“Tillis — who voted against the bill in a key procedural vote Saturday night and announced Sunday he would not run for reelection — delivered a scathing rebuke of the president’s agenda-setting bill in a Senate floor speech, explaining his position and pledging to withhold his vote unless his concerns about drastic cuts to Medicaid are addressed.
“What do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore, guys? I think the people in the White House … advising the president are not telling him that the effect of this bill is to break a promise,” Tillis said in his floor speech.”
The Republican claim that their bill’s Medicaid cuts won’t take away people’s health insurance because people will get employer health insurance is either spoken out of dishonesty or ignorance. Many people on Medicaid will not be able to get a full time job that supplies benefits like health insurance. They will be paid little and not receive health insurance. Medicaid expansion has not shown to increase unemployment.
Republican bill kicks millions of people off Medicaid. Speaker of House falsely claims that he wants to remove fraudsters from Medicaid when really he just wants the program to help less people. Rather than making the argument for having a less generous Medicaid program, he misleads.
“First, it’s not as if there is some secret knowledge to be uncovered by the DOGE when it comes to fixing the rampant inefficiencies of the federal government. Those Medicare and Medicaid overpayments are documented annually, for example. The Government Accountability Office and various inspectors general file regular reports. The Congressional Budget Office maintains a list of things that could be cut to reduce the deficit. Various members of Congress—most prominently, Sen. Rand Paul (R–Ky.)—periodically publish lists of silly, wasteful, or dubious government spending.
What’s lacking, in short, is not ideas but the political will to act on them.
The amount of political will is going to matter, because that is very relevant to the second point: Unless Trump is willing to set aside his promise not to touch America’s entitlement programs, the DOGE will be unable to follow through on its mandate.
Again, look at those improper payments made by Medicare and Medicaid. The $101.4 billion of improper payments the two entitlements made in 2023 accounted for 40 percent of all improper payments across the entire government that year, according to the GAO. That same GAO report suggested a simple change in how Medicaid bills some of its services that, if implemented, could save $141 billion over 10 years.”
…
“The same problem pops up when you start looking at other big swings that the DOGE could take. Seven of the top nine suggestions made by the Congressional Budget Office’s annual report on “options for reducing the deficit” involve changing elements of America’s three federal entitlement programs. Capping Medicaid spending, increasing premiums for Medicare Part B, or reconfiguring how Social Security benefits are paid to wealthier Americans each could save hundreds of billions of dollars over the next decade. None will be possible as long as entitlement reform is off the table.
All of this is a function of the federal government’s fiscal reality: Entitlements are the biggest and fastest-growing segment of the budget. This year, so-called “mandatory spending”—primarily Social Security, Medicare, and Medicaid, along with a few other government-funded health care programs—will cost nearly $4 trillion, while all discretionary spending will total less than $1.8 trillion.
Musk has promised $2 trillion in spending cuts, but he could propose eliminating all discretionary spending—good luck zeroing out the Pentagon—and would still fall short of that goal. It is impossible to be serious about fiscal reform while promising not to touch the entitlement programs.”
“What this allows the survey to demonstrate is that between 2002–2022—with the exceptions of 2004–2006 and 2013, in which no birthplaces were recorded—foreign-born respondents accounted for 18.6 percent less Medicare and Medicaid spending than their native-born counterparts. On average, this amounted to $1,775 per person in 2022 dollars, compared to $2,180 per person among those born in the U.S.
Bier breaks down the numbers even further to demonstrate that this trend holds across each year in the sample for which data was available: In 2022, the most recent year recorded, U.S.-born patients cost the health agencies $2,691 apiece, while foreign-born cost $2,116 each. The closest the two groups ever came to parity was in 2015, when the U.S.-born cost $2,312 and the foreign-born cost $2,233.
“Despite their lower incomes, immigrants are less likely to use publicly funded health care for several reasons,” Bier writes. “Most importantly, they are younger, but even controlling for age, immigrants tend to be healthier and participate in fewer high-risk activities. In addition, their eligibility for Medicare and Medicaid is more limited than for the US-born population….Finally, some eligible immigrants also do not enroll in these programs out of ignorance or fear about its immigration effects.””
…
“The survey only notes a respondent’s birthplace, not their immigration status.”