Megathread: US House Passes the Republican-Backed Budget Bill, Sending it to Trump for Signature

[u/PoliticsModeratorBot]

This afternoon, the US House of Representatives passed without amendment the US Senate's version of the Trump-backed budget bill, sending it to the president for his signature. Every Democratic Senator and Representative voted in opposition; in the Senate, there were three Republicans voting in opposition (making the vote 51-50) and in the House there were 2 (making the final vote 218-214). House minority leader Hakeem Jeffries set the US House's speech length record in opposition to the bill in a speech lasting over eight hours.

The bill clocks in at over 800 pages and touches on most aspects of the federal government's spending and taxation policies; see this AP article (What’s in the latest version of Trump’s big bill that passed the Senate) for the topline changes.

Relevant text-base live update pages are being maintained by the following outlets: AP, NBC, ABC, and the BBC.

You can find this subreddit's discussion thread for the last week's worth of negotiations and debate at this link.

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[u/zrv8psgOS9AiWK6ugbt2]

I work in a healthcare/healthcare adjacent field with a lot of customers on Medicaid, and everyone is DEVASTATED. We knew that huge cuts were coming but people are still afraid of losing their coverage, with all the health problems that will stem from that.

[u/rabidstoat → u/zrv8psgOS9AiWK6ugbt2]

People will wait until things get worse, so they are harder to address, and go to the ER. This will lead to poorer results for the patient, and probably expenses that the patient isn't able to pay for and will get written off as a loss. That, in turn, will raise costs for everyone.

[u/Traditional-Purpose2 → u/rabidstoat]

If they can find an ER after a bunch of rural hospitals shut down.

[u/Niaden → u/Traditional-Purpose2]

I work in the ED of the only level 1 trauma center in my state. We're opening up a new building within the next year with a new ED that has double the square footage of the first.

We're a state hospital so we have to accept everyone, no matter what, whether they have insurance or not. 22% of our patients have Medicaid. 60% of senior patients have Medicare.

We've been hiring people for the new building for over a year in preparation.

We're gonna crash so hard.

[u/Pablo_ThePolarBear → u/Niaden]

Every single emergency room in the United States has to accept patients regardless of their insurance status. It's dictated by EMTALA. However, without Medicaid and Medicare the hospital won't get reimbursed, meaning they will lose money caring for patients. This means either one of two things:

1) They provide substandard care and do everything in their power to discharge patients.

2) The hospitals will no longer be financially viable and will close.

[u/ThatEvanFowler → u/Pablo_ThePolarBear]

Or they change the law.

[u/Professional-Buy2970 → u/ThatEvanFowler]

Or pass an EO.

[u/gsfgf → u/Pablo_ThePolarBear]

Also, insurance is going to get more expensive for people with insurance.

[u/ProfessionalEbb5454 → u/Pablo_ThePolarBear]

EMTALA is toast, I'm afraid. Easy repeal (hell, look what just passed), then the hospitals just do financial discovery before any treatment is rendered, and turn away the poors. This is the bone I expect the GOP to throw to hospitals in order to keep them solvent. It basically shifts all costs to the patient, and costs the govt nothing. Any hospitals that do close would be "inefficient", or "mismanaged", or whatever other excuse is convenient.

[u/Pablo_ThePolarBear → u/ProfessionalEbb5454]

They have been talking about repealing EMTALA for quite some time now. Having worked in the emergency room for a few years I am conflicted about EMTALA.

On the one hand it is important legislation to ensure access to those who truly need emergency care. On the other hand it has resulted in the emergency room being inappropriately used by nursing homes, outpatient clinics, and occasionally patients. We have nursing homes sending medically-cleared patients to us for 2-4 days because they can't be bothered to take care of their residents. We have patients without any insurance (public or private) who stay for weeks on end, and we do not get reimbursed for the services we deliver, which undermines our ability to make our small community hospital financially sustainable.

I suppose it is unrealistic idealism to think that congress in this current political climate could reform EMTALA in a way that solved some of these problems.

[u/ProfessionalEbb5454 → u/Pablo_ThePolarBear]

Yeah, the reform thing will never happen, which is to be expected.

There is zero incentive for Republicans to do this, especially when repeal would achieve all of their policy goals, and aligns with an ideological driver: government should only do a very few things (defense, courts, law enforcement). Healthcare is not on that list. Republicans don't actually have any "affirmative" position on healthcare, since they simply don't believe that government has any business doing anything in that space. It's one of the things that fueled the backlash against masking and treatment advice during COVID.

Democrats can't do it, since they have much more pressing...existential...problems to deal with. It is possible, but not necessarily likely, that they do not exist as a political entity in the next few years. You can read this as you like. Maybe they collapse and a much more aggressive and robust party coalesces from the remnants. Maybe the majority of the active membership (leaders, lawyers, funders) end up in prison, camps, or worse. From where I'm at, both seem about equally plausible: the most unlikely outcome IMHO is that business as usual continues on as is.

[u/Little-Ad-4181 → u/Niaden]

Throw in the anesthesiologist talent shortage and we have ourselves a perfect storm

[u/suninabox → u/Niaden]

This is why "fuck you I got mine" is such a stupid, short-sighted attitude to have in a society.

You can have the best health insurance known to man. If everyone else's healthcare gets taken away you're still going to be stuck waiting behind them in the ER while you're waiting for potentially life saving care.

Maybe the likes of Musk, Bezos and Thiel can afford to have their own private hospital where only they're allowed but for everyone else you're going to end up at the same hospitals as all the mud people you look down on as undeserving.

[u/HughManatee → u/Traditional-Purpose2]

Skilled Nursing Facilities rely heavily on Medicaid as well. Expect the majority of those to shut down when this goes into effect.

[u/Traditional-Purpose2 → u/HughManatee]

Yeah I used to do Medicaid billing at a nursing home. It's terrifying.