sanctions?
 
Suit based upon election interference - CBS fraudulently editing the interview which was intended to help the Democratic candidate to the detriment to Trump. If it was so baseless why didn’t CBS file a 12b6 motion and dispose of it and move for Rule 11 sanctions?
Sigh.

1. "Election interference" is not actually a legal concept. There are no statutes that I know of addressing "election interference" and certainly not by a media outlet. There are laws against threatening voters, steering voters to the wrong polling places or telling them the wrong dates, political violence of course, etc. If you can find a statute addressing election interference

2. Where was the fraud? Do you even know the elements of fraud? And if anyone would have a case, it wouldn't be Trump.

3. Are you familiar with the First Amendment of the constitution? Are you familiar with New York Times v. Sullivan? Do you know anything?

4. CBS didn't file a motion to dismiss because it was trying to sell itself. It needs the permission of the FCC. Trump ALREADY used the FCC to block a merger -- Time Warner -- and Time Warner had to go to court to complete the merger (Trump got his ass kicked badly in that one).

CBS's owner (well, Paramount's owner, which owns CBS) is an old woman who wanted to sell her company. She didn't have any interest in fighting. So she paid a tribute and got on with things. It was a blatant act of corruption by Trump.

5. You might have noticed that Trump pulled all of his other "election interference" suits. Because they were all meritless. He just didn't have any means of shaking down the others.
 
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