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Federal Medicaid cuts in the OBBA are hitting NC in two months and they're pretty severe. The effects of this funding cut will slash a lot of things that I think most people right or left wing would agree are useful to have.
First every provider gets at least a 3% rate cut. Then due to the share of spending, a much larger rate reduction of 10% is on inpatient and residential medical institutions. This includes acute care hospitals, nursing homes, PTRFs (basically the mental hospitals/modern asylums), and intermediate care facilities (these are for intellectual/developmentally disabled people who need intermittent nursing).
The rate reductions will see an already stretched mental health system in the state need to cut back on access more. For an admin that claims to want more institutional treatment of the mentally ill, addicts, etc, this will ironically be one of the biggest deinstitutionalization effects in the state.
Another effect is the removal of GLP-1 drug coverage for obesity. I don't think I need to prove that they're very effective at weight loss, and obesity is a major health issue so a lot of people finally finding themselves losing weight are going to be hurting in the next few months as their prescriptions get cut. While GLP-1 medications isn't yet a net positive financially, the impact it has on people's health can not be ignored.
This also will likely hurt their ability to ensure proper compliance with the program.
And as they point out
Medicaid reimbursement rates are already lower than commercial insurances tend to be and plenty of providers won't take it for that reason already.. This will likely get even worse, as poor and disabled people struggle to find providers.
This is especially going to hurt the poor rural areas (ones that voted Trump in) that are already struggling financially and don't benefit as much from economy of scale like the local areas.
About a week ago The Asheville Citizen Times did a report on the nearby rural Mitchell county and their upcoming fears over the cuts.
For example, they're worried that the already tight financials of the Blue Ridge Regional might be forced to close
Blue Ridge Regional is the hospital of Spruce Pine, a town you might recognize from coverage of last year's storm as being one of the only places in the world with high quality quartz. It's still important to have some people in the surrounding region for this work (and other work providing for the quartz industry and workers) but their small size as mentioned before doesn't benefit from economy of scale and impact of automation has had a toll on their wealth too. Still they're very important to have around, making up anywhere from 80-90% of the high quality quartz used in the world. And sometime soon, they may be without a hospital, a hospital that was pretty useful during Helene.
So that's the issues my state is going to be facing soon. How is it going to impact your state Motte users?
As usual per republican policy, it'll probably affect poor areas more than rich areas, and rural areas more than urban or suburban areas. Can any poor or rural republican reply if they think otherwise? I can understand why most republican policy is in the best interest of republicans, but I'm honestly stumped on this. Is it legitimately just ideological consistency? A willingness to suffer to Do The Right Thing?
Rural republicans are mostly people who are stuck 'in the gap' where they don't have medicaid to begin with- they make too much. Rural medicaid users might vote republican if they voted, but alas, they do not.
You are forgetting that medicaid is not actually universal healthcare. It's entirely possible to go without healthcare in the US because you don't qualify for welfare. There are some pretty brutal benefits cliffs.
Are you a poor or rural republican? Your logic makes sense, but I'm looking for insights specifically into their psychology.
I am connected to two tribes of rural republicans, albeit not the poorer sorts. Having been around poor people who didn't like democrats, their likelihood of voting is rather low.
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Very true, and in some states it's a cliff on both sides of the coin. In some states that didn't adopt the medicaid expansion portion of obamacare you can't get government insurance in a situation where you don't have a job yet if you had anything other than the very lowest paying job possible you wouldnt qualify anyway.
I understand the reasoning behind not wanting to subsidize jobless bum's insurance, but it isnt hard to imagine a case of a non bum falling into this crack and having to go into medical debt over a broken arm or whatever.
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Insufficient resolution in your maps. The rural Republican counties that are pointed to as examples of Republicans voting against their economic self interest don't consist of 100% Medicaid users, they consist of a class of Medicaid users and a class of non-Medicaid users.
The latter class votes Republican because they hate the former class and want them thrown off Medicaid. This isn't poor people voting to throw themselves off Medicaid, it's contractors voting to throw addicts off of welfare.
Empathy and charity are easier at a distance. Racial Diversity is correlated with racist attitudes in the general public; this is equally true of economic diversity.
This is also Republicans possibly losing their rural hospital
From the article again
This is an all-republican board concerned about the impact.
Unless the good hard working rural Republicans are superhumans who don't need a hospital and anyone who is concerned is just a RINO, it's going to hurt them too because the economics of rural healthcare is already tight.
Actually, many rural republicans I know do self identify as people who don't need to or just don't go to a doctor. But that's more a matter of stupidity in those cases.
At no point am I arguing that rural healthcare won't be harmed, I'm arguing that they don't think it will be.
Yeah, a lot of these people think doctors are for 1) childrens and maternal care 2) emergency medicine and 3) really serious illnesses like cancer. Normal adults go to chiropractors, nutritionists, etc.
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https://youtube.com/watch?v=ERNAqqNSId0?feature=shared
This matches my experience (growing up in a rural deep red area) of medicine. You go to the doctor for broken bones, bleeding you can't stop, or when you're in enough pain your wife makes you go.
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At least here in the Appalachians, those rural hospitals have been closing down since at least 2010 and nobody other than the local residents has given a shit.
Could you explain how this is different and why I should be more concerned? Or, for that matter, why people who aren't from here and didn't care then should care now?
That's not true at all, there's programs like the rural health fund and the the start of rural emergency hospitals program in 2023 and stuff like that being created to help keep them open and functioning.
Rural healthcare struggles to break even yet alone turn a profit, even more would be shutting down if it wasn't for Medicaid/Medicare and programs like that.
And there's extra benefits even within these programs like how sole community hospitals get higher rates
It's arguably not enough, but it's definitely helping rural healthcare stay afloat when they're literally just given more money.
It's not different, we are doing stuff to try to help our rural hospitals already and we should keep doing that stuff and help more.
Rural communities and urban communities depend on each other. Urban zones might be the main money areas but they need things from the rural areas still like food or that high quality quartz.
Also ya know, empathy, religious duty, etc other general reasons to help out others in need.
Also keep in mind these cuts aren't impacting just the rural areas anyway. Less funds for mental institutions and the like will have an impact on the urban areas.
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But does the former class not also vote Republican? Folklore seems to say that they do, and are motivated by a mixture of "willingness to suffer to Do The Right Thing" and spite ("we suffer either way, but at least this way we get to wipe the smug grins off the city-dwellers' faces").
A lot of rural welfare users simply don't vote. It's extremely common.
The rural poor also understand that they're a peasant class and hate everyone who's in line ahead of them, which to be clear is most people. Given the economics of rural areas these people are a lot more dependent on local elites(who are very solidly republican) than the poor elsewhere; and a condition of that dependency is voting correctly.
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I genuinely believe what you call city-dwellers have absolutely no idea how strong that impulse is in a lot of rural Americans.
If I asked ten of my neighbors if they'd do something that harmed themselves if it hurt the nearest city twice as bad, I think twelve of them would say yes.
Trump's election in 2016 and 2024 represent the apex of this phenomenon, but it's not the only one.
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This is admittedly speculative due to a lack of contact with the former class but my general assumptions are that they aren't exactly hardcore voters to begin with.
I also suspect that if they do vote for the GOP, they probably aren't thinking "I'm going to get thrown off of Medicaid but it will make the blue-haired freaks unhappy so it's a net win for me," they are voting GOP under the theory that entitlement reform never happens but maybe their neighbor with the string of misdemeanor assaults and restraining orders will finally be locked up for good, or that it will help the economy, or things like that. My general assumption is that people who are "on the fringes of society" in the sense of being on welfare and not being particularly poor are more likely to be sensitive to the economy and crime, not less.
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There's two separate questions in there.
Are they in the Taker class?
Do they perceive and identify themselves as being in the Taker class?
Broke trailer trash generally abhor trailer trash, which they perceive as their neighbors rather than themselves. "I'm poor because I have to support all these people on welfare," "I'm a hard-working man, if I could, and my disability payments would be higher if it weren't for all the immigrants we're supporting..." "I'm just a drinker, he does meth," "I only do a little meth I'm not an addict like that guy over there," "I wouldn't be on the meth if it weren't for trying to compete with illegal immigrants..." There's various degrees of magical thinking involved in excusing one's own temporary circumstances, such as "Rural areas really produce things while urban gdp is fake and gay" or "Once you throw the bums off welfare and the immigrants out, I'll make more money and I won't need Medicaid." I do not think many GOP voters perceive themselves as takers, even if they mathematically are.
I do not think a significant number of Republican voters believe that bad things (for them) will result from Trump's policies and are willing to suffer for them. You can tell because Trump doesn't talk that way, more or less ever. They think that the policies Trump is pursuing will result in the instant improvement of their lives.
This might have been true at the beginning of the year, and still be true for a majority of people who will be badly affected by his policies. I am not sure that it will still be true at the end of his administration, depending on how bad his policies will get. He got a trade deal with the EU which will increase revenue and not directly hurt US industry (but I am less optimistic about the long term effects for the US hegemony). However, a trade war with China still has the potential to wreck the economy. Likewise, cutting medicare has the potential to be ruinous for a lot of his voters.
Most people have some awareness of their relative economic situation under different administrations. They suck at attributing it to specific policies (and often make off-by-one errors when policies take long to yield results) and economic effects unrelated to government policies, but they will notice if they are better or worse off. A few idiots will double down on their partisan preferences when things go badly for them, but I am hopeful that many will not vote for the leopard eating people's face party after having their face eaten for 3.5 years.
You're assuming the horror stories about the effects of Trump's policies are going to be both true and one-sided. This may not be the case. If his policies hurt Republican "takers" but help the working class (according to their own perceptions), that's probably a net win for Republicans. Republican takers are probably one of the least-reliable voting blocs (especially since Republicans lack the ground game to get them to the polls), and the working class has only recently turned Republican.
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I'd say it's that, despite all the talk of MAGA having wholly taken over the Republican party, much of the institutional core of the party is still the "what's good for Wall Street is good for Main Street" crowd. As someone in a several-hour-long Youtube video (on the county-level political map for Congressional elections, every two years, from the end of WWII to the turn of the century, with a focus on how, once you set aside the highly-granular and variable presidential elections — particularly the Reagan landslide — the South didn't really stop voting (D) until the 90s, as all the old "Dixiecrats" finally died, and the new generation of Dems were abandoning the working class for the professional managerial class and minorities) I once watched said, "the Republican Party was founded as the party of New England banking interests… and that's what it always will be."
I also recall, but can't find again, an interview with a GOP campaign strategist who got a bit too candid with the interviewer and ended up saying something to the effect that Republican candidates already know that their job is to make empty promises to working class rubes to get elected, then deliver for the "donor class" instead once in office, so his job, as strategist, is to help the politicians lie to those flyover rubes more effectively.
Both party elites are elites — while only Hilary may have said it openly, plenty of the top people in both parties consider blue-collar rural whites "deplorables" — R's are just the ones more reliant on winning their votes, and thus given more incentive to hold their noses and pander.
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