Yesterday, the US Senate passed Donald Trump’s big, ugly spending bill with a vote of 50-51. JD Vance broke the tie, because elections have consequences and people apparently didn’t like the way Kamala Harris laughed. This bill is a complete catastrophe in a million different ways. Republicans have also found a way to gut the Affordable Care Act, in a “death by a thousand paper cuts” sort of way:
The Senate version of President Donald Trump’s massive tax and immigration spending plan would wipe out many of the strides made by the Affordable Care Act in reducing the number of uninsured Americans, resulting in at least 17 million Americans losing their health coverage, according to nonpartisan estimates and experts.
The bill, which narrowly passed the Senate on Tuesday and now heads back to the House, would effectively accomplish what Republicans have long failed to do: unwind many of the key components of the ACA, President Barack Obama’s signature domestic achievement, which dramatically increased the number of Americans with access to health insurance.
To start, the Congressional Budget Office estimated that the Senate version of the bill would result in 11.8 million more uninsured in 2034, mostly because of Medicaid cuts, compared with 10.9 million if the House version became law.
In addition, both versions of the bill would allow pandemic-era enhanced subsidies for health insurance through ACA marketplaces to expire at the end of the year, sharply raising out-of-pocket costs for millions of Americans. The CBO estimates that 4.2 million people would lose insurance as a result. An additional 1 million are likely to become uninsured because of a combination of other Trump administration cuts and the Republican legislation, according to the CBO.
The bill also includes other, less-noticed changes that over several years would make it harder for states to maintain the ACA’s Medicaid expansion at existing levels, which currently cover some 20 million Americans, according to KFF, a health policy research organization.
“This bill — if passed, and if the enhanced subsidies expire — will be a very effective undermining of the vision of the Affordable Care Act to move the United States to a country where universal coverage is in sight,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “This was the 100-year fight to get to the passage of the Affordable Care Act.”
To be fair, Republican governors are already on a years-long project to dismantle the ACA at the state level, at least that’s true of Virginia’s current governor. Additionally, Trump’s war against schools, education and children continues unabated – in the last 24 hours, the Trump administration decided to withhold $7 billion in federal funding for after-school and summer programs.
In addition to all of that, Florida is now creating shipping-container concentration camps for immigrants. They’re calling it “Alligator Alcatraz.” They have hate-crime merch.
It’s costing taxpayers $450/M annually & Alligator Alcatraz concentration camp is already flooding. Imagine a hurricane. People are going to die.
There’s always enough money to hurt folks, but when it comes to public transit, low-income housing, schools, or public healthcare, “Sorry, we’re broke.”
— Christopher Webb (@cwebbonline.com) July 2, 2025 at 6:22 AM
Photos courtesy of Avalon Red, Cover Images.
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- Den Haag, The Netherlands, 2025-06-25 11:08:10 The Hague, 25-06-2025, World ForumHeads of state and government leaders arrive at the World Forum in The Hague for the summit meeting of the Atlantic Alliance.PHOTO: NLBeeld/Patrick van EmstIn the photo: US President Donald Trump,Image: 1014885427, License: Rights-managed, Restrictions: , Model Release: no, Credit line: /Avalon
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- Den Haag, The Netherlands, 2025-06-25 11:08:32 The Hague, 25-06-2025, World ForumHeads of state and government leaders arrive at the World Forum in The Hague for the summit meeting of the Atlantic Alliance.PHOTO: NLBeeld/Patrick van EmstIn the photo: US President Donald Trump,Image: 1014890156, License: Rights-managed, Restrictions: , Model Release: no, Credit line: /Avalon
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- US President Donald J. Trump walks to board Marine One on the South Lawn of the White House in Washington, DC, USA 06 June 2025. Kilmar Abrego García is reportedly in federal custody and is returning to the US to face federal charges. Featuring: Donald J. Trump Where: Washington, District of Columbia, United States When: 06 Jun 2025 Credit: Shawn Thew/POOL via CNP/INSTARimages.com
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- 250th anniversary of the United States Army with a military parade, which happens to coincide with US President Trump’s 79th birthday, is expected to cost up to 5 million and feature 6,600 soldiers, 50 helicopters and 60-ton M1 Abrams battle tanks Featuring: President Donald Trump Where: Washington, District of Columbia, United States When: 14 Jun 2025 Credit: POOL via CNP/INSTARimages.com
When it comes to this disaster it isn’t just 12 million people losing Medicaid because anyone who buys their insurance on the exchange will more than likely also lose their insurance because the premium hikes are going to ensure that no one can purchase those policies. Without the subsidies it makes insurance unreachable. This will leave approximately 20 million people without access to insurance of care.
The impact on rural hospitals and providers and long term care facilities will hit in about 6 months. Centene has withdrawn their 2025 Guidance. Centene is a $28 billion, highly Medicaid dependent corporation has pulled all current year guidance despite cuts not kicking in for 18 months. That is a solid indicator that this is going to hit in less than six months.
I do population health data that’s my job. What is going to happen will impact access to care for people on Medicaid and Medicare which will leave folks with no access to care. There are already plenty of physicians who no longer take Medicare patients because the reimbursement rates are ridiculous. For example, elderly diabetes patients often have many complications. Diabetes patients wounds do not heal and are generally very complex cases, but the Medicare reimbursement rates for one patients wound treatment is $12 and a few cents. You think I’m kidding but I’m not. And this bill cuts those reimbursement rates again! So many elderly folks will be unable to stay with their providers and in rural America they will be lucky to find another provider.
We’ve seen in Idaho as a result of the complete ban on abortion not only have OB/GYNs fled the state, but Pediatricians are few and far between and in Boise on of the larger cities there are so many openings for and no one wants to bring their families there to practice because of the restrictions Idaho has placed on how physicians can do their jobs.
At home, in Washington State, Valley Medical Center, in Renton, WA has been in financial straights for a while, and the pandemic didn’t help. Valley sits right in the middle of a Boeing enclave. Valley doesn’t just have a hospital, it’s Public Hospital District 1, it has clinics, primary care, cancer care, specialties etc. If Valley folds as a result of this, there aren’t a ton of options in that area for folks who cannot travel outside of the area to see their provider and at the same time there are not options to go to another network, MultiCare doesn’t have much down there and the UW system relied on Valley to cover the south end. UW Physicians often times split their time between UW and Valley, but that ends next year, Swedish Providence has very little in the south end, and it’s rare to find an independent provider who can add that number of patients to their already packed panels.
I haven’t even started with the impact on long term care facilities, because the vast majority of folks in those facilities are on Medicaid/Medicare to pay for their stays. But so many of these places will just go under leaving people not only without care but without a place to be! Not everyone has family! This is an absolute disaster and people will begin to see the effects soon, not in 18 months but fewer than six months.
But you know, folks like Lex Luthor, his weird looking bride, and the rest of the billionaires, I mean they need more, it’s imperative that we make sure they get more, in fact, apparently they need it all.
Anyway, this chick, me, I’m getting out of the pop health game by the end of this year, because I’ll probably be out of job anyway so I might as well go back to DevOps elsewhere.
I’m so sorry about your job Teresa. I hope you’re able to find something else. I want to thank you for taking the time to write this post. I learned a lot. My understanding is this bill also allows DT to just outright ignore court orders. I think it’s safe to say midterms will be cancelled. Florida has already “pushed back” their elections to 2026.
Find out season is gonna to hit folks really, really hard.
@SIde Eye, thank you. Fingers crossed that I’ll find something else soonish!
@side eye Florida hasn’t pushed back elections. A Miami commission voted to hold their local elections in even years, aligning with Presidential and gubernatorial elections, and impose term limits. The Florida AG is pushing back.
https://www.nbcmiami.com/news/local/florida-ag-pushes-back-on-miami-proposal-to-move-elections-to-even-years-limit-terms/3645499/
A change to the charter of elections from odd to even year requires voter approval, to the commission @Bqm. And the voters did not approve this. They changed the years from odd to even ON AN ELECTION YEAR. So yes, they postponed the elections.
Thank you for all this information. I’m convinced that the goal of these monsters is to kill us all 🤬. Btw, there’s a genocide occurring right now in Africa because of the USAID cuts. That is directly caused by Trump-Vance. Where are the genocide protesters?
The genocide protesters have been out there, protesting.
They are with (or the same people) who have been out in the millions, protesting many of the Trump administration’s cruel and unlawful actions, policies. All across the US (2000+ rallies, 5-10 million participants on July 14th) and in many locations worldwide; many other protests, rallies since then and more to come.
The mainstream media, though, has downplayed, marginalized or in some cases completely failed to cover these protests.
Republicans are a death cult, seriously.
@Teresa: Thank you for writing this all out for us. I am in WA State. I can’t get a straight answer from anyone. I’m in the process of trying to get my Dad into assisted living through Medicaid. I’m terrified he’s going to sell where he is now, go into AL, then get kicked out within a year and have no home anymore. He lives in a senior community with once a week visits through Medicare. Would you suggest he stays put so he at least has a roof over his head?
OMG @Sealit: I am devastated for you, this is horrific.
In case people don’t know, Medicaid requires that the recipient has no assets, no savings etc.
@Sealit has a Hobbesian choice here. I might contact the Northewest Elder Law Group and ask them some questions about this, like the questions you have above, because I don think you’d have any recourse once his assets are gone.
I wish I had better advice for you. I’m just so sorry.
Yes. If he’s able, he needs to stay put, unless he’s a danger to himself or others due to dementia etc. If he’s is, it might be better to see if family members can work something out, short term-ish, while we wait for all of this to shake out. Heck. Hiring a family member caregiver – which used to be possible with Medicaid – is better than moving.
I’m not the above poster, but I’ve been following and I’ve seen how this plays out way too many times.
The tier of Medicare / Medicaid housing for the elderly is already really really bad in a lot of places. Understaffed, under paid, over crowded and deeply under maintained. Many places are going to tank – even some of the rabidly for profit lux ones – because people’s savings which pay for these places are getting decimated in real time.
If he thinks “everything is going to be fine. Everyone js so dramatic” ok. Cool. So let’s just stay put for about a year before making any decisions. Because everything is fine, right?
@Teresa @Friendly Crow:
Thank you so much for your replies. I feel pretty much alone trying to decide what to do with my Dad. No one wants to give me an answer. I have 27 days before his appointment to start looking for AL with a caseworker. If he loses his home and AL, I’m going to pack him up and drop him off at my Republican Brother’s house in OH. He voted for this and claims everything is going to be fine.
Sealit—I chose to care for my mom at home when she developed dementia. She would have hated a nursing home, which would have wiped her out financially. Medicare paid for some home health care, but I had to private pay for most of it—which was tax-deductible. Check into Aging At Home programs online—my state has been pushing that option. Good luck!
important distinctions – Medicare does not cover any type of housing and only covers ‘skilled care’ for home health – so PT/OT, nursing, maybe a bath aide and that is for a limited amount of time.
Medicaid covers housing or in home caregivers, housekeepers etc. depending on the state — also assisted living or LTC — if your Dad is selling a home, he will have to private pay assisted living until he falls into the Medicaid window – they typically go back seven years for assets.
“If he thinks “everything is going to be fine. Everyone js so dramatic” ok”
@Friendly Crow, were you talking to my dad? That’s basically what he said when my sister (who works at a skilled nursing facility) voiced concerns about losing her job and not finding another one if facilities all over close.
Thank you for taking the time to explain this! Very awful but helpful to be aware of.
Thank you for taking the time to write this out. I think people are seeing the numbers in the headlines and not thinking how it will play out in real life.
Something else I’ll point out – you mentioned leaving the field and finding a different job. We need to think about that as part of a larger consequence of this. When these nursing homes and clinics close, people are going to lose jobs. a lot of jobs. and if you’re in rural alabama or kentucky, there probably aren’t that many other options for you bc those rural economies were wiped out long ago. (its partly why so many people in rural red areas are on disability – factories etc closed and there was nothing else.) And the Rs just made it harder for people to get any kind of assistance even when between jobs.
this is going to be awful.
Very comprehensive breakdown of how it’s going to fall apart. It’s such a mess and people ignorantly think that because they aren’t on Medicaid it wont affect them.
Here in Oregon there are 4 hospitals set to close with this passing, a 5th in Coos Bay is now bankrupt.
I too work in healthcare and am looking into a new field as I’m nervous but I don’t know what I should look into. I have ra and before it flared I did physical work. I got my degree later in healthcare management, I’m single live alone bought a house 3 years ago.
I’m a person without a backup plan, no generational wealth, I’m terrified if I’m honest. I take it a day at a time but this is devastating to the soul. I’m never going to forget this, the people who did this should be arrested, it’s treasonous.
Here’s hoping people get the memo, sooner, rather than later; and that it’s not too late, by then.
Enough of this fascism is “on its way”. It’s here. My heart aches for the misery and death the Republican party is courting in the name of billionaire greed. For a so called “Judeo-Christian” nation this is the most unchristian thing I’ve ever seen. I am disgusted.
They (Republicans in Congress, Trump’s administration, Musk, Bezos, the whole lot of them) are exactly like the VIPs in Squid Game:
gleefully orchestrating and watching those whose lives they consider expendable die for the sake of their own entertainment (in their case, amassing as much wealth and power as they can accumulate).
Disgusting indeed.
Here is a mathematical breakdown of what will happen to people who purchase their insurance on the exchange.
Around 20 million American’s will lose access to Medicaid and the exchange. The best example is this: a 60 year old couple with a total gross income of $85,000 per year, who now pay around $654, which is around $7500 a year, on a silver plan through the exchange will see their premiums go up to $26,000 per year. That equates to 30.5% of their total gross income not net, but gross. They pay 6.2% in social security taxes from their total gross income, and Medicare is approximately 1.45% of total gross income. And we aren’t even talking about their simple income taxes. Federal income taxes will be approximately 12.13%. In percentages alone we are talking about around 50.28 of their total gross income. That is in total dollars $42,738.00 per year, and so this couple potentially has $42,262 left without accounting for living expenses including power, water, mortgage or rent, car payments, car insurance, or credit cards etc and so on. Maybe in the end with state and local taxes that couple has $15,000 in disposable income. Well food is expensive and I haven’t added that in yet, but even if you only spend $500 a month on groceries, that’s $6000 a year and that means you’re down to $9,000 in disposable income, but you know how things are and $9,000 over the course of a year, well what if they need tires for their car or other emergencies. In all likelihood these folks will have no disposable income.
KFF gave me the premium rate hike information and the rest is just math and is quite simple to calculate.
I’ve got family members in their early 60’s who had been looking at retiring soon. Since they are a few years from 65, they’ve been looking at the state health insurance exchanges for coverage to bridge the gap until Medicare is available to them at 65.
It looks like that may not be an option for them anymore, because the premiums are likely to skyrocket. They are middle class, not wealthy. Their retirement plans include helping elderly relatives and disabled relatives who could use more help with shopping, errands, appointments and companionship. And doing things to maintain their own health so they can
live independently for as long as possible.
All that is likely off the table, they’ll need to keep working, just to tread water, their jobs won’t be freed up for someone else, their relatives won’t get the care, assistance that would have lifted them up.
It’s a cascade of damage and difficulty, courtesy of the cult of fascism, cruelty, and stupidity.
This. This right here. This is going to be happening to nearly every family because a reversal for this is not in the works. An alternative for this is not in the works.
So many retired patents have adult disabled children living with them and their day to day living was made just barely possible with the help from Medicare / Medicaid as many are paid caregivers for their children.
Between them all losing their medical insurance to no longer having access to the funds they created their retirement and their child’s care around …. Things are gonna get really dark and really grim very very quickly.
and a lot of people are forced into early retirement for one reason or another – maybe they had a back surgery that means they can’t drive that commercial vehicle anymore like they’ve done for the past 35 years, but they’re 60 and need SOMETHING to help tide them over until they can get medicare.
i work in disability law and the number of people who apply around 59-60 for health insurance is…..well, its a lot.
Someone asked me once what I thought would reduce the number of people applying for disability and i said universal healthcare. and its true. a great deal of the people apply for disability really need the healthcare.
It’s so so bad. I’m just.
I have no words other than trump and the repuglicans have no soul and just chase the money to line their pockets. The constitution which is supposed to be for the people means nothing to them and their enormous greed. FUCK THEM ALL!!!!
I am one of the people this will impact. I am unemployed, and the subsidy is the only reason I am able to afford health care. I was just diagnosed with breast cancer, and I cannot afford treatment without it (it will be a challenge even with insurance). The people passing this bill are evil and want us all to die, especially women.
I am so sorry M! I have no words for how evil all of this is.
I am so sorry about your diagnosis. Cancer is horrible enough to face without the ax of medical bills hanging over your head. I have relapsing multiple myeloma and I will have to pay WHATEVER my insurance company asks, because my treatment is around $500,000/year. This administration absolutely wants to kill the sick and the old.
I too will be affected because I got laid off in early June and decided to go with exchange coverage because $600 was cheaper than $836 per month for cobra.
I’m so sorry you’re looking at the same situation while also battling cancer. That’s just terrible. WTF is wrong with all these monsters?!
I keep asking myself why? Why did so many people want misery, darkness, death and billionaires hoarding money? This was completely preventable. Who would want this for themselves and their families?
Yes I know – misogyny and racism are rampant. I guess my question is why did they think THIS was the better alternative? Who picks billionaires and their minions literally trying to kill the working class aka the majority of us?
They didn’t think any of it would affect them, just “those” people. FAFO.
I agree this is probably true. It just still blows my mind that so many people are that stupid to think they wouldn’t be affected.
It’s also deeply disturbing that so many literally didn’t care how others would be harmed as long as they were fine. We are a cruel, malicious nation of white people.
There are plenty of magats who do not care how badly they themselves are impacted by this. So long as ‘the other guy’ gets the shaft, they’ll embrace being destroyed themselves.
Like all of the imbecilic self hating veterans who voted for the pos who called them suckers and losers. The VA is being destroyed, vets will have no access to health care by the end of 2025. Still millions of idiot veterans continue to embrace the orange menace.
Something I do find about social media that answers this question (at least in part) is that people just don’t know what this bill will do. The Rs go on Fox News or elsewhere and spout their talking points that are just blatant lies and MAGAts just parrot those lies back. Its weirdly eye opening to see how many people will believe a lie just because it comes from someone with a R in front of their name.
I listened to the Money With Katie podcast interview with Tressie McMillan Cottam yesterday, and she had an explanation that resonated with me.
It’s super clear to all of us that the economy, even when it was humming along under Biden, was not actually working for most of us. Republicans spoke to that, saying that the economy was terrible and they would fix it, which were lies, but because our day-to-day experience of the economy (not the stock market or GDP) was challenging, it was really easy for many people to believe those lies. Meanwhile, the Democrats were telling us the economy was great, essentially gaslighting people whose lived experience didn’t back that up.
Most voters are low-information voters. They’re not out here reading Heather Cox Richardson or watching Rachel Maddow. And sure, some of them are hateful racists or susceptible to racist arguments. But most people vote/take action from an emotional place, not a rational one. And struggling to pay your bills each month makes you really emotional.
well people are still struggling to pay bills, and now they’ll struggle to feed their families and go to the doctor, so I hope those feelings were worth it.
I can’t imagine what kind of ruin Donald will leave behind. But I’m sure that some people won’t learn anything from this.
They will vote for a Democrat to clean up the mess, then vote Republican again in four years because cleaning up the mess takes longer than a minute.
Nah, remember how some people blamed Joe Biden for the overturning of Roe because it happened while he was in office? This time it will be “It’s the Congressional Democrats’ fault because they should have stopped it!”
There will be no more elections after this bill.
MVP Harris broke ties to help people. JD Vance breaks ties to kill us.
With that bill passing the Senate, I fear it’s all over for the US. We’re heading into a Wild West scenario where we’ll have to watch our backs just to survive the onslaught of white supremacist vigilantes and bounty hunters. The middle class will be eliminated completely and the poor will die in the streets.
Between this bill, Nazi ICE, made up wars with Iran this country is done for.
It seems clear to me that trump hates everyone in America and will kill as many of us as he can in revenge for our failing to love and worship him. It’s also clear that the rich have never heard of the concept of “enough”.
He wants his magat followers dead too, because he thinks they’re all idiots. This is all one big game to him. Kill millions. Deny health insurance. Starve the people in the us. Force raped children to give birth. Start a war. Enrich himself by billions.
Fire the nukes. Deport citizens. End elections forever.
As long as the world is paying attention and kissing his ass, he wins.
All one big fucking global game for this psychopath.
After the recent Pew study that found Trump would’ve won by an even larger margin if the non-voters had shown up, which is contradictory to what most of us assumed, I’d say the US is getting exactly the future it deserves. A lot of people are going to find out the hard way just how much easier Democrats, flawed as they were, made their life without them realizing it, but it’s going to be too late to change any of it. It’s clear they wouldn’t be this brazen if they didn’t expect to have to actually win elections going forward.
This country voted for selfishness, so that’s the way people are going to have to survive. Take care of yourselves and a small community you form. Everybody else will have to make do.
Few weeks ago, I talked to my parents who are on SS and Medicare. We talked about what if something like this happens. If their Medicare is cut and if SS is cut, this will cause them to have to dip into their retirement savings even more. They’re in their 70s and 80s. Husband and I said we’d move in with them to help with bills, property taxes ‘n stuff. We are still working, so we’d have an income that will help with some of their money issues. Looks like this will probably happen, now. Not that it’s that much of a problem. They have a big house so we’d be able to set up our own space quite comfortably. And they could use the help around the house, grocery shopping and the like.
That’s really nice of you and your husband to do that, and I’m sure your parents will appreciate the help. Hopefully it all works out well, I know that can be challenging for many people. I would never do that, even though my parents are both in their 80’s, because my dad especially is a loud and proud Trump supporter and no way on earth am I subjecting myself to that.
If a known Republican would be found torture-murdered with a copy of the bill inserted deep in a body opening, progress would slow.
Otherwise it’s a money bath for these over fed pigs.
And some $175 billion more will be going to ICE. As The Intercept points out, its current budget is about $8 billion.
Imagine what’s going to be done with that massive infusion of money. Stephen Miller and Tom Homan are going to be completely unfettered.
The word “dystopia” is not going to cover it.
I don’t want to live in the country that this bill creates. Unfortunately, I don’t have much choice. The best I can do is hope desperately that it runs aground, in the House. Call your Representatives!