The Democrats' making healthcare the issue in the shutdown may have unintended consequences

The unintended consequence may in the long term be a total overhaul of health care affordability and the role government plays. The red states are the most harmed by the misnamed Big Beautiful Bill, and it may be a wake-up call that leads eventually to Medicare for All.

If it does not, the red state politicians can at least make sure both Medicaid and the ACA are workable because the alternative, letting the lower-income brackets go without health care accessibility and affordability, will be politically untenable and viewed as inhumane. It will be expensive for those who have health insurance, as the cost of medical care by the emergency room will be passed on to them. covered by higher costs and bigger bills for them. Those are the reasons that the ACA, Obamacare, was passed and now has more public approval than ever.

Update: 11/5/2025 MUFTIC FORUM BLOG: Killing off OBAMA care: GOP's stubborn subversion plan: remove subsidies   Their plan: subvert it by making premiums so expensive by removing subsidies, no one can afford it.

Update 10/29/25: a good analysis of the impact of the BBB on Obamacare/ACA: Americans Are Getting a Look at Next Year’s ACA Premiums and Many Don’t Like It

Continuing with the original post

That Democrats in Congress are making health care cuts the issue in the shutdown is a moral one....but it is also aiming at the soft belly of MAGA-run red states. Steve Rattner on Morning Joe this morning presented some extremely fascinating statistics in graphs that show the negative impact of the BBB on healthcare will hit the red states in the South the worst. Especially harmed were states that refused to expand Medicaid coverage when they had a chance in the Biden and Democratic administrations. Using Obamacare (the ACA) to fill in the gap they left in so many uninsured and now they will have the largest increase in their state ACA programs, more so than blue states, because the subsidies to make the ACA affordable have been taken away by the Big Beautiful Bill. Those of us in blue states will also feel the pain.... That is the short-term political dilemma that the GOP is finding itself in.

In the long term, the ACA will have to be replaced, because it has not resulted in the profit-driven health insurers reducing costs...and instead, the ACA is just a method to help consumers afford the private insurers' unbridled greed. The only way out is a Medicare for All kind of a program that has a huge advantage: the pool of insured becomes the whole country...an average that includes both the sick, elderly and the healthy, spreading the risk around and reducing the cost for everyone. There will come a time when Americans will realize that their fear of socialism will be eclipsed by the need to cope with the cost of modern medicine, and they will rise up and demand it. I am not sure we are there yet, but the BBB BS by an uncaring GOP may be a catalyst for voter attitude changes, it is so jarring and harmful.

msn.com

Steve Rattner: Red states use Obamacare more; health care cuts hit red states hardest

Morning Joe economic analyst Steve Rattner discusses how the government shutdown is impacting health care.

The old GOP trick: Whenever in doo doo, the GOP invokes law and order

 Fear is sweeping DC that Democrats will take over the House in 2026. Pulling the panic button the GOP not only tries to cut expected losses by gerrymandering to gain seats, they are pulling their old rabbit out of the magic hat: Democrats are soft on crime; the GOP is tough on crime. President makes provocative claim during Cabinet meeting as National Guard patrols DC streets | Fox News Trump will make crime the top issue in 2026.

Willie Horton in 1988? GOP ads in 2022? The GOP mouths familiar words, but their Big Beautiful Bill cuts funding to after-school programs and adds nothing to local policing. Instead, Trump cut billions from local police reforms and improvements and Gov. Pritzker charged he "defunded police". Trump Reverses Biden Directive on Policing Reforms | Brennan Center for Justice. Trump's big beautiful bill diverted funding from policies that shift funds away from some policing and crime-prevention programs. So, Trump threatens to send in the military just to make the point that he is the big muscle caring about your safety and protection against crime.  As usual, the perception by the loyal GOP followers is that crime is always out of control whenever there are black mayors in blue states.  The statistics show crime rates are as bad to worse in red states' cities, but who in the GOP cares about statistics? Perception is all that counts. 

  In the meantime, if there was a crime wave to justify such military intervention, the Big Beautiful Bill added nothing to support of urban policing and instead yanks funds from community-based policing and taking guns off the street beginning in 2026..  Instead, all law enforcement increases were for combating immigration.  Trump loves crime committed on his behalf  or by those who support him enough as he issues pardons and gets immunity to commit crimes himself, a gift from the Supreme Court. 

The next question is how Democrats should counter this Trump strategy to make crime the issue: One way is to show that Democrats don't like crime either, and then come up with a plan that makes sense. It may vary from one area to another, but it isn't just strategy and collaboration, or solving urban social problems caused by poverty.  I have served in big city local government, have had close friends in law enforcement, and sat through interminable city council debates.  There is no silver bullet. However, more cops on the beat on foot or bike do two things: one, make a visible statement, giving reassurances to residents,  and two, get on the ground response more quickly in high crime urban areas. The difference is that Democrats would extend such programs not only to cities with high crime rates in blue states but also to cities in need in red states.

In politics, visibility counts in shaping perception.  I could see some smart candidate proposing an idea like "a cop a block" in targeted high crime areas or something catchy and visible like that, and then proposing funding more cops visible on the streets.  That may be where Congress fits into the picture. That may not be the best and highest use, but at least it would provide something better than a soldier on every block for only 30 days. What happens when they leave, anyway?  Soldiers are not trained to be cops of civilians, make arrests, and intervene to defuse hot conflicts.  It is like the concept of community cop policing in schools. or a cop on every subway train or bus stop. 

 https://www.nlc.org/article/2025/07/11/local-impacts-from-congress-one-big-beautiful-bill #:~:text=The%20bill%20maintains%20the%20direct,2034%20period%20by%20$3.4%20trillion.%E2%80%9D 

  MUFTIC FORUM BLOG: So is Trump going to send troops into crime ridden cities located in red states?

To keep kids out of trouble, the Big Beautiful bill also It is also withholds nearly $7 billion in gran is to admit t funding to school districts – for before- and after-school programs, teacher training, ... https://www.nlc.org/article/2025/07/11/local-impacts-from-congress-one-big-beautiful-bill/: 

The Campaign Ad that Reshaped Criminal Justice | The Takeaway | WNYC Studios   Willii Horton

Local crime news coverage and concerns about crime | Pew Research Center  2022

https://giffords.org/press-release/2025/05/trump-budget-defunds-the-police/

Trump loves criminals convicted of crimes committed on his behalf  or by those who support him enough as he issues pardons and gets immunity to commit crimes himself, a gift from the Supreme Court. List of people granted executive clemency in the second Trump presidency - Wikipedia

The hard truth in a nutshell: tax cuts to the rich costs $4T; health care for poor gets cut $1T; consumers get the tariff bills.

The hard truth in a nutshell: tax cuts to the rich cost $4T over 10 years; health care for the poor gets cut $1T (over 10 years); consumers get stuck with much of the tariff costs.The only winners in Trump's economic policies: the rich and the appearance of more income to the federal balance sheet. The losers: the poor and near-poor, and all American families who will pay more for what they buy. 

Please do not call Trump a populist: this budget only takes away from people some popular programs relied upon by so many who are barely making it.  In addition to financial deprivation, the Trump regime also subverts or destroys consumer protections from products, as well as protections from fraud, all to the benefit of business interests.MUFTIC FORUM BLOG: Donald Trump, unsafe at any speed updated 8/4/2025

 Please do not cite current conditions of "how great his economy is". .These are forecasts; the stuff is just beginning to hit the fan.  When Trump blows his horn, his economy is great now, the impact of his policies has not yet been felt, but will.  Most cuts hurting the middle class will not take place until after 2026 midterms.  MUFTIC FORUM BLOG: MAGA supporters cheer Trump's economy, but the stuff has not hit the fan yet

 When Trump says his policies will be good for the economy, it will be great for him and his friends, but not for everyday Americans, who will get screwed, and so will the federal balance sheet: $3.4 trillion will be added to the deficit. Trump Tax Law to Add $3.4 Trillion to US Deficits, CBO Says (2)

Per  a check with  Google AI and their sources based on Congressional Budget Office figures (not the White House's)  over the next 10 years, the amount cut from the federal programs serving the poor and near poor is $1 trillion dollars.   Tax cuts to the rich will decrease income to the US treasury by $3 to $4 trillion dollars.   

Trump tariffs could bring in about 2 trillion plus in ten years to the treasury, but it would cost a family in the US in higher prices $2400 per year since some of those costs are just passed on to consumers.  It is a shift that is deceptive...consumers pay for the tariffs, but the federal balance sheet looks impressive.State of U.S. Tariffs: August 7, 2025 | The Budget Lab at Yale    The bottom 60% of Americans will see $400 tax cut, however, but not enough to offset the tariff screw.  Trump   suggests a rebate to consumers to help offset the cost of tariffs on consumer goods, but Congress must approve, and the impact on the deficit will only make that balance sheet worse, making Congress approval unlikely. Nice BS, Trump; more empty promises about family affordability. So what about your health care insurance?

Per Google AI:

Permanently extending the expiring provisions of the 2017 Tax Cuts and Jobs Act (TCJA) that largely favored high-income individuals and large corporations, often referred to as "Trump tax cuts," could cost the U.S. Treasury an estimated $4 trillion over the next decade, according to the Congressional Budget Office (CBO). 

This potential revenue loss includes $3.4 trillion from extending expiring individual and estate tax provisions and $551 billion from extending business provisions. 

It's important to note that extending these tax cuts would disproportionately benefit the wealthy. For example, households in the top 1% (making more than roughly $743,000 a year) would receive average tax cuts of $61,000 a year, while households in the bottom 60% (making roughly $96,000 or less) would only see about $400 a year. 

Some estimates suggest the cost could be even higher. The Center on Budget and Policy Priorities states that extending the expiring tax cuts could cost $4.2 trillion over the decade 2026-2035, with approximately half of the benefits going to the top 5% of earners (making over roughly $320,000). 

These figures highlight the significant financial implications and distributional effects of making permanent the tax cuts enacted in 2017.

• Permanently Extending the Trump Tax Cuts Would Cost $4 ...

  May 8, 2024 — Permanently Extending the Trump Tax Cuts Would Cost $4 Trillion Over the Next Decade. Permanently extending the Trump tax cuts would cost $400 billion per year ...
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Cute GOP trick.Most won't know they will lose health care after Nov. 3, 2026 midterm elections

 There is a cute GOP trick afoot. Most won't know they will lose health care after the Nov. 3, 2026  midterm elections. Most of the dire cuts to Medicaid. CHIPS and Obamacare premium hikes will not take place until after the Congressional elections on November 3. 2026.  Depending on the state, nearly 12 million of you will receive notification anywhere from Nov 1 to Dec 20, 2026, that individuals will lose your Medicaid-related insurance beginning Jan.1, 2027 (pre the Congressional Budget Office, not per the opinions expressed by the GOP mouths), and those on the ACA  that your Obamacare premiums might have doubled or tripled. Before Nov. 3, 2026, some will begin to see nursing homes and rural hospitals close and ACA premiums rise as they anticiiipate their loss of income beginning Jan.1, 2027. The GOP has pulled a fast one on you to protect the reelection of their members of Congress from voter wrath.  For sure, the fallout will be a reality, and the pain will be felt every time many get medical bills they cannot afford to pay on time for the 2028 presidential elections. The reality of Medicaid funding loss sets when it is too late to get mad at your congressperson for screwing you for voting for the "Big Beautiful Bill".  You will have that much time, you get a notice to move Grandma out of a nursing home and take over her care expenses, too. 1.2 million nursing homes get Medicaid coverage. covering 60% of institutional costs, and it will cause many nursing homes to close their doors to the 40% of self-paying patients, as well.   That's why it is so silly for Mitch McConnell to think that between then and November 2026 and November 2028, you, voters, are so gullible that nothing has happened, so you will forget they lost health insurance, and to be informed before in time you have a chance to vote your Congresspeople out.  You will "get over it"  McConnell claims.  That is why J D Vance, VP, thinks you will be so happy with mass deportations funded in billions in the Big Beautiful Bill, cuts to your health insurance as an issue will be   "immaterial" per USA Today. Your health care costs are "immaterial"? Are you really that easily fooled? You'll know who to blame, and it will not be an incumbent Democrat Senator or House member.

When We’ll See the Full Damage From Trump’s Megabill

MUFTIC FORUM BLOG: The new GOP mantra: caring for those who cannot help themselves is waste and civilization weakness

Will it cost the GOP House in 2026.  It could. Republicans just cut Medicaid. Will it cost them control of Congress?

Also slated for post 2026 are cuts to food stamps (SNAP)  Medicaid, SNAP cuts not supposed to take effect until after 2026 U.S. midterm elections | Watch

 Google AI: Medicaid is the primary payer for the majority of nursing home residents in the United States. Over 60% of nursing home residents rely on Medicaid to cover the costs of their care. This translates to roughly 1.2 million individuals who are Medicaid beneficiaries in nursing facilities, according to KFF. (That does not count the number of nursing homes that will go out of business  and rural hospitals that 

close  so even paying patients will have to scramble to find new facilities or drive many miles to the nearest hospital.

In response to those who think cutting out waste and abuse of Medicaid will strengthen them, 

There is no free lunch here...we will all be paying the price in some way...in heartbreak or in money. When a rural hospital closes, it affects far more than those on Medicaid. How do we know this? Because that is what happened before Medicaid and Obamacare.  It is why both came into being. It affects the self-paying patients, also depriving them of timely and easy access to hospital care. It affects the families who have to take over the care at home of those who can no longer afford in nursing homes, because the nursing homes serving rural communities close. It affects all those employed in the closed hospitals and nursing homes who become unemployed. It can be a matter of life and death..with long and deadly ambulance rides, for those in a medical crisis.

What about those hospitals and nursing homes in both rural and urban America that survive, and the patients who use them, both who lose Medicaid and Obamacare, and those who do not and are still self-paying?. If non-paying patients reach the nearest hospital, they become a charity-funded case, covered by a shift of higher bills for paying patients to make up the difference. It means greater use of hospital emergency rooms, the most expensive form of primary care available, as sicker patients who delayed attention have to depend on them. If surgery, diagnosis, specialists are needed, and there is no money to pay for follow-up care, either the patient dies or they go bankrupt, and no one gets paid....the provider, the hospital, the doctors, or other creditors..

 Expect MAGA-dominated states to do what Alaska did: demand supplemental federal aid or special carve-outs. In the federal budget. Expect the blue states to raise state and local taxes to cover the loss, partially..

Democrats: keep it, simple, and to the point on Medicaid cuts: messaging again

 Medicaid cuts: Republicans are losing on this one, and Democrats can score even more points by making comments simple and sharp.   Some ideas for better messaging.  Don't get lost in weeds or much data or belabor  morality issues. Go to the point and repeat, repeat, repeat.

Inform: GOP will take away health care for  10 million     people by cutting Medicaid,\  Another 15 million  will lose Obamacare and other health care coverage per the Congressional Budget Office 

Fix:

1) Simple: don't give tax breaks for the rich.  Keep Medicaid coverage for the needy   

     rebuttal points if needed

2)Don't take health care from innocent, needy people with chainsaws in the name of waste fraud abuse.. Throwing the baby out with the bathwater kills people (Thanks, Sen. Joni Ernst for the MAGA answer: people are going to die anyway:https://www.npr.org/2025/05/31/nx-s1-5418932/we-all-are-going-to-die-ernst-joni-town-hall-iowa-senator)

3) Fraud and abuse. Improve, empower, and fund inspectors general. Let them find waste, fraud, and abuse. Trump fired the inspector general the day after he was elected. 

4) Work requirements will not save money.  .They cost  millions to administer. States already can implement work requirements for Medicaid. Work requirements tried by states never increased employment.States can already apply for work requirements already; a few have and that is why we know costs and effects.. 

In the weeds, if necessary: 

Only  a few have. They do not work. (why? One reason: Over 60% of those on Medicaid are already working.  Those who are able, not disabled or elderly, are already working.)  5 Key Facts About Medicaid Work Requirements | KFF

Six Reasons Work Requirements Are a Bad Idea for Medicaid - Families USA "Nearly eight in ten non-disabled, non-elderly adults live in families where at least one member works, and sixty percent work themselves. In some states, closer to three-quarters of Medicaid enrollees are working themselves. Of those who are not working, more than one-third reported illness or disability as the primary reason for not working. Another thirty percent cited caretaking obligations as an impediment to work"