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PaperclipPerfector  5d ago (text post)   18135 thread views

Culture War Roundup for the week of August 11, 2025

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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.

Sangvai also indicated administrative cuts ahead, including ending or reducing contracts, letting temporary employees go, and ending some quality control and compliance functions. “These cuts will significantly impair NC Medicaid’s ability to be responsive to emerging needs and inquiries, monitor services for quality and compliance, and continue making timely operational improvements,” he wrote.

And as they point out

“Despite careful efforts to minimize harm, the reductions now required carry serious and far-reaching consequences. Most immediately, reduced rates and the elimination of services could drive providers out of the Medicaid program, threatening access to care for those who need it most,” Sangvai wrote. “NCDHHS remains hopeful that additional appropriations can be made to prevent these reductions.”

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

During a June 19 special meeting of the Mitchell County Board of Commissioners, Jeff Harding, chair of the all-Republican board, said the hospital’s closure “could be devastating to our small community” and urged residents to contact their elected officials.

At the meeting, commissioners passed a resolution in support of the hospital, calling it a “vital resource,” one that saved lives during Helene, which devastated Mitchell and the surrounding counties the hospital serves.

Immediately after the storm hit, the hospital became a hub for relief efforts. It wasn’t just where people could go if they were severely injured and needed care, it was the one place where nonprofits, the federal government and others could show up and help, Kimmel said.

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?

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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