Tag: healthcare

What’s Really at Stake in the Medicaid and ACA Fight — and the Myth About “Free Healthcare for Illegals”

~ Chris Cocca ~ Leave a comment

Visit just about any major government agency webpage and you’ll get a message that the “Radical Left has shut down the Government.” The President and his allies say it’s because Democrats want to give free healthcare to undocumented people (or, in their parlance, illegal aliens, even if many have provisional status).

The heart of the matter:

  1. Deep cuts to Medicaid enacted in 2025 — tighter eligibility, reduced federal support, and added red tape;
  2. The potential end of enhanced Affordable Care Act (ACA) subsidies, which help millions of Americans afford health insurance.

Democrats argue that both measures will lead to skyrocketing costs and coverage losses for working- and middle-class families. Independent analysts — including the Congressional Budget Office (CBO) and the Kaiser Family Foundation (KFF) — largely back up those warnings.

Millions of Americans have already been notified by their insurance providers that their premiums will dramatically increase to unstainable levels.

But the debate has also been clouded by a wave of misinformation, particularly claims that Democrats are trying to give “free health care to illegals.” That talking point has little basis in fact.

1. The Real Impact of Medicaid Cuts

The Republican reconciliation law known as the “One Big Beautiful Bill Act” (OBBBA), passed on July 4, 2025, slashes over $1 trillion from Medicaid and the Children’s Health Insurance Program (CHIP) over ten years, according to the CBO.

Analysts estimate that between 7.8 and 10.3 million people are projected to lose Medicaid coverage by 2034, depending on how states respond:

Many of those who lose coverage still technically meet eligibility rules but get tripped up by new work-reporting or documentation requirements — procedural “drop-offs” that states are not equipped to handle efficiently.

Rural hospitals, which depend heavily on Medicaid reimbursements, face what Axios calls a “one-two punch” of funding cuts and coverage losses. Several could close outright.

The Medicare Rights Center estimates these changes could lead to tens of thousands of additional deaths per year due to reduced access to care.

1A. Context: The Current October 2025 Shutdown

To clarify the present fight: OBBBA is already law. The current October 2025 government shutdown has big triggered by its fallout. As the law’s healthcare provisions began to take effect, millions started receiving notices about coverage loss or higher premiums.

In response, Democrats are refusing to approve new government funding — via a continuing resolution (CR) or budget package — unless it restores or delays OBBBA-driven Medicaid cuts and extends ACA subsidies. Republican leaders have insisted the OBBBA reductions remain in place. That standoff is what has shut down large parts of the federal government this month.

In short, this is a funding fight over whether to reverse or uphold OBBBA’s Medicaid and ACA subsidy changes.

2. The ACA Subsidy Rollback: Premium Shock

Even for those not on Medicaid, another looming threat is the expiration of the enhanced ACA premium tax credits, which were expanded during COVID and later extended through the Inflation Reduction Act. If they lapse, millions will see monthly premiums jump sharply — in many cases double or more:

  • The CBO projects that 4.2 million additional people would lose insurance if these subsidies expire.
  • KFF’s modeling shows an average 75% increase in out-of-pocket premiums.
  • Some states could see hikes exceeding 100%, according to insurer filings reported by Health System Tracker.

In other words: the claim that ending these subsidies would “soar insurance costs for millions” is not hyperbole — it’s consistent with the best available data.

3. Are the Democrats Right?

On balance, yes. Projections from nonpartisan and centrist sources largely support their case: OBBBA’s Medicaid cuts and allowing enhanced ACA subsidies to expire are likely to lead to millions losing coverage and sharply higher costs for those who remain insured.

Exact outcomes depend on implementation — e.g., whether states cushion the blow with their own funds, whether Congress delays certain provisions, or how strictly administrative burdens are enforced — but the trendlines are clear and unfavorable for low- and middle-income households.

Even FactCheck.org, which scrutinizes partisan claims, finds that these warnings are “largely consistent with independent projections.”

4. The “Free Healthcare for Illegals” Myth

One of the more charged talking points is that Democrats are fighting to give “free health care” to undocumented immigrants. That’s a myth.

What the law actually says:

  • Undocumented immigrants are barred from Medicaid, Medicare, CHIP, and ACA subsidies under federal law. (KFF explainer)
  • The enhanced ACA subsidies Democrats want to preserve do not apply to undocumented immigrants; they benefit U.S. citizens and lawfully present immigrants. (Georgetown CCF fact check)
  • A few state-funded programs (e.g., in California, Illinois, New York) offer limited coverage to undocumented residents — but those are state initiatives, not federal policy.

So why the myth? Because it’s effective politics. By implying that “illegals” are receiving taxpayer-funded benefits, opponents distract from the actual content of the bills — which overwhelmingly affect citizens and legal residents. As The Guardian notes, the strategy is to pivot away from coverage losses toward resentment-driven sound bites.

5. What’s Really at Stake

At its core, this is a fight over priorities:

  • Do we fund healthcare access for low- and middle-income families, or redirect those funds toward tax cuts and deficit trimming?
  • Do we sustain programs that reduced uninsured rates to historic lows, or accept millions losing coverage to save on federal spending?

In the context of Trump-era tax cut agendas and GOP fiscal goals, there is a deeper tension at play: the drive to lower taxes (especially for high earners) often requires offsetting cuts somewhere, and social programs like Medicaid and ACA subsidies are frequent targets.

The CBO, KFF, and other independent watchdogs have made the tradeoffs plain. One side warns of fiscal restraint (while cutting taxes for higher earners); the other warns of human cost and of the unsustainable systemic cost of millions of people losing coverage.

It’s hard to imagine arguing in favor of the former at the expense of the latter under the guise of fiscal responsibility.

What’s certain is this: the outcomes won’t be abstract. They’ll show up in hospital closures, family budgets, and community health — not in the scare stories about “free care for illegals.”

Related Reading

How the Big Beautiful Bill Threatens Everyone

~ Chris Cocca ~ Leave a comment

I’ve done both street-level and systems-level work with—and among—the people who are about to lose their healthcare because of the so-called “Big Beautiful Bill.”

I want to dispel a few persistent myths—about the people most affected by this legislation and about what’s actually happening behind the political spin.

1. The Myth of the Idle Poor

One of the favorite talking points of BBB supporters is that this bill only takes Medicaid away from “able-bodied, able-minded” individuals who simply refuse to work. If only that were true.

In all my experience, I’ve never met a person who actually wants to be homeless, who prefers instability, or who wouldn’t welcome connection to services—most of which only become available once you have a permanent address.

I have met countless individuals who are clearly disabled, yet have not been officially classified as such by the Social Security Administration. Why not? Because the process is deeply flawed.

Homeless people, by definition, have no stable, permanent address. That should be obvious.  It should also be obvious that a safety net that requires an address can’t possibly catch or help the most vulnerable.  Homelessness  makes it nearly impossible to receive correspondence, fill out paperwork, or remain in contact with agencies. And even when those hurdles are somehow overcome, the SSA routinely denies initial applications—sometimes automatically.

I’ve seen cases take years to resolve, even when the person has clear medical documentation and even when highly trained social workers and counselors are doing everything right.

Until now, Medicaid has been a critical lifeline during this liminal period—a bridge that allows people to access care while navigating the slow-moving machinery of disability classification. When the BBB kicks in, that lifeline will be cut.

And when it is, thousands of people stuck in this bureaucratic no-man’s-land will be left with nothing. It’s not just immoral. It’s economically reckless.

2. The Myth of Government Waste

Another popular refrain is that Medicaid is bloated, mismanaged, and wasteful—that it’s a drain on public resources and ripe for cuts. But this argument falls apart when you look at the actual impact of the program.

Medicaid isn’t just a health plan. It’s one of our most cost-effective tools for preventing larger-scale social and economic crises. It keeps people out of emergency rooms, where care is exponentially more expensive. It reduces hospitalizations. It lowers incarceration rates and decreases the burden on mental health and addiction systems. In short, it keeps people stable.

Cutting Medicaid in the name of “fiscal responsibility” is like smashing the brakes on your car to save gas. You may feel like you’re saving something now, but you’re setting yourself up for disaster later. We will pay for these problems one way or another. The only question is whether we’ll do it preventively—with dignity and foresight—or reactively, through crisis management that’s far more expensive and far less humane.

3. The Myth of the Deserving vs. Undeserving Poor

Perhaps the most harmful myth of all is the one that divides people into the “deserving” and the “undeserving” poor. We’ve told this story in American policy and culture for generations. It’s the quiet moral justification behind countless cuts, restrictions, and barriers.

But real life doesn’t fit neatly into those categories. People lose jobs. They get sick. They flee violence. They struggle with trauma, addiction, and mental illness—often without support. These aren’t personal failings; they’re deeply human realities, compounded by structural inequities: underfunded schools, unaffordable housing, generational poverty, systemic injustices that cut across race, gender, and geography. 

To speak of “undeserving” poor is to ignore these realities—and to ignore our own responsibility. It allows us to believe that someone else’s suffering is somehow earned, or inevitable, or irrelevant. The BBB doesn’t punish people for poor choices made with the best of intentions.  It punishes them for circumstances they were born or thrust into.  It punishes homeless veterans, opioid addicts, people in poverty regardless of color, and, ironically, it punishes many of the people who think they support it.

What’s more, many people don’t even realize that the healthcare they rely on is Medicaid—because it goes by different names in different states. In some places it’s called MassHealth, in others, TennCare, or Medi-Cal. These programs may feel local or distinct, but they’re all part of the broader Medicaid system. That means people who support the so-called Big Beautiful Bill may not even realize that they’re voting to gut their own coverage—or the coverage that keeps their parents, neighbors, or children healthy. The disconnect is dangerous, and it’s being exploited.

Where This Leads

The “Big Beautiful Bill” isn’t beautiful. It’s devastating. It punishes the vulnerable while claiming to protect taxpayers. It strips essential care from people already fighting uphill battles against illness, poverty, and bureaucracy. And it does so based on myths that are convenient for those in power—but ruinous for the rest of us.

Reading, Michael Landon, Warren Buffet (Random Morning Observations).

~ Chris Cocca ~ Leave a comment
  • I have been doing some very good reading lately. Many things contribute to good writing, but the most important is good reading.
  • In the books, Pa Ingells has a beard. When you’re producing television, you don’t cover half of Michael Landon’s face for the sake of accuracy.

Will Our Priorities Change?

~ Chris Cocca ~ Leave a comment

A few years ago, the idea of Universal Basic Income was a complete nonstarter. Medicare For All seemed almost as unlikely. Since the last presidential election (even before the coronavirus began to lay bare the gross inequalities of so many of our systems), UBI and M4A had gained serious traction, with support for the latter becoming mainstream.

Now, of course, the world economy is on the brink of complete disaster. The idea of healthcare as a commodity instead of a right seems not just cruel but also patently absurd.

What would something like M4A mean for you in your current circumstance? What kind of world might we build when this pandemic is over? How can we be sure we’re ready for the next one?

Stay safe. Stay home. Stay engaged.

Get some rest.