Opinion – Bill Straub: Big Beautiful Bill does not improve care for 1.3M Kyians on Medicaid

The Kentucky Hospital Association, insists it is "dedicated to sustaining and improving the health status of the citizens of Kentucky." Yet it somehow wants you suckers to believe that cutting federal funding for Medicaid by $793 billion, as estimated by the Kaiser Family Foundation, in the stupidly named One Big Beautiful Bill will somehow magically improve health care for the 1.3 million Kentuckians enrolled in the program.

Medicaid, of course, is the largest source of health insurance coverage in the U.S., government operated with about 70 million enrollees, mostly low income. In a statement, the association said the tax-and-spending package passed by the House and currently in the hands of the Senate, "protects the Kentucky Medicaid program, which means that our patients will continue to have access to the care they need, when they need it. If the bill does not pass the Senate, there is a strong likelihood that our Medicaid patients will not be able to access all the services our hospitals currently provide. We have called on the U.S. Senate to concur in the House Medicaid provisions."

That, friends, is called gaslighting. It runs counter to the stated positions of the American Hospital Association and the American Medical Association, who note accurately that millions of Medicaid recipients nationwide will be tossed from the rolls if this bill becomes law.

The NKyTribune's Washington columnist Bill Straub served 11 years as the Frankfort Bureau chief for The Kentucky Post. He also is the former White House/political correspondent for Scripps Howard News Service. A member of the Kentucky Journalism Hall of Fame, he currently resides in Silver Spring, Maryland, and writes frequently about the federal government and politics. Email him at [email protected]

The always reliable Kaiser Family Foundation estimates that 180,000 Kentuckians will find themselves uninsured under the proposed changes in Medicaid. It could go as high as 240,000. That apparently, in the eyes of the KYHA, is tantamount to Medicaid patients having "access to the care they need, when they need it."

What's more, the measure certainly threatens the very existence of perhaps dozens of small, rural hospitals that depend on Medicaid payments to maintain operations. And its fatuous support doesn't even consider the number of elderly nursing home residents who risk being tossed out on the street if they lose their benefits.

So, let's see if we can't figure out why the KYHA is pulling a fast one. I contacted them but didn't receive a response. First some background.

The One Big Beautiful Bill was conceptualized to make permanent several tax cut measures adopted during the first term of President-cum-Dictator Donald J, Trump. Those provisions are due to expire, so Republicans, naturally, are frothing at the mouth to make sure the already wealthy, who benefit from the package to a disproportionate degree, don't have to pony up.

The problem is the Congressional Budget Office has declared that extending the tax cuts will add $2.4 trillion over the next 10 years to the already bloated national debt of $37 trillion. To offset some of that red ink, majority Republicans in Congress have, naturally, elected to make the cost of the tax cut less onerous to the U.S. Treasury by slashing Medicare, thus placing it on the backs of the poor.

What a brilliant idea.

Trump initially vowed not to cut Medicaid. No one, of course, with the sense God gave to a goose believed him and the House proceeded to mangle the program by imposing new work requirements – which have never worked (Kentucky tried during former Gov. Matt Bevins' Reign of Incompetence but it was rejected by the federal court) – and by attacking, now get this, waste, fraud and abuse.

A personal note here: Over the years I have covered dozens of campaigns on the local, state and federal level. Vows to attack waste, fraud and abuse constitute the single biggest ongoing scam perpetuated in the history of American politics. It became a running joke among political reporters. Ask a candidate how he/she intends to come up with the gazillion dollars it would take to implement a new program, the answer would always come down to reducing waste fraud and abuse. It's never done and it's one of the primary reasons this nation carries a $37 trillion debt. Anyone who vows to attack any of those items is playing to the crowd and cynically exploiting the electorate.

Anyway…

All this brings us to that dimwit Rep. Andy Barr, R-Lexington, who claims anyone maintaining the Medicaid package will add to the debt is lying – simple math has never been one of Andy's already few assets – and engaging in "fearmongering."

In an op-ed for the Lane Report, Barr said foes of One Big Beautiful Bill are pushing a "new big lie" that the changes "in this package come at the expense of Kentuckians on Medicaid."

"Nothing could be further from the truth," sayeth Andy. "We are strengthening Medicaid by kicking millions of illegal immigrants currently on Medicaid, off."

Alright, let's engage the truth. Kicking 180,000 Kentuckians down the proverbial stairs and robbing them of Medicare coverage sure sounds like the changes are coming "at the expense of Kentuckians on Medicare."

Then, it's already against the law for illegal immigrants to enroll in Medicaid. Does that mean some don't game the system and wrangle their way on the rolls somehow? No. But there's no evidence that an outrageous number of undocumented workers are doing so.

Trump, for one, maintained on X that a CBO report suggested that 1.4 million illegal immigrants are taking advantage of the Medicaid program. That's a misreading of the report – probably intentionally.

The document in question asserted that 1.4 million people could, under a provision in the bill, lose health insurance provided by "state-only funded programs" that are not connected to Medicaid. The 1.4 million who will lose coverage in state-funded – not federal – programs "includes people without verified citizenship, nationality, or satisfactory immigration status."

In other words, the 1.4 million refers to undocumented residents enrolled in state programs – not Medicaid. Currently, seven states and Washington DC utilize local or state funds – not federal money – to cover some individuals, including undocumented immigrants.

There is no evidence of "millions" of undocumented immigrants utilizing Medicaid and that, Andy boy, is the truth. Some might say suggesting otherwise is a lie.

At any rate, despite KYHA's acquiescence, almost all health care outfits are hostile to the One Big Beautiful Bill. The American Hospital Association was direct: "AHA urges Congress to reject reductions to the Medicaid program that would not only strip access to health care from some of the most vulnerable populations but also destabilize hospitals and health systems, leading to a loss of services that would impact patients and communities nationwide."

Then there's the American Medical Association and its outgoing president, Dr. Bruce A. Scott, a Louisville ears, nose and throat specialist, who told a gathering that the package, "… takes a step backwards by limiting access to care for millions of low-income Americans. Medicare, Medicaid and the Affordable Care Act are literal lifelines for children and families for whom subsidized health coverage is the only real option.''

Oddly, KYHA, on its website, features a page urging folks to take action against the One Big Beautiful Bill. Who'da thunk it?

"Cuts to Medicaid funding will create irreparable harm for our nation's most vulnerable communities, including millions of children, veterans, those with chronic illnesses, seniors in nursing homes, and working families. Medicaid helps provide security to these Americans, keeping them healthy at every stage of life. Congress should vote against efforts to reduce Medicaid funding and instead focus on policies that strengthen access to 24/7 care, rather than take it away."

So, the KYHA is, literally speaking out its sides of its mouth. What gives?

One issue apparently roiling the KYHA is beneficiary taxes, which, frankly, is a pretty neat racket. Medicaid is a joint state-federal program. Kentucky and 45 other states assess a tax against health care providers. The states then use those funds to generally pay for their share of the Medicaid bill and leverage an increase in the amount of matching dollars from the federal government, resulting in higher payments to the providers who paid the tax in the first place.

Everybody's happy, except the federal government.

The Paragon Health Institute, a conservative think tank, has likened the process to money laundering, and they're not wrong. The House version of the bill prohibits states from creating new provider taxes or expanding existing ones and restricts how provider taxes can be used to finance Medicaid. That may have been met with some relief by the KYHA, which thanked Rep. Brett Guthrie, R-Bowling Green, chair of the House Energy and Commerce Committee, for his efforts in that regard.

But not so fast. The Senate, which, surprisingly, seems to be taking a harder line on Medicare and wants to steal billions more from the program, may upset the apple cart, Under current rules, states can use the taxes to increase federal payments as long as they aren't higher than 6 percent of medical bills. The Senate may reduce that to about 3.5 percent over a period of years which would blow a giant hole in many state budgets.

Medicaid provider taxes also provide a source of funding for state directed payments, which allow states to make supplemental payments to managed care organizations. These state-directed payments, health care providers claim, are critically needed to keep clinics and hospitals that rely on Medicaid operating.

The Senate is looking at this too.

Maybe the Kentucky Hospital Association felt the House, with Guthrie in the lead, produced a package that wasn't as bad as they feared. It's beginning to appear the optimism they expressed, as is often the case with this bunch in Washington, was misdirected.

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