health

Bringing Some Mania To the Media, Gushing With Gallows Humor

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It’s no surprise to anyone who has worked in Journalism (or had loved ones who have) that people working in the Media either develop a dark sense of humor over time or have one to begin with. Gallows humor isn’t uncommon in people who experience physically or psychologically stressful and challenging situations in their line of work. It’s something that research has consistently shown to be true for Medical Professionals, First Responders, Veterans, Journalists, and others who regularly encounter difficult and unpleasant things in their line of work.

This makes perfect sense, considering the well-established connection between humor and stress reduction, as well as the impact it has on depression and irritation. Dark Humor is, for many people, a Coping Mechanism that helps to stave off depression and distress in response to traumatic experiences, and not exclusively those associated with one’s occupation. It’s been compared to “whistling past the graveyard” by some.

Several studies have been conducted on the correlation between Dark Humor and Trauma, available from organizations such as the National Institutes of Health and the American Medical Association. The overall effectiveness of this kind of outlook (as far as catharsis is concerned) is debatable, but the prevalence is undeniable.

That being said, my tendency toward Gallows Humor can run a bit darker and deeper than most. Some of that could be related to my secondary career as a horror author and a certain desensitization that goes with intentionally exploring some truly taboo and horrific topics, as well as the worst aspects of my own human nature. It could be a result of Childhood Trauma combined with my career choices. It could be something in the way I’m hardwired. I do know that my greatest enjoyment concerning jokes and comedy has always leaned in that direction, at least as far back as I can recall. My suspicion is that (at least in my case) it’s a combination of all of the above that influences my brand of humor as it stands today.

One of the ways my humor manifests in my career as a Journalist is in a fascination with both alliteration and rhyme, especially in places where it’s thoroughly inappropriate. Some of my colleagues can appreciate my perspective, and even the inherent humor behind my statements and suggestions, while others find it perplexing and in poor taste. I suspect some of the latter individuals would find themselves less shocked by my occasional outbursts and the like if they’d been working in the industry longer than they have.

When I was still working in Western South Dakota, during the late summer of 2022, there was a murder that took place at a mobile home in Box Elder, the town that is butted up against Ellsworth Air Force Base. I typed up a quick Limerick and sent it via text to my News Director so that it would be the first thing she’d see when she woke up for work that morning. I received a one-word response a short while later, “No!”

Naturally, I wasn’t sincerely going to incorporate anything like the following rhyme into my scripts for the Newscast, but that didn’t change how amusing I thought it was to imagine doing so.

There was a middle-aged man in Box Elder.
He hated a woman and felled her.
He’s under arrest.
Despite his protests.
He was caught trying to run from the trailer.

In May of this year, Oregon Governor Tina Kotek declared the month to be Wildfire Awareness Month. When we were covering the story, I suggested a poem for the reporter we were assigning to it. I don’t consider the following poem to be particularly dark, but I understand how and why it was nevertheless unacceptable in practical terms.

Top fire officials share an outlook that’s quite concerning…
Offering tips to keep Oregon’s forests from burning.
Governor Kotek signs a new declaration.
Wildfire Awareness Month is her creation.
The fire cache is stocked up with much-needed supplies.
What you can do to avoid a scorching surprise.

There are several more incidents of me attempting to insert levity where most people would insist it does not belong, and I suppose I should share a few more examples. Some of these may be a bit grim, while others (I insist) are simply funny.

It was May of 2024 when Washington’s former Attorney General, Bob Ferguson, was campaigning for Governor. A Republican activist recruited two men, also named Bob Ferguson, to campaign as Democrats as well, going so far as to pay their filing fees and handle the registration of their campaigns. Those two fraudulent campaigns were ultimately withdrawn from the race because it’s a Class B Felony to intentionally mislead or confuse the election as they were. I put the story together for my Newscast and suggested that I should use a graphic saying, “Two Bobs, One Gov.” The way I looked at it, anyone who picked up on the reference to “Two Girls, One Cup” wasn’t likely to complain about it.

In October of 2024, one of our reporters provided a multi-part explainer on how the new Ranked-Choice voting process works because Portland had implemented Ranked-Choice for the Mayoral Race. When he was delving into how tabulation of the results would be performed, I opted to tease the story with, “What to expect when you’re electing.”

That same month, there was an Officer-Involved Shooting in a Taco Bell drive-thru, and I suggested we should lighten the tone by saying the individual who was shot had been trying to make a run for the border. I wasn’t alone in making bad jokes associated with that particular incident. Things like Glock-o Bell may have been tossed around for our amusement.

In November of last year, I found a story from Alaska about a beached fin whale near Anchorage. Part of the story focused on a mother who homeschools her children, and how she used the carcass as supplemental material for biology lessons. While putting the story together for my Newscast, I added a graphic that said, “A Whale Of a Lesson,” and I’m still pretty proud of that.

In April of this year, we were discussing updates to the police investigation of a mother and her children who were found hanging in their home a couple of weeks earlier. It wasn’t a quiet environment when I muttered (thinking it was only to myself), “I’m just hanging with my family this weekend.” It was, however, quiet enough that one person did hear what I said, and their response seemed to display both appreciation and shock at what I’d just said.

There is a walking trail near where I live in Vancouver, featuring various gnome figures and fairy gardens, because several children use that path to get to school. It provided a little bit of magic as kids made their way to and from school, and the nearby community put a fair amount of time and effort into contributing to those additions to the trail. People being who they are, it’s no surprise that someone came along and started destroying the gnomes, and I proudly wrote a script that said the community intended to fight back against the “gnome wrecker.”

It wasn’t long ago that we learned of a sperm race taking place at the Hollywood Palladium in LA, complete with a tiny racetrack and high-resolution cameras monitoring the speed and motility of the sperm cells facing off head-to-head. We chattered about that on and off for a couple of hours, leading to a deeply unserious environment. One of our photographers said he could fly down to LA to shoot the event, and I asked if we could refer to that as a new form of “skeet shooting.”

From what we were seeing, the main event appeared to be a contest between sperm from a white man and a black man. I asked how long it would take for the racists to start in with accusations of “fast-twitch flagella.”

Some of these are dark, and some are inappropriate, but they’re also emblematic of what it can be like to work in the field that I do. This may go some way toward explaining my attitude at times when I’m discussing politics and other topics as well. Combined with my deeply-rooted cynicism, my tendency to find humor in things that might not be inherently humorous occasionally causes issues for me in my personal life, more often than my professional one. There’s a degree of amusement to be found in my professional environment being where some of my least professional comments are the most acceptable. But, the reality is that we understand one another there, and we understand how some of the things we expose ourselves to would wear us down far more quickly if we didn’t find a way to laugh through the pain and whistle past the graveyard.

Not Only CAN We Pay for It, We SHOULD.

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There’s always a lot of talk about how we can’t afford Single-Payer Healthcare here in America, and how much our taxes would increase if we were to implement a Universal Healthcare System. I got tired of listening to people who probably haven’t performed any mathematical operations more involved than basic addition or subtraction since they reached adulthood. I decided it was worthwhile to examine three countries that do provide for their citizens: Denmark, Canada, and the UK, to see how they compare to us here.

For the sake of simplicity, despite it making the whole process far more complicated for me, I’ve taken the liberty of converting all currencies to USD based on the conversion rates as they were today.

In Denmark, there is no Federal Tax on the first $8,080 an individual earns. From $8,080 to $94,224, there is a 12% Federal Tax rate. Anything above $94,224 is taxed at a rate of 15%.

If someone were to earn a hypothetical annual income of $150,000, they would face a total Federal Tax burden of $18,673.68, leaving them with $131,326.32 of their income.

There’s also a Municipal Tax rate that falls between 22 and 27% on all income. At the highest rate, it would decrease the remaining amount to $95.858.49. This means they pay a total of $54,141.51 in taxes on an annual income of $150,000. At the lower rate of 22%, it amounts to a grand total of $51,673.68 they’d pay.

In America, an individual is looking at a tax rate of 10% on the first $11,925. They pay 12% on everything earned between $11,925 and $48,475, 22% from that amount to $103,350, and 24% up to $197,300. So, the same person earning $150,000 in the United States would have a Federal Tax burden of $28,847, which is substantially higher than the federal taxes paid in Denmark.

To factor in municipal taxes, the closest comparison is to consider state income taxes, where applicable.

In the eight states where there is no State Income Tax, that $28,847 is all the individual pays, based on their annual wage. Most of us, of course, live in the 42 states where there’s an income tax levied on an individual’s wages.

Fourteen of those states have a single rate applied to all income, as opposed to a progressive system like we have at the federal level. Arizona is 2.5%, Colorado and Mississippi are 4.4%, Georgia is 5.39%, Idaho is 5.695%, Illinois is 4.95%, Indiana and Louisiana are 3%, Iowa is 3.8%, Kentucky is 4%, Michigan and North Carolina are 4.25%, and Pennsylvania is 3.07%.

In Arizona, the individual would pay an additional $3,750, and in Idaho, they would pay $8,542.50 in addition to the $28,847 they’re paying in Federal Income Tax. The larger amount is $38,389.50, so an individual living in Idaho would pay only $15,752.01 less in state and federal taxes than someone living in Denmark, on the same $150,000.

For states with progressive tax rates, you could be facing a maximum rate of 5% in Alabama and Massachusetts, 3.9% in Arkansas, 9.3% in California, 6% in Connecticut, 6.6% in Delaware, 7.9% in Hawaii, 5.58% in Kansas, 7.15% in Maine, 5.25% in Maryland, 7.85% in Minnesota, 4.7% in Missouri, 5.9% in Montana, 5.2% in Nebraska, 6.37% in New Jersey, 4.9% in New Mexico, 6% in New York, 1.95% in North Dakota, 3.5% in Ohio, 4.75% in Oklahoma and Rhode Island, 9.9% in Oregon, 6.2% in South Carolina, 7.6% in Vermont, 5.75% in Virginia, 4.82% in West Virginia, 5.3% in Wisconsin, and 8.5% in the District of Columbia.

For someone in North Dakota, that would translate into a total State Income Tax of $2,925, while in Oregon, it would come to $12,894.50 above the federal taxes collected, or a total tax burden of $41,741.50. This is only $12,400.01 below the maximum federal and municipal tax burden on the same income in Denmark.

We already know that taxes are higher in Denmark than in the U.S.. That comes as no surprise. But now we understand what the difference is, instead of imagining some abstract higher dollar value. So, let’s take a look at two other nations with universal healthcare.

Canadian federal taxes are 15% up to $41,883.75, 20.5% from there to $83,767.50, 26% up to $129,853.86 and 29% up to $184,992.22. The same $150,000 annual salary would lead to a total of $32,693.57 in federal taxes.

The individual provinces have their own tax rates, of course. The highest rate you’d experience at that salary would be in Nova Scotia, which is 21% on anything over $112,894.50. The lowest would be Nunavut, which has a rate of 11.5% on any income above $129,853.13. Looking at the highest rate, you’d be looking at an additional $24,829.79 beyond the $32,693.57 in federal tax, for a total of $57,523.36, which is moderately higher than the highest burden you’d encounter in Denmark.

In the UK, there is no tax burden up to the first $17,220.90. We’re looking at 20% from there until $68,869.90, and 40% up to $171,441.80. So for the same income of $150,000, you’d pay a total of $42,781.84 in federal taxes. You’d also be responsible for National Insurance Tax of 8% on earnings from $17,220.90 to $68,869.90, and 2% on earnings above that. Thus, you’d be paying an additional $5,754.52 on top of the $42,781.84, for a grand total of $48,536.36, which is lower than in both Canada and Denmark, but still slightly higher than the previous examples of Idaho or Oregon.

Of course, in Denmark, Canada, and the UK, you benefit from Single-Payer Healthcare along with those higher tax burdens; burdens that may not be quite as comparatively high as people in the U.S. often imagine them to be. Those increased taxes are largely offset by what we pay for our Insurance Premiums, even with employer-provided insurance.

The cost of individual Health Insurance Premiums in the U.S. can average anywhere from as little as $1,368 to as much as $8,951 per year, and family coverage is often dramatically higher. None of that even factors in the Out-Of-Pocket expenses for care and medication or multi-thousand-dollar deductibles we’re responsible for, before Health Insurance provides any assistance at all. For example, I have comparably fantastic Health Insurance through my employer. The Deductible for my Family Coverage is $3,300 annually, with an Out-Of-Pocket Maximum of $7,500. God forbid we have to find help Out-Of-Network, though, because the Deductible there is $10,000. Halfway through July, my Insurance Premium has cost me $1,491. It’s worth noting that this is entirely separate from Dental and Vision Insurance. To put all of that in perspective, that means that, in addition to the $1,491 I’ve paid just for the privilege of having Health Insurance, I also have to pay $3,300 Out-Of-Pocket before Insurance begins contributing to further Medical Care or Mental Health expenses. Until I’ve paid $7,500 Out-Of-Pocket, all my Health Insurance will contribute is a percentage toward those costs. I want to remind you that I have exceptionally affordable Health Insurance compared to many people I know.

All of this is brokered through Insurance Companies that receive massive Subsidies from the tax dollars we’re already paying. Companies that actually increase the cost of healthcare in the process. UnitedHealth Group, made famous by Luigi Mangioni, is a perfect example of this.

UnitedHealth Group raked in $372 Billion in 2023, $281 Billion of that revenue from the insurance division headed by Brian Thompson, the man killed on a New York City street by Mangioni. Only two years earlier, UnitedHealth’s insurance division obtained 72% of its revenue from Federal Subsidies, and it can only be assumed that the percentage increased by 2023. In 2024, the Federal Government spent between $1.7 and $1.9 Trillion on Healthcare Subsidies. All of this is money paid out to an industry of middlemen who have inserted themselves between people and their healthcare providers, while making massive profits in the process. In contrast, the UK spent approximately $353.5 Billion on healthcare in 2024. That is less than 19% of U.S. spending. Of course, the population of the UK is just shy of 70 Million, roughly 20% of the U.S. population of nearly 350 Million. What that means is that the Per Capita spending is virtually the same, though actually lower for the UK…but the majority of U.S. taxpayers see none of the benefits associated with that health spending. Looking at those numbers, it makes me wonder why there would even be a need to increase Income Tax rates if we weren’t propping up a parasitic and unnecessary industry in the process.

Or is it simply that the UK and other nations are better equipped to efficiently provide for their citizens than the U.S. happens to be? I’m willing to admit that we’re just not very good at doing things efficiently or effectively. I think there’s more than sufficient evidence to reinforce that perspective.

Beyond purely financial considerations, Single-Payer systems are far less likely to deny service, and when it does happen, it is typically an administrative error. Whereas, here in America, it’s a cost-saving measure on the part of the provider to maintain its profit margins.

And, the real kicker, if you don’t receive at least your premium costs in coverage from your insurer (and most people don’t), that money gets spread around to everyone else covered by the same insurance provider and to the people working there, leading to massive profits for the corporations in question and CEO salaries that can reach as high as $23 Million in total compensation. For example, even though I have reached my Deductible of $3,300 for the year, my Insurance Company is highly unlikely to pay out even the $1,491 I’ve paid so far in Premiums for their percentage of the payments before the new annual cycle begins.

Of course, none of this even takes into consideration the portion of my Premium that’s paid by my employer, which has reached almost $8,000 so far this year. So, even if my Insurance Company somehow ends up paying out $5,000 for their part of my Healthcare expenses, they’ve already got $4,419 lining their pockets without either me or my employer paying another dime toward the Premiums. I don’t get that money back. My employer certainly doesn’t receive the excess back at the end of the year either. Have you ever looked at your paychecks and calculated how much free money you and your employer are handing over to an Insurance Company that (as a policy) does whatever it can to avoid helping you? Now, take a moment to consider that all of the money coming in from people like you adds up to maybe a quarter of what the Insurance Company has for revenue.

But, of course, it’s “Socialism” if your Tax Dollars provide Single-Payer Health Coverage for every Citizen in the U.S.. But if your money is distributed between the thousands of people with the same insurer (while lining the pockets of the obscenely wealthy), then it’s an entirely different sort of thing. It’s “Socialism” even though it’s a Public Service provided by the Capitalist Governments of essentially every other Civilized Nation in the world, as well as several that we consider less than “First World” countries.

One additional benefit worth noting is that public universities cap most tuition at less than $13,000 per year in the UK. Canadians can expect an average annual tuition of under $4,800, and college tuition is not charged at all in Denmark. Whereas in the U.S., In-State tuition averages roughly $11,000 per year (ranging from less than $7k in Florida or Wyoming to more than $20k in Connecticut or Pennsylvania), and Out-Of-State tuition explodes to an average of around $30,000 (from less than $13k in South Dakota to more than $60k in Michigan).

Which is to say that you can be both healthier and better well-educated at substantially less cost in those nations, even when you factor in the increased tax burdens. Of course, as I pointed out already, there’s no reason to raise the taxes individuals pay in the U.S. if we were more efficiently utilizing the slightly higher amount the U.S. already pays Per Capita for Healthcare Subsidies than the government of the UK.

Don’t let idiots and fear-mongers influence you. None of the nations discussed are “Socialist” countries. They just take the role of government more seriously, providing for the public good.

It might also be worth noting that, in 2023, UnitedHealth Group donated $792,500 via PAC contributions to federal political campaigns. Roughly 54% of those PAC contributions went to Republican candidates and 45% went to Democrats.

It also spent an even more substantial amount of PAC funds on In-State campaigns all across the U.S.. This was divided up between individual candidates, party contributions, and ballot measures.

And, in 2024, UnitedHealth Group (according to its filing with the U.S. Senate) dedicated $6.85 Million toward lobbying efforts, above and beyond Millions in PAC spending. Think about that for just a moment. This Corporation receives most of its revenue from Federal Subsidies. And then it spends a small portion of that revenue to support the campaigns and political parties that ensure it keeps getting that money.

It’s easy to spend that kind of money when a company brings in a net income of $14.4 Billion (which was UnitedHealth’s lowest profit margin since 2019), a number heavily impacted by the Billions they spent recovering from a cyberattack on one of their claims processing subsidiaries. With everything adjusted accordingly, they proudly claimed a record high profit of $25.7 Billion for last year.

Spending $6.85 Million through lobbyists and millions more through PAC contributions isn’t a challenge when you have that kind of profit involved. The amount spent on corporate lobbying was, after all, only 0.048% of the net profit.

Of course, UnitedHealth Group has already dedicated $3.37 Million toward lobbying efforts so far in 2025, so they’re hardly skimping on graft despite it not being an election year.

While the industry rakes in massive profits, it’s happy to return the favor by lining the pockets of politicians and political parties across the political spectrum, all to ensure it has its interests taken care of.

If you can look at this and think it’s fine, while Single-Payer Healthcare would be too costly, you’re not only missing the point, but you’re being intellectually dishonest.

America’s Healthcare System Is Terrible…But That’s Okay…It’s Getting Worse

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The Healthcare System in this country is so totally broken. And it never ceases to amaze me that so many people either fail to see that or simply don’t care. I can only assume that the bulk of those individuals have never known or loved someone with a chronic illness or a disability of some kind, or–god forbid–something atypical in their biology.

They’ve never listened to the tearful conversations with doctors who regretfully share the news that the procedure or medication they recommended on the patient’s behalf has been declined by someone who is paid by the Insurance Company to locate any possible errors in Medical Coding, Coverage Limits, or what their Tables indicate as Appropriate Treatments.

I assume that they’ve never watched someone they care about waiting months as they jump through one hoop after another, as the actual Medical Practitioners dot every “i” and cross every “t”, per the wishes of an Insurance Provider who is just as likely to Deny the recommended treatment after all is said and done.

Surely, they’ve never watched someone give up, too exhausted to keep fighting Denial after Denial, of something several Medical Professionals have confirmed they need or that would improve their Quality of Life

After all, how could anyone who has witnessed or experienced things like that be of the mind that our Healthcare System isn’t bad enough as it stands, and needs to be made worse? That’s precisely what the Trump Administration and Congressional Republicans have opted for. As it turns out, they didn’t need to do anything at all, because things were on the way to getting worse without any assistance.

Not only are we looking at huge numbers of people removed from Medicaid and Medicare, combined with rising costs for Health Insurance obtained through the Affordable Care Act Marketplace, thanks to the new Congressional Budget Bill…but, according to a new study, more than half of American Employers are planning to pass rising costs of Health Insurance on to Employees.

Even if you’re lucky enough not to see a bigger bite taken from your paycheck, you might be one of the fortunate many who can expect to see higher Deductibles and/or Out-of-Pocket Maximums. Of course, there’s no guarantee you won’t see those increased costs even if you’re also experiencing higher Premiums.

Apparently, this is because the Employer-Paid portion of Health Insurance is expected to increase by 6% next year, after a 4.5% increase last year. Naturally, the Employee is the one who should shoulder that cost.

And the Insurance Companies are blaming it on increased Healthcare Costs (ignoring the rampaging elephant in the room, that the existence of Insurance Companies is a major driver behind those increased costs). Of course, they’re also pointing the finger at the popularity of expensive GLP-1 medications used for weight loss. Naturally, as should surprise literally no one, fewer Insurance Companies will be covering GLP-1 drugs next year. And, to maintain their year-over-year Profit Margins, they’re likely to stop covering a lot of things people have come to expect and depend on. So, as we should have learned from “Shrinkflation” in virtually every other industry, we look forward to paying more for less.

And all of this comes about as a new report indicates one in three Americans live in a “Healthcare Desert” where people lack access to vital services such as Pharmacies, Trauma Care, and Primary Care Physicians.

That’s not altogether shocking. After all, roughly 150 rural hospitals have closed their doors in the last 20 years…and the odds are good that more will be following suit. It’s still horrible to imagine that an estimated 28 Million Americans live more than 30 minutes from the nearest hospital, and that about 50 Million live more than an hour from a Trauma Center. This is only going to get worse as a byproduct of the Congressional Budget Bill, because $10 Billion a year (to be distributed between all 50 States) for rural hospitals isn’t going to go half as far as GOP Senators think…or at least not as far as they suspect their supporters are stupid enough to believe it will. I opted to amend that because I’m sure the Senators knew exactly what they were doing, and they simply didn’t care.

As the cost of Healthcare goes up, the ability to access it is going down.

I’d sincerely like to hear someone answer the same question proponents of Single-Payer Healthcare are always being badgered with.

“How can we afford this?”

The Truth About Medicaid, Medicare, & Other Fraud: It’s Not What You Think

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It has always seemed obvious to me that if people want to know where Medicare and Medicaid Fraud come from, they need to stop looking for illegal recipients. It isn’t as simple as some might think to defraud programs like SNAP, Social Security, Medicare, and Medicaid by filling out an application with false information.

I don’t know why it bears mentioning, but neither Medicaid nor Medicare provides Beneficiaries with cash. They operate as a substitute for Health Insurance. That might come as a surprise for those of you who have never needed to use one of these programs. So, even if someone successfully applies via Fraud, they aren’t lining their pockets at the expense of Taxpayers.

Even if someone manages to obtain Medicare or Medicaid coverage through fraudulent means, what happens then? In the worst-case scenario, they would obtain medical treatment that they otherwise could not have received. Let’s assume it’s the most expensive surgical procedure from 2024, which is a Heart Transplant. At the most expensive rate, that would cost Medicare or Medicaid $1.3 Million, assuming it would cover the surgery in the first place. It would require more than 38,000 people receiving fraudulently obtained Heart Transplants to equal the $50 Billion House Speaker Mike Johnson claimed was lost to Fraud, Waste, and Abuse of Medicaid each year. If that seems absurd to you, you’re absolutely correct.

Just last week, CVS Health’s Omnicare (pharmacy services for long-term care & senior living communities) was found guilty of fraudulently billing the U.S. Government for invalid Medicare, Medicaid, and Tricare Prescriptions and ordered to pay $948.8 Million in penalties & damages. A massive $406.8 Million of that was for Damages, which were tripled as per the False Claims Act.

All of this came about because a Whistleblower brought attention to more than three million false claims between 2010 and 2018.

In 2021, the average Medicare Spending per Beneficiary was only a little over $15,000. To put that in perspective, it means the Fraud committed by CVS translated into the equivalent of the total annual spending for just under 9,000 Beneficiaries, or just under 1,000 Beneficiaries each year for which CVS was found Guilty of the illegal billing.

And this is just the Fraud from one Corporation. I can assure you that they are not alone.

One thing that people need to understand is that Improper Medicaid payments are not the same as Fraud. It’s a challenge for some people to wrap their heads around that distinction because certain individuals have played fast and loose with conflating the two things…because it suits their agenda.

According to the Centers for Medicare & Medicaid Services, Improper Payments made up only 5.09% of the total payments made by Medicaid in 2024. Of that 5.09%, roughly 80% (or 4.07% of the Total) were caused by missing documentation that would determine whether a payment was correct or incorrect, and payments that went to the right Providers in the right amounts, but that may not have complied with some regulations or statutes. In all of those cases, if the paperwork had been correct, they wouldn’t even factor into these numbers, because the payments wouldn’t have been classified as Improper or because they wouldn’t have been issued in the first place.

It’s the remaining 20% of that 5.09% where we find people who weren’t eligible for Medicaid. But it is also where we locate the individuals who were eligible but received a service that wasn’t covered.

So, while all of these 5.09% of Improper Payments count as Monetary Loss, they do not constitute Fraud. All of the Fraud falls into the minuscule 1.02% of the Total Payments.

Yes, we should be combating Fraud, but it’s not the Beneficiaries of Medicaid and Medicare who are the criminals, guilty of committing the vast majority of Fraud; it’s Ambulance Services, Pharmacies, Nursing Homes, and other Providers who have utilized creative bookkeeping and manipulation of the system. The victims are the Beneficiaries, Legitimate Providers, and Taxpayers alike.

Fighting Fraud doesn’t involve cutting funding for Medicaid, and it won’t have any impact on the rate of Improper Payments, because the Beneficiaries were never the primary Source of them.

What I hate more than anything is that this is ultimately yet another dog whistle for anti-immigration proponents. I’m not going to use Undocumented as a descriptor here, because we’ve all heard the plan, shared far and wide wherever cameras are rolling, that the Trump Administration intends to strip Documented Status from Immigrants, including those who are Citizens. It was never about doing it the right way; it was about being the right ethnic makeup, which is why there was so much support from people who believe in “The Great Replacement” myth.

Across the years 2021, 2022, and 2023, Wyoming and South Carolina were the two states with the highest rates of Improper Medicaid Payments (at 20.7 and 20.5% respectively), with Delaware, Connecticut, and Idaho following close behind. As you might notice, none of these five states are among the most populated, and none of them are near the top of the list of states with the largest immigrant populations.

California, New York, New Jersey, Florida, and Nevada are the states with the largest immigrant populations, yet they all fell below a rate of 9% during those three years.

So, people need to stop pretending this is even remotely connected with our Border Policy or Immigration Statistics, because there isn’t even a Correlation to mistake for Causality.

House and Senate Republicans upheld their promise not to tamper with Medicare as far as work and age Eligibility Requirements were concerned when drafting the 2025 Congressional Budget Bill. However, Eligibility for certain Immigrant groups will be impacted, as some Non-Citizens who were previously Eligible as Permanent Residents of the U.S. for at least five consecutive years will lose coverage 18 months after the Legislation is passed.

Medicaid, however, was far from off-limits to Congressional Republicans…and where they have tampered with Medicaid and other health coverage through the ACA, it could have dramatic and widespread impacts on healthcare systems across the nation.

Medicaid is funded through a combination of Federal and State Taxes, with roughly 70% of that funding coming from the Federal Budget. States often derive a significant amount of their funding through Provider Taxes, which are taxes paid by Health Care Providers (hospitals, nursing homes, and the like). The House version of the Congressional Budget Bill would have prohibited States from creating new Provider Taxes or increasing the current percentages paid by Providers, which are capped at 6%. The Senate version, however, gradually decreases that percentage to 3.5% by 2031, but only for the 40 States (and the District of Columbia) that employed Medicaid Expansion under the Affordable Care Act, leaving exceptions in place for nursing homes and intermediate care facilities.

This will dramatically decrease the amount of matching funds paid by Federal Taxes, creating a bit of a double-whammy on States that are being penalized for adopting Medicaid Expansion.

The concern here is that States will almost certainly have to make dramatic cuts to Medicaid as a result of the lost revenue, further cutting the number of people covered or the amount paid to Providers.

Of course, there’s also the addition of out-of-pocket expenses for Medicaid enrollees, as a $35 co-pay will be required for some services (again, only in States with expanded Medicaid) for individuals with an annual income of more than $15,650 (Federal Poverty Level). The Senate did add allowances for States to charge an even greater co-pay for Emergency Room visits for Non-Emergencies. The silver lining is that the co-pay policy doesn’t apply to primary care, mental health, or substance abuse services.

Access to insurance coverage through the Affordable Care Act marketplace is about to become more challenging as well. It will also be more expensive as enhanced subsidies are scheduled to expire at the end of 2025, which could result in some costs for ACA insurance coverage increasing by an average of 75%. I don’t know how many people can afford to see their Insurance Premiums go up by 75%, but I would be irate if it were happening to me.

Hundreds of thousands of Lawfully Present Immigrants are likely to lose insurance coverage through the ACA, because additional subsidies that keep those costs down will also be expiring.

All of this is devastating at a time when hospitals and medical facilities across the country are already facing massive budget shortfalls. Part of that comes from Medicaid and Medicare payments not being sufficient to keep pace with rising operating costs. Those skyrocketing operating costs are partially derived from administrative expenses produced by Insurance Companies, due to prior authorizations and the appeals associated with denials.

According to a report from the American Hospital Association last September, administrative costs alone accounted for more than 40% of the average hospital’s total expenses. Not only does the Commercial Insurance Industry delay and often deny necessary care for patients, but it also dramatically increases the costs for Providers to operate in the first place, which leads to increased costs for the rest of us. Of course, the Industry is thriving as a whole, with many Insurance Companies seeing record profits year after year.

You may notice some disdain for Insurance Providers, and that’s something I’m entirely conscious of. I’ve experienced frustration regarding the predatory practices of the for-profit Insurance Industry while researching their standards, profit margins, and actions.

What we’re likely to see if the House and Senate Republicans have their way, in addition to fewer people being covered by Medicaid (and health insurance in general), is staffing cuts at Providers or (in the worst case) closures. This is most likely to happen in areas where the population is lowest, impacting rural Providers more than those in urban areas…though the impacts would still be massive there as well.

Because of this, Senators added a $50 Billion fund ($10 Billion annually) to the Congressional Budget Bill, insulating rural hospitals from some of the worst impacts. The House version of the bill would have allowed rural hospitals that closed between 2014 and 2021 to reopen under the Rural Emergency Hospital designation, which allows Medicare to provide them with a potential lifeline. This could have been good, since 146 hospitals in rural counties closed between 2005 and 2023. The Senate, unfortunately, included no provision to reopen those hospitals under the retroactive designation.

So, there are some small bits of good mixed in with the bad aspects of that portion of the new budget, but none of those “good” things would be quite as necessary if it weren’t for all of the “bad” aspects of the Congressional Budget Bill. And altogether too much of that “bad” is tied up in transparent bigotry directed toward Immigrants, and the false claims that they are responsible for Fraud in the Medicaid and Medicare systems, along with the other things people often refer to as “entitlements.” Of course, while focusing on Legislation to further disenfranchise already disenfranchised people, the same Lawmakers are providing additional handouts to Corporations, the actual sources of Fraud, Waste, and Corruption.