Republicans Once Wanted Government out of Health Care. Trump Voters See It Differently, KFF Health News, Feb. 27, 2025, by Noam N. Levey

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Government regulation of health care prices used to be heresy for most Republicans. GOP leaders fiercely opposed the 2010 Affordable Care Act, which included government limits on patients’ costs.

But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.

Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how health care providers can pursue people over medical debt.

Even Medicaid, the state-federal insurance program that Republican congressional leaders are eyeing to dramatically cut, is viewed favorably by many GOP voters.

Skepticism about government lingers among rank-and-file Republicans. And ideas such as shifting all Americans into a single government health plan, akin to “Medicare for All,” are still nonstarters for many GOP voters.

But as tens of millions of Americans are driven into debt by medical bills they don’t understand or can’t afford, many are reassessing their inclination to look to free markets rather than the government.

In a recent national survey, Fabrizio Ward and Hart Research, which for decades has polled for Democratic candidates, found that Trump voters were more likely to blame health insurers, drug companies, and hospital systems than the government for high health care costs.

Three-quarters of Trump voters back government limits on what hospitals can charge, Ward’s polling found.

Mike Perry, who’s convened dozens of focus groups with voters about health care in recent years, said the support for government price caps is all the more remarkable since regulating medical prices isn’t at the top of most politicians’ agenda. “It seems to be like a groundswell,” he said. “They’ve come to this decision on their own, rather than any policymakers leading them there, that something needs to be done.”

Other forms of government regulation, such as limits on medical debt collections, are even more popular. About 8 in 10 Republicans backed a $2,300 cap on how much patients could be required to pay annually for medical debt.

As Trump and his allies in Congress begin shaping their health care agenda, many Republican leaders have expressed more interest in cutting government than in expanding its protections.

“There is oftentimes a massive disconnect,” Ward said, “between what happens in the caucuses on Capitol Hill and what’s happening at family tables across America.”

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Comment:

By Don McCanne, M.D.

The important message here is that it is not only Democrats who are concerned about health care costs so much that they want the government to take action—it is Republicans as well, including those who voted for Trump in 2024. In fact, many Trump supporters think he would do a better job in controlling their health care costs.

Yet there is still significant opposition to single payer / Medicare for All. This is despite numerous studies showing that such a model would be more effective in controlling costs while ensuring access to comprehensive, high quality care for all, affordable for each one of us. They want the government to help, but they remain uncomfortable with the single payer model. So what is going on here?

Most of all, the private insurance industry has been very effective in marketing their products. A predominant example: people on Medicare believe that private Medicare Advantage plans will provide greater benefits at a lower cost than traditional government-managed Medicare. When the insurance product is marketed to them, it seems like that is true. They get a few additional, nominal benefits that are not offered in traditional Medicare, and the up-front costs are lower than premiums in the traditional program especially if including Medigap plans needed to fill coverage holes.

But the financial advantage is illusory. The purpose of health insurance is to provide better access to necessary health care while controlling costs that they would otherwise be exposed to when they need to access that care. Is that the way private Medicare Advantage plans work? No. When beneficiaries need to use their plans, they usually have a limited choice of providers because of the narrow networks covered; they face prior authorization requirements; and they often have greater out-of-pocket expenses because of the deductibles and copays required by the plans, often creating financial hardship. At that point, they might want to return to the greater choices and more affordable coverage of traditional Medicare, but the Medigap plan may no longer be available because of pre-existing conditions (which are ignored at the time of original enrollment).

Actually, what patients want at the time of medical need would be choice of providers, truly comprehensive benefits, with elimination of cost-sharing at the time of service. The way you would get that is through a single payer system, an improved Medicare for All.

Paying for it? This would happen via a public insurance program which would be progressively financed through taxes with those in poverty paying nothing, and increasing with income, with the billionaires paying significantly more than the actual costs. This would be the most equitable method, with no person suffering a financial hardship (when unaffordable costs happen to be one of the greatest sources of dissatisfaction with today’s health care system).

Of course, Republicans have heavily opposed single payer since they greatly favor further reduction in taxes for the billionaires while having the masses fund care through reduced benefits and greater financial contributions. They currently support a privatized Medicare Advantage for All that would do this: fewer paid benefits for lower income individuals and greater cost sharing at the time of service – the opposite of what our system should be providing.

We see that the public broadly does want the government to be involved in fixing our system, providing better care at lower costs. But we really need to do this through the more humanitarian single payer model, rather than through tweaking a system designed to shift our health care dollars to wealthy private investors and away from care.

Our task now is to explain to everyone (including Trump voters!) that they can have the government controls that they want, but that the system needs to be designed so that it works for the people, all of us, rather than being designed to increase the wealth of the private investors at a cost to the average citizen of affordability and access to the care that they need.

Once they understand the system, that’s what they’ll want.

https://healthjusticemonitor.org…

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FLASH BREAKING: Major news on Republicans CUTTING healthcare, YouTube video (8 min), Feb. 25, 2025, by Brian Tyler Cohen

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Liberal Redneck – On Gutting Medicaid and Food Stamps to Cover More Tax Cuts for the Wealthy, YouTube video (8 min), Feb. 26, 2025, by Trae Crowder

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“I was a poor kid, I know gross, but I was I was on all these programs. Food stamps subsidized my education all through college; don’t know what I would have done without them and in the intervening years since I have paid back far more in taxes than I ever got for the government. So the point is stop looking at these programs as an endless money glitch for a bunch of freeloaders, and look at them instead as an investment in one of our most vital resources: each other. I am walking breathing talking proof that the ROI can be pretty damn good. We can use these programs to lift up countless other Americans out of poverty.”

“All right, look, giving these rich people even more money is not going to work. You know how I know? Cuz we’ve been doing it for more than 40 goddamn years. If the Blessed urine of our betters was ever going to trickle down to us, I think we’d have felt a drop or two by now. All right so I’m imploring you — wake up stop tongue-polishing the boot that’s on your throat, and recognize the value of investing in your fellow Americans.”

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The Debate Over Federal Medicaid Cuts: Perspectives of Medicaid Enrollees Who Voted for President Trump and Vice President Harris, KFF (Kaiser Family Foundation), Feb. 25, 2025, by Amaya Diana, Jennifer Tolbert, & Robin Rudowitz

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• Many Trump and Harris voters said that … they did not recall hearing about changes to health care programs (including Medicaid) during the campaign. Most participants said the government has a role to play in making health care more affordable and accessible … both Trump and Harris voters [said] that state verification procedures prevent individuals from defrauding the program on a large scale …

• … Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Both Trump and Harris voters expressed fears that these changes would jeopardize the program, take away access to health care, result in worse health outcomes, and increase out-of-pocket costs. A few Trump voters did not believe Trump would follow through on the cuts to Medicaid because they believed he understood their financial struggles.

• Both Trump and Harris voters valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Participants also valued Medicaid because it helps to protect them from financial disaster, alleviates stress, improves health outcomes and often supports their ability to work. Participants said losing Medicaid would “be devastating” and lead to serious consequences for their physical and mental health and exacerbate pre-existing financial challenges.

• If work requirements were introduced to Medicaid, participants who were working generally felt confident in their ability to meet the requirements; however, they worried about the burden of monthly reporting requirements when those were described to them. Many participants across parties noted that access to treatment for chronic conditions, including prescription medications and mental health treatment, were key in helping to support their ability to work. More Trump voters supported a work requirement but some who were not working were convinced they would qualify for an exemption. Other participants, including both Trump and Harris voters, who were not currently working felt they would face challenges in meeting the requirements. Those who were not working said they wanted to work (and many had been previously working for many years) but were generally unable to because of disability or because they were caring for young children or a sick parent.

• Both Trump and Harris voters wanted policymakers to focus on improving Medicaid instead of cutting it. For example, some participants said they would like to see enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Focus group participants wanted policymakers to consider the implications of federal cuts to Medicaid for people, their health, financial stability, and ability to be productive members of society.

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Comment:

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

This week’s House budget resolution sets targets for subsequent detailed appropriation bills. The two largest priorities: cut Medicaid for the poor, and slash taxes (predominantly) for the rich. Net result: an increase in debt of nearly $3 trillion – that’s $8500 per person, >$25,000 for a family of three, while growing the ranks of the uninsured.

These strategies are widely unpopular, including the Medicaid cuts, as heard by KFF in their bipartisan focus groups.

The $880 billion in Medicaid cuts is about 10%. Where will that come from? Payment rates are already dangerously low. Benefits are slim. A GOP Congressman in the Tyler Cohen video, when repeatedly asked if he’ll vote against “cuts to Medicaid”, robotically intones with a smirk: “No benefit cuts.” What does that mean? How is that possible? Presumably: the budget cuts will arise from restrictions in eligibility (who qualifies), without removing benefits for those covered. So what’s better, less for the same number of beneficiaries, or excluding millions of beneficiaries? Cruel either way, IMO. But for the GOP rep, it’s all political subterfuge.

I do appreciate that economics was highlighted in both of these decidedly non-economic forums. Brian Tyler Cohen presents the Center for American Progress graphic summary of the budget proposals. And Trae Crowder talks about “return on investment” – his taxes as a worker far exceeding what the government invested in his healthy growing up.

Progressives have been losing the social media wars. With entertaining and whip-smart presenters like these YouTubers, we are making up lost ground!

But what’s most encouraging to me is how much a wide swath of voters like and rely on Medicaid. Not that it’s a perfect program, far from it. Despite its limitations. Just imagine how they’d feel about lifelong universal health insurance, with broad benefits, paying fair rates to providers, and no significant cost-sharing. It would be heaven. It’s called single payer. It’s an important way to unite left, middle, and right against the billionaires (but they’d be covered too).

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.

Bridging the Medicare Cost Gap: Knowing Your Options, The New York Times, Feb. 15, 2025, by Mark Miller

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Medicare can cover most of your health care needs when you turn 65, but it doesn’t pay for everything. And one of the most significant financial challenges to watch out for are the out-of-pocket costs you can face aside from monthly premiums — including deductibles and other types of cost sharing.

Just how much you’ll pay, and when, depends on the type of Medicare enrollment that you choose: traditional Medicare, which is operated by the government and provides care on a fee-for-service basis, or Medicare Advantage, which is run by private insurance companies and operates on a managed care model.

There is no built-in annual out-of-pocket limit in traditional Medicare for outpatient and hospitalization services. Protection is available from supplemental insurance coverage – most often it means purchasing Medigap — a policy offered by private insurance companies that covers part or all of Medicare’s cost-sharing requirements.

Medicare Advantage plans come with out-of-pocket limits — but they can be high. When serious medical conditions arise, out-of-pocket costs can be a significant financial hit or make it difficult to afford care altogether. Medicare Advantage plans offer one-stop shopping and extra benefits, but they restrict care to in-network providers and have been criticized for techniques such as “prior authorization.” Traditional Medicare offers the widest access to health providers, and only a small group of medical services require prior authorization.

Medigap

Buying Medigap can be daunting, since the policies come in an alphabet soup of lettered plan choices (A, B, C, D, F, G, K, L, M and N). Medigap premium prices will differ, but the benefits offered by plans are standardized. All Medigap policies cover hospital coinsurance — the costs that you pay for longer stays after deductibles are met. Many cover all or part of the hospital deductible. Medigap plans also cover all or part of the 20 percent of fees for most physician services. They are required to also cover some or all of the cost sharing for outpatient services, and the more robust plans cover the annual hospital deductible and cost-sharing in skilled nursing facilities.

When you first sign up for Part B, which covers doctor visits and outpatient care, that’s when Medicare forbids Medigap plans from rejecting you. The opportunity is available to you during your six-month Medigap Open Enrollment Period, which starts on the first day of the month in which you’re 65 or older. After this period ends, Medigap plans in most states can reject applications or charge higher premiums because of pre-existing conditions.

Medicare Advantage

Jan. 1 through March 31 — this is the time when people enrolled in Advantage can switch plans or move to traditional Medicare. Before making a decision to move to traditional Medicare, make sure you can obtain a Medigap policy. Once you’ve identified a plan that interests you, contact the insurance company for details. The premium will vary.

High-deductible MediGap G plans are not a well-publicized option since Medigap commissions generally are a percentage of the premium, it incentivizes brokers to sell the G plans with the higher premiums.

With Advantage, the exposure can be high in years when you need lots of health care, and out-of-pocket features in the Advantage program vary by plan. It’s not necessarily true that Medicare Advantage will save you money. “The information is published, but it’s very difficult to compare,” Dr. Tricia Neuman of KFF said. “It’s really on the consumer to try to sort through which plan provides the most or least protection, and that’s tough to do.”

More generally, people enrolled in traditional Medicare with supplemental coverage are the least likely to report problems managing their costs, because they have the greatest level of protection, KFF research shows.

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Health Care Affordability for Older Adults: How the U.S. Compares to Other Countries, Commonwealth Fund, Dec. 4, 2024, by Munira Z. Gunja, et al.

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Nearly a quarter of older adults in the U.S. spent at least USD 2,000 over the past year on out-of-pocket expenses, compared to less than 5 percent in France and the Netherlands who spent an equivalent amount.

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Comment:

By Don McCanne, M.D. and Jim Kahn,M.D., M.P.H.

We have long tried to simplify the single payer concept of financing health care by labeling it “Medicare for All,” with the idea that Medicare is a straightforward publicly administered and financed program that serves everyone well. But no longer. These days, it’s a diverse and overwhelming set of options: public traditional Medicare, dozens of supplementary private insurance options (Medigap), and hundreds of private insurance plans (Medicare Advantage) – representing massively complex variation in out-of-pocket costs, benefits, and providers. There is also dual eligibility with Medicaid to assist poor and disabled seniors. Understanding and choosing rationally among Medicare options is impossible.

Simply stated, modern Medicare is a convoluted nightmare that even trained professionals can barely understand. Imagine how intimidated the the average consumer is when receiving reams of information from Medicare, and from private insurers who seek to extract maximum profit from enrollees.

Seniors in other wealthy nations (such as in the OECD) have far superior financial protection for their healthcare, as documented by the recent Commonwealth survey.

What’s behind that success?

• Seniors don’t need to hassle with intimidating choices. They’re just covered, like everyone else.
• The coverage is broad and standard. There are no complex and variable rules about benefits, coverage circumstances, and provider panels.
• Cost-sharing – deductibles especially – is modest. Skipping care for financial reasons is much less frequent, and medical bankruptcy isn’t a phenomenon.

So, we certainly don’t want to keep the current US system with its profoundly complex and expensive administrative excesses that are designed to divert health care funds to wealthy investors while limiting access and choice in health care and leaving millions of people with minimal health care or none at all.

How would US single payer help seniors? Unsurprisingly, it echoes successful foreign practices:

• Streamlined coverage: Standardize and thus radically simplify the process to obtain insurance. Indeed, nothing would change at age 65 – just a continuation of lifelong insurance.
• Reduced financial risk: Cover all necessary medical services, with minimal cost-sharing.

US single payer would be equitably funded by using progressive taxes based on ability to pay, ranging from free for those with very low incomes to more generous funding by our billionaires who would be able to fully maintain their current lifestyles with the riches they would retain. Thus payments into the system would be affordable for all.

We would make health care free or nearly so at the point of service, funding the system through global budgets and other rational economic methods that would fairly compensate providers. Physicians, nurses and other health care professionals would be able to devote all of their time to patient care without worrying about their incomes being based on the amount and intensity of services provided.

Everyone would receive the care they needed. It would be both universal and comprehensive.

It would be publicly administered, eliminating the excessive administrative costs and private profits of our current system.

In opinion polling in the US, two-thirds of adults say “yes” to the following proposition: “Would you support the government paying for all health care, if taxes would rise but premiums and cost-sharing would disappear?” Our online household cost calculators confirm that the vast majority of households would save money with single payer.

In today’s massive political upheaval our beneficial institutions – including public insurance programs — are being threatened. How about affordable, comprehensive health care for all (left and right politically)? Wouldn’t that be a giant step toward making America great?

https://healthjusticemonitor.org…

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