It is, at the same time, very easy to write about the healthcare abuses enacted and proposed by the Trump administration and its GOP legislative sycophants, and very difficult to do so without seeming repetitive. I have written recently about cuts to Medicaid, changes in Medicare, evil mis-messaging about vaccines, and the promulgation of false treatments that range from an ineffective waste of money to downright harmful. What else is there to say? Essentially, the administration is doing anything that they can do to hurt people’s health, and they continue to do more of it.
Eleven million people are likely to lose their health coverage with the Medicaid cuts now proposed in the Senate, which are even more extensive than in the House. Virtually none of them will be the able-bodied-but-not-working-or-looking-for-work-person Medicaid deadbeat trumpeted by the GOP. Most Medicaid recipients are children and their caretaker mothers, most Medicaid dollars are spent on long-term care for seniors, and most adults receiving Medicaid are already working, at a job, often more than one job, that pays so little that they are Medicaid-eligible. Frequently, these are jobs working for the very corporations (run by the very rich individuals) who will benefit from the tax cuts that are to be funded by the Medicaid cuts! Sigh. There is nothing close to morality, or humanity, here. Since Medicaid is paid to healthcare providers, not to patients, when fraud occurs it is usually on the part of providers, mostly hospitals and other institutions such as nursing homes (also owned by the very wealthy). On the other hand, rural hospitals that are often dependent upon Medicaid (people are older, sicker, and poorer) are likely to close. It’s a good thing no Senators are dependent upon them for healthcare!
The Commonwealth Fund’s “2025 Report Card on State Health System Performance” reports that
Every state has reduced its uninsured rate over the past decade, and today there are fewer adults who are skipping needed care because of the cost. This progress is largely due to the Affordable Care Act’s Medicaid expansion, marketplace plan subsidies, and consumer protections.
That progress is now at risk. Proposed Medicaid funding cuts, work requirements, new requirements for enrolling in marketplace plans, and the expiration of enhanced ACA premium subsidies could together leave millions of Americans uninsured and drive up costs for many more.
The report is full of useful graphs, like this one:
Cutting Medicaid, and other associated cuts like kneecapping the Affordable Care Act (ACA) including by eliminating the eligibility for Medicaid for those a little above the poverty level, and increasingly converting Medicare into for-profit Medicare “Advantage”, are mean. Also heartless, cruel, vicious. But there are other changes being made that are even meaner and discriminate against groups of people. Not surprisingly, one of the main groups being attacked is trans people, long a focus of Trump and his coterie of orcs. They talk incessantly about “men” who will play “girls’” sports, as if this is a main, or even significant, reason, people go through the painful, arduous, socially difficult, and expensive in every way process of transition (not to mention the lack of discussion of “women” playing “boys’” sports!) People do not “choose” to be trans as if they were choosing a pair of shoes; they are acknowledging that who they know they are is different from the label that society has assigned them. Among the circumstances that they have to face is worse health status and worse healthcare, including worse health insurance, and much worse mental health status. This is a real problem, unlike the silly sports discussions.
But it’s not just trans people. Another group that is getting targeted for worse health care is veterans. While they are less often publicly demeaned than trans people (and, of course, there are many trans people who are veterans), veterans are seeing their health care cut. This is happening globally, with decreased funding to already-stretched thin VA clinics and hospitals. It is happening more for certain veterans who fall into categories that the administration can identify for particular abuse. As reported first in The Guardian, and now elsewhere, physicians and other healthcare providers are being given permission to refuse healthcare to people who, among other things, are unmarried or Democrats!
Medical staff are still required to treat veterans regardless of race, color, religion and sex, and all veterans remain entitled to treatment. But individual workers are now free to decline to care for patients based on personal characteristics not explicitly prohibited by federal law. Language requiring healthcare professionals to care for veterans regardless of their politics and marital status has been explicitly eliminated.
I certainly hope that the physicians and other providers at the VA have the ethical and moral commitment to their profession to never refuse care for these completely unacceptable reasons that violate the most central tenets of medicine. But the executive order by the President goes even farther. The providers themselves, if they meet these same conditions, can be fired because of them! The idea that people who are armed services veterans, who have served and now need health care, can be divided into those whose characteristics completely unrelated to that service, are worthy of treatment and those who are not, is an infamy. It is, of course, completely impossible to reconcile these directives with democracy, freedom, or ethics of any kind.
What is even more damning (probably not objectively “worse”, but certainly adding insult to injury) is that the administration’s order allowing discrimination against some veterans – particularly women – is titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”. !!! This is a real-world version of the satire of Lewis Carroll’s Humpty Dumpty (“a word means whatever I choose it to mean”), but goes farther, to George Orwell’s “1984” by using words to mean the opposite of what they actually mean. War is Peace, Freedom is Slavery, Ignorance is Strength. Donald Trump would have fit right in!
On a more positive note, a judge recently decided that the cuts made to grants from the National Institutes of Health (NIH) to researchers based on the fact that they studied the health problems of minority groups, including LGBT+ people, were illegal and must be reinstated. Moreover, the language he used was damning:
Judge William G. Young of the Federal District Court for the District of Massachusetts delivered a damning assessment of the Trump administrations’ motives in targeting hundreds of grants that focused on the health of Black communities, women and L.G.B.T.Q. people. He ordered the government to restore much of that funding for now, pending an appeal.
“This represents racial discrimination and discrimination against America’s L.G.B.T.Q. community,” he said. “That’s what this is.”
Judge Young, a Reagan appointee with 40 years of experience added that:
…over the course of his career he had “never seen government racial discrimination like this,” and that he felt duty bound to state his conclusion about the government’s intent.
“I would be blind not to call it out,” he said.
He is obviously correct, but what is most distressing is that the administration is trying to enact such discriminatory criteria, into both research grants and, as in the VA, the clinical care of people. [See the Bethesda Declaration, by NIH researchers.] Of course, it is not as if such orders have no precedents. The “Nuremberg Laws” in Nazi Germany come to mind!
There apparently are no limits on what bigoted, racist, discriminatory, undemocratic, un-Constitutional, and generally mean, petty, and vicious policies that Donald Trump and his administration seek to implement in healthcare, as in so many other areas of our polity. The question is whether there will be any limits on them from Congress (so far no) or the courts. The latter is so far yes, but Judge Young’s decision will be appealed, and it is far from certain that, should they review it, the Supreme Court will support it.
While it is more reassuring and easier to have a system that protects us by ensuring freedom and non-discrimination that we can passively accept, when this system is under attack, as it is today, it is ultimately up to us to make sure those practices are maintained.
