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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?
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.
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").
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.
Yeah — the other poster who is anti Trump believes Trump’s policies will be bad and therefore Trump’s voters will abandon him.
That is not unreasonable for anti Trump person to believe but isn’t necessarily the best reflection of reality. Take tariffs. Suddenly Democrats hate tax increases*. But it’s far from obvious how much of a tax increase it will be for American consumers. First, tariffs are on the import price which often is a small fraction of the overall price. Second, some of the incidences of the tax will fall on non Americans or capital. To the extent the tariff revenue is used to shrink the budget deficit, it could on net help consumers. Doesn’t mean tariffs are good (or this will work) but the idea that it’s the end of the world doesn’t make sense (especially by people who were pushing for mark to market taxation and significantly higher corporate and individual tax rates).
Take immigration as a concrete example. Jobs are meh but the mix of the jobs were foreign less and natives more. A dem would point to “limited job growth” whereas a Republican would point to “our people are getting jobs.”
I would bet all things equal life is pretty similar for a lot people on 2028 as it was in 2024. I think the one thing Trump could do to change that is passing some kind of massive zoning reform (he is stealthy doing some of that for large projects via the EPA).
*there are of course arguments that tariffs are bad kinds of taxes precisely because they are easy to avoid and therefore people will make non economic decisions. But this second order thinking is always absent in democrat plans so hard to take it seriously.
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