They Voted For Trump And A GOP Congress— Now They’re Being Paid Back With A Loss Of Healthcare

"Donnie Dump" by Greg Bart

Democrats are united, as far as we know, is fighting tooth and nail to derail the GOP plans to defund Medicaid. Trump may lie that he opposes cuts, as do a number of congressional Republicans, but the budget framework they passed— unanimously among their conference members— mandates it, to the tune of the better part of a trillion dollars. They can’t blame it all on Musk. Only 17% for the public backs cutting Medicaid, 42% wants funding increased! Only a third of Republicans want it cut— and less than a quarter of people of people living in rural communities want it cut. 

More than 72 millions use Medicaid for their healthcare. And, wrote Ron Brownstein and Ed Wu on Friday. “dozens of House Republicans represent districts where the share of residents receiving health coverage through Medicaid is greater than in the average district nationwide. And far more House Republicans than House Democrats now hold seats in districts where the share of residents confronting serious health challenges— including diabetes, high blood pressure, obesity, breast cancer deaths, cardiovascular problems and a lack of health insurance of any kind— exceeds the average. Obesity, high blood pressure, diabetes are Republican illnesses— as are under-insurance and cardiovascular deaths. “Given the substantial number of their own constituents who now rely on Medicaid, House Republicans are visibly more uneasy about cutting Medicaid than they were when approving major reductions in the program during their attempt to repeal the Affordable Care Act in 2017— much less when they voted to block grant (i.e., limit to a fixed sum) and slash Medicaid during their 1995-96 budget showdown with then-President Bill Clinton.”

The nationwide average of people using Medicaid is 22.7%. Among Republicans whose constituents are way above that are these half dozen conservatives:

• David Valadao (CA)- 60.7%

• Jay Obernolte (CA)- 44.1%

• Hal Rogers (K)- 44.0%

• Doug LaMalfa (CA)- 39.1%

• Dan Newhouse (WA)- 35.9%

• Cliff Bentz (OR)- 35.0%

Writing from Hondo, county seat of Medina, Texas, Lauren Weber reported on the services to poor people provided by Medina Regional Hospital, paid for by Medicaid, a hospital at risk of being forced to close down if the Republican budget passes. Medina voted 70.9% for Trump, 67.5% for Senator Ted Cruz and 75.5% for Rep. Tony Gonzales, the Republican incumbent.

“Rural hospitals across the United States,” reported Weber, “fear massive Medicaid cuts favored by the Republican Party could decimate maternity services or shutter already struggling medical facilities in communities that overwhelmingly voted for Donald Trump. Nearly half of all rural hospitals nationwide operate at a deficit, with Medicaid barely keeping them afloat. Already, almost 200 rural hospitals have closed in the past two decades…

Rural hospital leaders in Arkansas, Colorado, Kansas, Mississippi, Missouri and Texas who spoke to the Washington Post warned that the enormous cuts congressional Republicans are weighing could further destroy limited health-care access in rural America. Proposals to slash up to $880 billion over 10 years— which is expected to be accomplished largely by scaling back on Medicaid— would also impact those who do not rely on the program but do rely on the medical facilities that are financially dependent on the program’s reimbursements.

… Heart attack and stroke victims may lose crucial time being ferried by ambulance to big-city hospitals, health-care experts say. Rural nursing homes may vanish, straining families in the poorest of regions. Those who are pregnant may have no choice but to drive long distances for prenatal checkups and to give birth.

Public perception often associates the health-care safety net used by more than 1 in 5 Americans with the urban poor. But rural children and non-elderly adults are more likely to rely on Medicaid or the Children’s Health Insurance Program (CHIP) than those in metro areas, according to the Center for Children and Families at the McCourt School of Public Policy at Georgetown University.

The possible cuts are an “existential issue” for rural hospitals, said Alan Morgan, chief executive of the National Rural Health Association.

“Medicaid cuts are going to result in rural hospital closures,” he said. “It’s just a question of how many.”

Medina Regional Hospital sits in an 8,000-person agricultural town roughly an hour west of San Antonio, the drive between the two dotted with taxidermy signs, John Deere tractors and cattle. Per capita income comes in under $20,000 annually, according to the economic development director for the town.

The facility’s chief executive, Billie Bell, had considered closing the unit serving expectant mothers a few years ago. It’s a service the hospital already loses money on, Bell said, as the vast majority of obstetrics patients are on Medicaid, which does not reimburse the facility dollar for dollar for care. She managed to keep the unit open because she feared adding to the maternity health-care deserts in a state that far outpaces the nation in rising rates of maternal deaths.

More than 35 percent of U.S. counties don’t have birthing facilities or obstetric clinicians, according to a March of Dimes report. In Texas, that figure is even worse: Nearly half of the state’s counties are considered maternity-care deserts. Bell warned that cuts to Medicaid could shutter her unit completely.

“We’d lose a big heart of our community,” Bell said. “We provide care from the time someone is born until they die.”

Even if rural facilities manage to stay open but are forced to cut Medicaid-heavy services such as nursing homes or obstetrics care, more rural Americans— and Republican voters— will be left to deal with the consequences.

Some Republicans, such as Sen. Josh Hawley (R-MO) and Trump ally Stephen Bannon have warned against gutting Medicaid, pointing to the vast number of Trump supporters who qualify for the program amid the populist wave that has transformed the GOP. The president has repeatedly said he will not touch Medicaid [a typical Trump bold-faced lie to cover his ass].

But he has also endorsed the House’s plan to find ways to cut spending across federal programs, which are expected to come out of the Medicaid program if lawmakers avoid cutting Medicare or Social Security. All three programs make up more than 40 percent of the federal budget. The House and Senate will work to reconcile their visions for cutting the federal budget in coming weeks.

The Republican Party suffered large congressional losses in 2018, the last time it tried Medicaid cuts, said KFF’s executive vice president for health policy, Larry Levitt, whose nonpartisan health-care research group surveyed Trump voters on Medicaid. Similar political reprisals could happen again, he warned.

“Rural America is Trump country,” Levitt said. “When they voted for Trump, I don’t think they expected cuts to their health care.”