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Universal Healthcare is a Winning Strategy for the Dems & All of Us

Universal Healthcare is a Winning Strategy for the Dems & All of Us

Current political battles over health insurance focus on premium ACA subsidies and protecting Medicaid funding. The president of PNHP reminds us that the real answer lies in a grander vision, which has wide popular support: universal health insurance.

Universal Healthcare Will Save Lives… and Could Save the Democratic Party, Common Dreams, Oct. 22, 2025, by Diljeet K. Singh, MD, DrPH, president of Physicians for a National Health Program

As the only wealthy country without universal coverage, sticking to our current system is truly not “politically feasible.” Democratic leaders need to understand and embrace America’s desire for change.

The ongoing government shutdown, a standoff over health insurance premiums, is a missed opportunity to truly reform healthcare and revive the Democratic Party.

Democrats have been hyper focused on restoring Medicaid cuts and preserving Affordable Care Act (ACA) subsidies to blunt the harmful healthcare impact of the Republican budget. But this narrow strategy not only fails to address the core issues of the current system but ignores what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy. …

Americans want trustworthy, high-quality healthcare without conflicts of interest, co-pays, deductibles, or financial risk. A May 2025 Pew poll confirms this, with 68% of Americans, including 90% of Democrats and 45% of Republicans, believing the government should provide health insurance for all. A November 2024 Gallup poll shows 62% of Americans, including 90% of Democrats, 65% of Independents, and 32% of Republicans, think the federal government should guarantee health coverage for everyone. And a 2024 Marist Poll found 86% of Gen Z and 76% of Millennials also share the opinion that health insurance is the government’s responsibility. …

Meanwhile, Democrats are defending the status quo instead of fighting for the comprehensive health care reform that Americans need. Despite the unpopularity of much of what the Trump administration has done, support for the Democratic Party from its core members remains slim, with historically low voter registration and approval numbers. Championing universal healthcare gives Democrats a chance to move away from the status quo and win back frustrated voters, especially the youth.

Comment:

By Don McCanne, M.D.

Recently we pointed out that a health policy issue (ACA premium subsidies) is central to the federal budget battle and shutdown. Dems and voters favor retaining the subsidies.

In the above commentary, Dr. Singh – president of PNHP – emphasizes that maintaining a few subsidies isn’t going to cure our health insurance woes or help the Democrats. Instead, what’s needed is universal coverage – i.e., single payer, Medicare for All.

Dr. Singh states that “what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy.” And, “Americans from all parties agree that our political and economic systems need change.”

Yet neither major political party has it right in that the Republicans propose changes that would make our system worse, and the Democrats defend the status quo that has been so ineffective.

What both sides should agree on is that a comprehensive system progressively funded based on ability to pay, with billionaires contributing far more healthcare costs than they consume (but leaving them plenty for their extravagant lifestyles).

Bringing health insurance reform to the forefront now is timely with Dr. Singh leading the upcoming national meeting of PNHP, an organization that has long been a leader in the fight for comprehensive, accessible health care for everyone at a price that each of us can afford. She is correct that advocating for guaranteed, high quality, affordable health insurance that would boost the Democrats.

Yet, let’s look more broadly. Since we prefer that reform be based on sound policy rather than divisive politics, can we contemplate joining across parties in supporting health care justice for all, rather than battling ballrooms for billionaires vs. the unpopular status quo? There are plenty of Republicans, Independents, and Democrats who would unify on a government-financed health insurance approach that would guarantee all Americans “trustworthy, high quality health care without conflicts of interest, co-pays, deductibles, or financial risk.”

Let’s do it.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

“Last Week Tonight” on Medicare Advantage

“Last Week Tonight with John Oliver” aired a lengthy segment on the so-called “Medicare Advantage” program on October 26, 2025.

Oliver covered the many disadvantages of these corporate health plans masquerading as Medicare: limited provider networks, prior authorization requirements, surprise medical bills, and outright denials of care.

PNHP was one of the organizations briefing the show’s producers on the ins and outs of the “Advantage” program, including our comprehensive reports on overpayments, patient harms, and racial inequities.

Universal Healthcare Will Save Lives…and Could Save the Democratic Party

As the only wealthy country without universal health coverage, sticking to our current system is truly not “politically feasible.” Democratic leaders need to understand and embrace Americans’ desire for change.

By Diljeet K. Singh, M.D., Dr.P.H.
Common Dreams, Oct. 22, 2025

The ongoing government shutdown, a standoff over health insurance premiums, is a missed opportunity to truly reform healthcare and revive the Democratic Party.

Democrats have been hyper focused on restoring Medicaid cuts and preserving Affordable Care Act (ACA) subsidies to blunt the harmful healthcare impact of the Republican budget. But this narrow strategy not only fails to address the core issues of the current system but ignores what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy.

As a practicing gynecologic oncologist, I witness the human toll of this political timidity every day. I’ve seen patients on chemotherapy skip nausea medications because of co-pays, delay a surveillance PET scan because of the deductible, or substitute ineffective online elixirs for proven treatments because they cost less. As president of Physicians for a National Health Program, I have heard from thousands of physicians who are struggling to uphold their professional commitment to high-quality care because health insurance companies routinely deny coverage for medically recommended treatments.

What I hear in my clinic is also reflected in the polls and crosses party lines: Americans want trustworthy, high-quality healthcare without conflicts of interest, co-pays, deductibles, or financial risk. A May 2025 Pew poll confirms this, with 68% of Americans, including 90% of Democrats and 45% of Republicans, believing the government should provide health insurance for all. A November 2024 Gallup poll shows 62% of Americans, including 90% of Democrats, 65% of Independents, and 32% of Republicans, think the federal government should guarantee health coverage for everyone. And a 2024 Marist Poll found 86% of Gen Z and 76% of Millennials also share the opinion that health insurance is the government’s responsibility.

Today, more people, regardless of insurance status, are being forced to make difficult healthcare choices based on their finances. I have patients who regularly ignore pain and nausea because they are behind on medical bills and cannot afford to seek care. Consider that in America, 66% of bankruptcies are linked to medical issues, and 80% of those who went bankrupt had health insurance when they incurred the debt. In 2023, the average household medical debt was $10,570, and in 2024, about 20% of adults aged 18-49 borrowed money to pay for healthcare costs. A 2025 KFF poll found that 70% of adults worry about medical or dental bills leading to debt.

Americans from all parties agree that our political and economic systems need change, and most believe Republicans, not Democrats, can deliver it. According to an April 2025 Navigator poll, 74% of Americans (including 71% of Democrats, 78% of Independents, and 77% of Republicans) think our system “needs major changes,” with 12% feeling “the system needs to be torn down completely.” The same poll shows that 51% of Americans see Democrats as “focused on preserving the way government works,” including 54% of Democrats, 43% of Independents, and 54% of Republicans. Meanwhile, 65% of those surveyed believe Republicans are focused on changing the government, including 65% of Democrats, 57% of Independents, and 68% of Republicans.

Republicans are giving us change, but it’s not what Americans were hoping for. Their comprehensive efforts to reduce healthcare access, dismantle public health systems, and cut funding for essential medical research will have deadly consequences. Specifically, the mortality impacts of the Republican budget reconciliation bill—which includes deep cuts to Medicaid, the elimination of ACA subsidies, rollbacks to Medicare drug access, and weakening of nursing home safety standards—are estimated to cause 51,000 preventable deaths each year. This tragic number adds to the approximately 45,000 preventable deaths already linked to lack of insurance. While we can estimate the increased death toll among the millions losing healthcare coverage, the long-term effects of defunding the public health system and losing future lifesaving research are impossible to measure.

Meanwhile, Democrats are defending the status quo instead of fighting for the comprehensive health care reform that Americans need. Despite the unpopularity of much of what the Trump administration has done, support for the Democratic Party from its core members remains slim, with historically low voter registration and approval numbers. Championing universal healthcare gives Democrats a chance to move away from the status quo and win back frustrated voters, especially the youth.

The main arguments against universal healthcare are that it is unaffordable and politically unfeasible. However, the cost issue is challenged by basic economic analysis: We could afford to cover everyone if we weren’t actively wasting 25-30% of our healthcare spending on bureaucracy, overhead, and excessive profits for the health insurance industry. There is no evidence that these corporations improve healthcare or make any meaningful contribution. To the contrary, privatized Medicare (Medicare Advantage) wastes resources, costs more, and results in worse outcomes. In fact, when states deprivatize Medicaid, they save money and improve outcomes. For example, Connecticut shifted from privatized to public Medicaid in 2011, leading to a 4.7% increase in early cancer detection, an 8% increase in cancer survival, and savings of over $4 billion over 13 years.

The US spends more per person than other developed nations but has worse health outcomes, including lower life expectancy and higher maternal and infant deaths. As the only wealthy country without universal health coverage, sticking to our current system is truly not “politically feasible.” Democratic leaders need to understand and embrace Americans’ desire for change. They must fight for guaranteed universal healthcare—a system free from profit-driven conflicts, co-pays, deductibles, prior authorizations, and bankruptcy risks. Universal healthcare will save lives and may resuscitate the Democratic Party.

Dr. Diljeet K. Singh is a practicing integrative gynecologic oncologist and the president of Physicians for a National Health Program.

https://commondreams.org…

Government Shutdown Pivots on ACA Premium Subsidies

The federal budget stalemate and associated government shutdown are pivoting entirely on the role of the government in supporting ACA health insurance premiums. The Dems and voters say yes; the GOP says no. Is health reform building a big head of steam?

At Stake in the Shutdown Fight: Obamacare Prices That Could Rise by Thousands of Dollars, The New York Times, Oct. 1, 2025, by Margot Sanger-Katz & Alicia Parlapiano

Democrats say they will not vote to end the government shutdown unless Congress extends extra Obamacare subsidies that are set to expire next year. Republican leaders have said the subsidies shouldn’t be a part of legislation to reopen the government, though several individual lawmakers are open to the idea.

Should the extra subsidies expire, how much more will people with Obamacare plans pay?

The subsidies, first passed in 2021 and extended in 2022, make health insurance less expensive for nearly all those who buy their own coverage. Since the subsidies’ creation, enrollment in Obamacare markets has more than doubled.

Extending the subsidies would cost the federal government … about $350 billion over the next decade, according to estimates from the Congressional Budget Office. But, without them, many Americans will face much higher costs before the midterm elections next fall — in some cases, increases of more than a thousand dollars per month.

Despite Budget Concerns, Three-Quarters of Public Say Congress Should Extend the Enhanced ACA Tax Credits Set to Expire Next Year, Including Most Republicans and MAGA Supporters, KFF, Oct. 3, 2025

7 in 10 Marketplace Enrollees Say They Could Not Afford Coverage if Their Premiums Doubled; 4 in 10 Say They Would Expect to Be Uninsured

More than three-quarters (78%) of the public say they want Congress to extend the enhanced tax credits available to people with low and moderate incomes to make the health coverage purchased through the Affordable Care Act’s Marketplace more affordable, a new KFF Health Tracking Poll finds. That’s more than three times the share (22%) who say they want Congress to let the tax credits expire.

Comment:

By Jim Kahn, M.D., M.P.H.

For the last two weeks, my focus has been on a major medical issue facing my wife, so HJM has paused. We restart with this post on a health insurance issue currently central to US national politics, and will aim to maintain a steady flow moving forward.

In recent weeks, health insurance has been THE driving issue in the federal government shutdown, which was precipitated by a stalled budget bill for the 2026 fiscal year (started October 1). The sticking point is that the GOP failed to extend COVID-era Affordable Care Act premium subsidies benefiting 13 million individuals. The Democrats in the Senate – whose votes are needed to pass the bill – insist on maintaining the subsidies. They are convinced that highlighting this policy debate will harm the GOP, which appears indifferent to premium jumps of 100% or more. Public opinion polling suggests overwhelming support for extending the subsidies — 92% among Democratic voters and 59% among Republicans. If the budget passes without ACA subsidies, the GOP likely will be blamed for the jump in premiums, which will occur in January 2026 (years before Medicaid cuts passed earlier in 2025), perhaps influencing the 2026 congressional elections.

This is remarkable – a major showdown on federal government subsidies for health insurance. Unlike much of current US politics, it is actually a policy issue: Should the government broadly subsidize health insurance? The message from voters is an adamant “yes.” The GOP seems indifferent; the Dems seem determined.

Is this a pivotal moment where health insurance tips the political scales? It’s too early to say. In the short term, we don’t know who will win the budget bill fight, or what a compromise might look like. And we don’t know how the battle over subsidies will influence the 2026 congressional midterms. Or the 2028 presidential election.

Nonetheless, I’m quite encouraged by the stand that some politicians are taking in favor of broad health insurance, and the public’s extremely supportive reaction.

In an upcoming post, I’ll review how politicians are talking about health insurance. Lots of creative efforts there.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Missouri can save money and improve care by cutting the middleman out of Medicaid

By Ed Weisbart, M.D.
Missouri Independent, Oct. 21, 2025

What would you say if I told you it’s possible to cut $250 million from the Missouri Medicaid budget while also improving the health of people on Medicaid? All we need to do is cut out the middleman by not renewing our state contracts with insurance corporations like Centene, Blue Cross and United Healthcare.

Over the past decade, the corporations running Medicaid nationally averaged an astronomical overhead rate of 13%. On top of that, Missouri spends untold millions of dollars overseeing these corporations.

All this waste disappears if we switch to an enhanced form of the fee-for-service model that Missouri Medicaid currently uses for our aged, blind and disabled people. Other states, such as Connecticut, have cut out the middleman and run their Medicaid programs with a total overhead of 4-6%. Since 2012, that tiny state has saved $4 billion.

Connecticut did this without a significant increase in state agency staffing by outsourcing much of the work to private commercial businesses called “Administrative Services Organizations” that are paid a flat fee for a defined service, avoiding the conflicts of interest inherent in so-called “managed care” organizations.

States like Missouri that allow insurance corporations to run their Medicaid program have consistently seen higher and more rapidly growing expenses. Between 2004 and 2015, counties that outsourced their Medicaid program to insurance corporations had their costs rise $1,584 per person per year above what was being spent in comparable counties that avoided this trap.

By switching to enhanced fee for service, we would have to absorb some of the administrative functions done by insurers, but we would also stop spending anything on insurance company overhead and oversight. On balance, we could expect a modest increase in administrative expenses but save between 10-17% of total costs.

In total, after accounting for the portion of savings that would go back to the federal government (they fund the majority of Medicaid), our state would save between 152 and 258 million dollars per year, in 2023 dollars.

We’re not the only state in this position. Nationwide deprivatization of Medicaid would annually save all states combined as much as $34 billion and the federal government as much as $43 billion, for a total of $77 billion for the country.

To be clear, that’s not enough to completely mitigate the recent federal cuts to Medicaid funding – but it would go a long way. Without this approach, we face a range of unpalatable alternatives.

We could instead cut the “optional” Medicaid benefits like pharmacy, dentistry, physical therapy, occupational therapy, and hospice care. Sadly, many states facing a budget crisis decide to cut long-term home health services, a self-defeating strategy as these are the very services that keep people from being institutionalized at even higher costs to the state.

Or we could cut more people from Medicaid.

Or we could cut back on what we pay doctors, though many people on Medicaid already have difficulty finding a physician who accepts Missouri’s paltry Medicaid fee schedule.

Or we could cut back on what we pay hospitals, but Missouri already has too many hospitals at risk of closure. Cutting their funding would accelerate the crisis, particularly in rural communities.

Or we could reduce state funding for other essential services, like education.

Or we could raise taxes.

None of these choices are acceptable. Removing managed care organizations from Medicaid would protect the entire healthcare system while saving us hundreds of millions of dollars per year.

As striking as those numbers are, it’s not just about money. Removing the insurance industry’s barriers to care has been shown to attract more physicians into Medicaid, increase early diagnosis of cancer, and improve overall health.

I worry about people like my 31 year-old patient with juvenile diabetes who works as a self-employed roofer. Before Missouri expanded Medicaid, he frequently resorted to taking his insulin every other day. No physician wants to see people go back to rationing a life-saving medication.

The politics seem daunting, given the prominence of large insurance corporations in Missouri. But remember, Connecticut found a way to do this in 2012, and that state is often considered “the insurance capital of the world.”

If they could figure out how to make it happen, Missouri can, too.

Dr. Ed Weisbart is a retired family physician in Olivette and board secretary of Physicians for a National Health Program.

https://missouriindependent.com…

We’re the Lucky Ones

Health insurance in America is fantastic … for me and a few others. It can and should be for everyone.

Comment:

By Jim Kahn, M.D., M.P.H.

My wife just got a very serious medical diagnosis.

We’re lucky:

  • World class clinical care at UCSF (with no network restrictions).
  • No financial worries. We have great insurance – $0 deductible, minimal copays.

Shouldn’t it be that way for everyone?

We know it’s affordable, as demonstrated repeatedly.

Let’s overcome the avarice and cruelty.

(This of course led to the HJM pause; will resume shortly.)

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

German Hospital Reform—Going Global

Germany, facing high hospital costs and overcapacity, recently passed a law shifting payment from solely patient diagnoses to primarily global budgets. The US can learn from this shift, especially since single payer anticipates hospital and overall global budgets.

Germany begins major reform of its hospital sector, DW – Health Germany, Nov. 22, 2024, by Ben Knight

The German parliament has passed a law aiming to reorganize the health sector, slashing the number of hospitals, boosting clinics and digitalizing bureaucracy. [Now former] Health Minister Karl Lauterbach called it a “revolution” … with gradual implementation starting January 2025 and ending in 2029.

The two-pronged hospital reform will change the way German hospitals are financed and impose new care standards.

Germany has the highest number of hospital beds per capita in the European Union, at 7.9 beds per 1,000 inhabitants, compared to the EU average of 5.3. But maintaining these is expensive. According to Lauterbach, this has left many hospitals on the brink of bankruptcy. The result is that patients are being kept in hospital unnecessarily so hospitals can charge health insurers extra money — which in turn drives up the whole country’s health costs and insurance contributions.

The reform means that hospitals will no longer be paid per treatment — instead, they will get a guaranteed income for making certain services available. This, it is hoped, will alleviate the financial pressure on hospitals to pack in as many operations and treatments as they can, even if they are poorly qualified to carry them out

This measure is supposed to ensure that patients needing complex treatments are referred to specialists earlier. This, according to the Health Ministry, will reduce health costs in the long run, as patients stand a better chance of being cured and are less likely to fall victim to mistakes, as hospital staff will be less rushed and overworked. Lauterbach has claimed this reform will save tens of thousands of lives a year.

Lauterbach: Hospital Reform Law Will Save Rural Hospitals, Kommunal.de, July 31, 2024

[Now former] German health minister Karl Lauterbach:

“It is precisely the goal of the reform to protect care in rural areas. Without the reform, many rural hospitals would not survive because of rising personnel costs and inflation. We are currently experiencing the steepest cost increases in the hospital sector ever in German history. All that, despite the fact that 30% of the beds sit empty. If we do not pass this reform, the precarious financial situation of many hospitals will only get worse. Then it is foreseeable that two out of three hospitals would face deficits, as it now almost is. With the reform, the necessary rural hospitals will stay solvent. I therefore predict that the majority of rural hospitals will remain.”

Comment:

By Thomas Lane 

Last year, Germany’s parliament passed a landmark hospital payment reform to shift from a purely diagnosis-based system to mainly global budgets. This addresses serious problems similar to those facing US hospitals – high costs and the financial viability of rural hospitals. Remove the references to Germany in the Lauterbach interview, and it could be about the US. Despite having universal healthcare, Germany relies on a multi-payer system (albeit which provides standardized broad coverage and generates no insurer profits). There are important structural parallels between the US and Germany, such as how hospital stays are compensated. The strategies which Germany uses to control costs offers lessons for the US quest for single payer.

Germany has more hospital beds per capita than most wealthy nations, so a key problem is wasteful spending on hospital overcapacity. Before the reform, Germany’s countless small local hospitals were funded solely via patient-level DRG (diagnosis-related group) payments. In pursuit of patient volume to stay financially afloat, many would treat complicated health issues for which they were inadequately equipped. It’s not hard to see how the new law was quite controversial. Reducing overcapacity means allowing some allegedly unviable or excessive hospitals to close. However, the law simultaneously protects hospitals in underserved areas (mainly rural regions) by replacing the current DRG payments with a mixed 60% global budget and 40% DRG scheme. Perhaps surprisingly, Germany’s government seems set to mostly continue with the reform despite the elections and change in governing coalition that occurred after the law’s passage.

What might we learn from watching Germany’s hospital reform law as it is implemented? The U.S. has far fewer hospital beds per capita than Germany, and I am not trying to imply that the US has too many hospitals. But we do share a misallocation of hospital resources in common with Germany. Wealthy, often suburban regions tend to have the most and best hospitals in America, while our rural hospitals are constantly on a knife’s edge, and many urban safety net hospitals are similarly struggling. To maximize the benefits of single payer, we will need to think about this allocation issue in addition to accomplishing the main goal of efficiently funding necessary care for all. After all, handing out Medicare cards to people in areas without a nearby hospital doesn’t help them much! This has become even more important given the looming cuts to Medicaid and the wave of safety-net hospital closures that will likely follow.

The most recent Medicare for All bill in Congress wisely puts hospitals on global budgets to protect our struggling facilities in underserved areas.  At the same time, global budgets can prevent already well-resourced areas from capturing new resources that are better used elsewhere, as they require hospitals to explain everything they are doing and make choices about what to fund (or not) with their now predictable but limited budgets. By observing how the Germans handle this transition, noting successes and problems, we prepare for how to best implement single payer in the U.S.

https://healthjusticemonitor.org…

Thomas Lane is a master’s student in the health economics, policy & management program at Sweden’s Karolinska Institute, and an analyst at the Swedish Dental and Pharmaceutical Benefits Agency, the government agency tasked with keeping pharmaceutical costs affordable. He graduated in 2024 with a bachelor’s degree in economics and German from Dartmouth College in New Hampshire. He spent several years working in state-level health reform with PNHP in his home state of Minnesota and in New Hampshire, where he was a member of the Granite State PNHP steering committee. The views expressed in HJM are his own.

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Preventable Deaths – Does Magnitude Matter?

A right-wing political leader, Charlie Kirk, was assassinated last week. We do not condone political violence. Nor should we accept the far greater human toll exacted by failed “free-market” health insurance and other fraught societal choices.

Deaths in US (annual) Sources
An assassination 1
Assassinations 9 Durbin 2021
Mass murders 722 (2023) Pew Research 2025
Medicaid cuts 2026 budget 8,000 – 24,000 Gaffney 2025
Gun murders 17,927 (2023) Pew Research 2025
Gun suicides 27,300 (2023) Pew Research 2025
Lack of insurance 45,000 Wilper 2009, Woolhandler 2017
Gun deaths 46,278 (2023) Pew Research 2025
Drug overdoses 105,000 (2023) NIDA 2025
Lack of & Under-Insurance 195,000 HJM 2024

Comment:

By Jim Kahn, M.D., M.P.H.

One murder is too many. I disagreed often with Charlie Kirk, finding many of his statements reprehensible – inaccurate and demeaning. But I certainly never wished him dead, and do not condone his assassination.

Still, I find the aggressive public mourning from conservatives out of step with the scale of the loss. I am baffled that preventable deaths on a magnitude one to tens of thousands times higher are routinely accepted as the price we must pay to preserve favored American values, such as unrestricted gun ownership and a profoundly failed free market in health insurance.

I provide today’s table as a service to myself and HJM readers, to have close at hand the hard numbers – hard in the sense of quantitative, and hard in the sense of troubling.

Please let’s continue, indeed redouble, our quest for a just and efficient health system and other social changes that drastically reduce these painful numbers.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Here’s how many Granite Staters may die due to Congress’ Medicaid cuts

By Thomas Lane and Don Kollisch, M.D.
New Hampshire Bulletin, Sept. 10, 2025

There are a lot of confusing statistics about health insurance, health care costs, access to care, and other features of our complex health care system circulating around right now.

Unfortunately, the actual health of our country’s people and communities is often lost among these mostly financial metrics. One of this column’s authors, Don Kollisch, is a doctor who has practiced family medicine in New Hampshire for more than 40 years. He has worked at medical schools and Veterans Affairs (more commonly known as just “the VA”), but his clinical heart is in the rural North Country of our state, where he worked for many years.

Dr. Kollisch was a believer in prevention and worked hard to control the blood pressure, diabetes, and cholesterol of his patients. One day, covering the ER of his small critical-access hospital, he admitted a man in his 60s who had a stroke that was most likely caused by untreated high blood pressure. The patient lost some speech and some of the use of his right arm and leg. Dr. Kollisch realized, with dismay, that the man lived in a small house near Dr. Kollisch’s own clinic, which he ran 8 miles up the road. The man never came in for treatment of his blood pressure because he worked for a small company and didn’t have health insurance. Food and electricity had to be higher priorities.

If Dr. Kollisch had any doubts previously about the need for everyone in his community to have health insurance, they were permanently dispelled. He became an advocate for expanding publicly funded health insurance to cover everyone, and he is dismayed that current political trends are moving in the opposite direction, toward people losing rather than gaining insurance coverage.

Congress passed and on July 4 President Donald Trump signed the “One Big Beautiful Bill Act,” the largest ever cut to government health care funding in U.S. history. The Congressional Budget Office projects Trump’s “One Big Beautiful Bill Act” will push about 10 million Americans off of health insurance while growing the deficit by $3.4 trillion over the next decade. When combined with the looming expiration of enhanced subsidies for health insurance plans under the Affordable Care Act (more commonly known as “Obamacare”), that uninsurance figure rises to 14.2 million Americans, according to nonpartisan health policy news and analysis organization KFF.

Health economists like author Thomas Lane have studied the link between health insurance and health outcomes. Their work allows us to estimate how many more preventable deaths may occur as health insurance coverage declines, among other outcomes. For example, in a study called the Oregon Health Insurance Experiment, a lottery was run for people on a waiting list to join Medicaid, and the outcomes of those selected were followed over time and compared to those not selected. By combining the results of studies like these with KFF’s projection of the number of Granite Staters who will lose their health insurance due to the OBBBA and related policy changes, Thomas can project its health impacts.

After doing the math, discomforting results quickly become apparent. New Hampshire can expect to see an extra avoidable death slightly more often than once a week, as well as thousands of other residents cut off from necessary care and medications. Over 5,000 may join the already swollen ranks of those in medical debt.

Make no mistake, however. The craziest part of all of this should not be these figures themselves. It’s the fact that they can mostly still be prevented from coming to fruition by our state Legislature.

KFF estimates that the OBBBA will cost New Hampshire about $230 million per year over the next decade, leaving a big hole for our state legislators to fill. Although some of these harms are caused by Congress’ imposition of work requirements and paperwork burdens on Medicaid beneficiaries that the state cannot do much about, most of the damage comes from the funding cuts.

Funding cuts are something the state can definitely do something about. It just needs to come up with roughly $230 million on its own.

How exactly can the state find such a large sum of money? Despite the protests of budget hawks, it’s not actually that complicated. Currently, the state runs Medicaid through private third-party administrators, called managed care organizations (MCOs). MCOs are a product of the 1990s, when the public policy world thought the problem with health care was that people were using too much of it, and health care needed gatekeepers. This is an evidence-free claim. Americans actually use less care than people in Europe and Canada despite spending far more per capita, all while living shorter, less healthy lives. If anything, we don’t use enough. Nonetheless, the MCOs still run New Hampshire’s Medicaid program, adding significant administrative expenses onto the state budget while doing nothing to make health care better.

Connecticut got rid of these wasteful MCO contractors in 2012, instead opting to run its Medicaid program itself. Unsurprisingly, they saved lots of money doing so. Nonpartisan health policy research and advocacy organization Physicians for a National Health Program estimates that New Hampshire could save up to $81 million annually from the removal of MCO contracting alone, but changes like this cascade through the Medicaid system and lead to other beneficial effects, too.

It’s possible to roughly guess what this total effect might look like by simply comparing the difference between what New Hampshire and Connecticut spend on Medicaid per beneficiary. That difference comes out at around $307 million in lower costs annually if New Hampshire’s program had the same costs per beneficiary as Connecticut’s.

That $307 million in potential savings is far more than enough to fill the health care-related $230 million hole in the state budget. With that money, the state can ensure tens of thousands of Granite Staters get the care they need while preventing closures of the countless New Hampshire hospitals and nursing homes that depend on Medicaid for funding.

Other states are starting to consider legislation that would cut out these unnecessary and wasteful Medicaid middlemen. For example, there was a bill in the previous session of the Minnesota legislature called the Patient-Centered Care Act that would more or less copy what Connecticut did (SF1059/HF255). One of us previously wrote a column in support of it, explaining why MCOs are so unhelpful from just about everyone’s perspective, no matter where you fall on the political spectrum.

Back then, it was admittedly still uncertain whether Congress would actually pass a massive budget cut package, but it did, and now there are no more excuses.

Our state Legislature can quite easily alleviate most of the financial problems Congress has passed onto it and thereby save lives. All New Hampshire has to do is copy what Connecticut did and pass a not very big — but in our opinion quite beautiful — bill to cut wasteful MCO middlemen out of our Medicaid program.

Thomas Lane is a health economics, policy, and management master’s student at the Karolinska Institute in Stockholm, Sweden. He recently graduated with a bachelor’s in economics and public policy from Dartmouth College in Hanover, New Hampshire. There, he was a member of the steering committee of Granite State Physicians for a National Health Program.

Dr. Don Kollisch is a family physician who still practices in a free clinic for uninsured people. His career began in private practice in the North Country of New Hampshire, where he had a clinic, worked in a hospital, and served as a deputy medical examiner. He then moved into academic medicine at a number of medical schools, and ended his full-time practice at the VA in White River Junction, Vermont. He still teaches at the Geisel School of Medicine and at Dartmouth Health. He is the Convener of the New Hampshire chapter of Physicians for a National Health Program.

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