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Hello, and welcome back to the World of Pain podcast,
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where we read what Congress hopes that you'll ignore. Today,
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we're going to be digging into a bill that looks
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like a harmless surface, just another budget extension, but from
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the inside it actually hides some of the most significant
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policy reversals in the last decade. I'm talking about Senate
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Bill two eight eighty two, the continuing resolution that the
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Democrats have put through the Senate, the one that is
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kind of holding up our country right now. It's officially
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titled the Continuing Appropriations Extension and Other Matters Act of
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twenty twenty six. Now it sounds like bureaucratic nonsense, but
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that's the point. These bills that slip through quietly. They're
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labeled continuing resolutions or funding measures, and politicians vote for
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them just to avoid government shutdowns, all while rewriting major
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policies inside the fine print, This one, Senate two eight
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eight two, doesn't just keep the lights on. It reverses
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a lot of the healthcare reforms from last year's well
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this year's technically One Big Beautiful Bill Act, or the OBBBA.
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It sneaks in provisions that change how presidents control budgets,
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how Congress manages spending, and even how much oversight taxpayers
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can expect in the years ahead. It's not just a
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healthcare bill. It's a power bill, and it's a story
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about how Washington uses complexity as camouflage and takes advantage
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of other people's hardships. Using a government shut down that
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affects government employees, benefits, paychecks, everything, our military, They just
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affects everybody, and they're taking advantage of this. They're trying
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to use this to be able to push through a
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measure that is just completely absurd. Pass the continuing Resolution,
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allow the government to open back up, and then sit
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here unless debate the one big beautiful bill's healthcare changes.
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You guys allowed that to pass because you knew in
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just a few short months that you guys could sit
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here and try and hinder the government based on a
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spending bill. It's a bunch of bs led by Democrat
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senators to try to hold off and try to profit
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and push through something based on other people's hardships. It's
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a bunch of bs. Grab your coffee, because this one's
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going to be a deep one. We're gonna try and
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break it down piece by piece. At this point, the
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One Big Beautiful Bill Act had just been passed. It's
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been marketed as a return to fiscal sanity after years
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of reckless pandemic era spending and massive entitlement growth, which
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we have our Medicare and Medicaid spending is growing almost
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out of control. The context here matters. Medicare spending is exploding.
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The Medicare costs exploded to over eight hundred billion dollars
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a year, with more than ninety million Americans enrolled, which
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is roughly twenty seven percent of the entire US population.
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Many of those are people who are receiving coverage temporarily
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under pandemic waivers that were that weren't supposed to expire
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but didn't. Hospitals were billing the federal government for billions
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in uncompensated care of through Medicaid, including treatment for people
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who are not lawfully in this country. The GOAO and
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CBO both warned that the system was unsustainable, and in
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several states lawmakers openly admitted that the emergency care reimbursements
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for non citizens were being used as a backdoor funding
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stream to keep hospitals solvent. It's also being used as
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a back door to provide illegal immigrants healthcare. So OBBA
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was written up to clean it up. It wasn't perfect,
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but it was an attempt to bring order, fairness, and
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responsibility back to a system that is bleeding cash. Before
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what the OBBBA states that had a lot of freedom
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to define who counted as a qualified alien for Medicaid purposes.
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That term deceptively broad. Under the pre OBBBA law is
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considered and covered not all only lawful permanent residents, Green
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card holders, but also refugees, assylies, paroleis, trafficking victims, certain
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abused spouses or children, and even people with pending immigration
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cases who had temporary work authorization. Some of those categories
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made sense, others were ripe for abuse because once a
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state declared someone was qualified, it could build a federal
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government for a share of that person's health care costs.
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So when the Democrats are trying to sit here and
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tell you that illegal immigrants are not getting Medicaid or
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Medicare funds, it is not true. They are deceptively trying
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to say this because not only does do they get
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Medicaid funding through the Amtala Act, the Emergency Medical Treatment
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and Labor Act, but there are also getting it through
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these roundabout ways of of of a kind of a
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vague kind of a a outlandish definition definitional loophole. But
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that is that is exactly what they're doing. They're using
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these loopholes, these these vague definitions to be able to
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push this stuff through while the average working American is
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still having to pay increased health care health insurance, while
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illegal immigrants are getting it for free, if not discounted,
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if they're paying anything at all. Before the o BB
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had changed, that we were paying way too much for
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these illegal immigrants. And and and that's part of the
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reason why we have had Medicare costs just exploding over
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the past few years. Obib's authors saw that as a physical,
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as a fiscal and moral problem. If Congress doesn't doesn't
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appropriate funds for these populations, states shouldn't be allowed to
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pass the bill to Washington. So that really is where
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this came into place. Under the Big Beautiful Bill Alien,
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under a section seven to one one nine, Alien Medicaid
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eligibility was established. It rewrote the law. From this point forward,
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federal medicaid dollars could only go to US citizens lawful
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permanent residents, So people with a green card, people who
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have completed the five year waiting period, because you are
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required to have a five year consistent work history, among
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other things, pay taxes, not break ice law, immigration law.
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You have to be in good compliance with the United States.
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They're just asking you to be a good citizen. Cuban
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or Haitian entrance covered by special humanitarian laws, citizens of
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freely associated states such as those from the Marshall Islands,
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Micronesia or palou that's it. Everyone else, even the what's
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technically considered a lawful migrant, the asylum seekers and stuff
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like that, because there is that five year waiting period.
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Once you have applied for asylum or the other technical
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lawful ways of becoming a citizen, you have to wait
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five years before your technically are eligible to be able
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to get into the medical care medicaid systems, because by
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doing so, we know that as a country that you
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have paid in to those systems and not just mooching
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off those systems. So who lost coverage The refugees in
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Assylis who hadn't yet received the permanent resident status paroles,
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the people who are granted temporary humanitarian entry, victims of
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human trafficking, and certain abuse survivors covered under the Violence
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Against Women Act, and people who with pending asylum or
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adjustment of status applications who were lawfully present but not
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yet permanent residents. Many of these people who were here legally,
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they worked, they paid taxes, and in many states qualified
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under for medicaid under the old federal guidance. Really, what
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they're doing, why they're saying this is and why I'm
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saying this is because under the old guidance, they weren't
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reinforcing the five year minimum, which which is used to
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make sure that you're paying into the systems that you
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were also going to then pull from. So that five
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year minimum made sure that you at least paid in
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and have had a good work history, have done these
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things that normal Americans would have to do before they're
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before they get their benefits too. I mean, this is
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what's expected of an American citizen. It's just being extended
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now to the legal immigrants. They're expected to be good
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and good, good citizens. I mean really, critics rule has
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said that it was cruel. They it's punishing the very
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people that the USA pro mus to protect. Supporters said
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that it was about priorities citizens first, legal residents next,
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and everything else handled by the States, charities or the
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private sector, which I understand that people who want to
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pay for healthcare for the people who were sex trafficked,
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for the people who were domestic abuse survivors, and stuff
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like that, because that's just being human. It's wanting to
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take care of others, the people who are in those situations.
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There are a ton of charities that are already helping
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those people. There are charities and shelters set up to
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help those people, and in a lot of cases, they
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get free legal aid to be able to help get
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themselves asylum, to help get applications process through. The only
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thing that they're waiting on is that five year waiting
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period where they are in good standing with the United States.
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They are working, they've provided a work history, they have
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provided all this stuff to be able to help put
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them on the right track, and then they would be
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able to collect medicator medicare too. If they fell on
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hard times, they would still have to follow the same
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exact other guidelines set in this bill, which I'll cover
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here in a minute, but they would qualify. Is it
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really that bad to request for five years that someone
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stays in good standing with the United States and is
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a good citizen before they are able to start pulling
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our citizens programs. It's just that's not too that should
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not be too much to ask. Next, the OBBA took
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aim at little known programs which I talked just kind
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of mentioned briefly, the Emergency Medicaid, which reimburses hospitals for
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treating undocumented migrants who arrive in life threatening condition. Hospitals
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must provide care under the MTALA Act, the Emergency Medical
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Treatment and Labor Act. That's federal law, but under earlier rules,
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states could build Washington for up to ninety percent of
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those costs enhanced match with enhanced matching rates, the Beautiful
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Bill reduced that reimbursement to the standard f MAP, which
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is it's the acronym used for your reimbursement rate. The
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regular federal share every state gets for Medicaid. Now f MAP,
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which if you really want to know what that is,
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it's Federal medic Medical Assistance percentage is calculated by state income.
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By law, the federal share can't fall below fifty percent,
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but it also can't exceed eighty three percent. Wealthier states
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like Massachusetts sit near the fifty percent floor. Of all
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poorer states such as Mississippi get the seventy eight percent.
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That means under the Big Beautiful Bill, Washington still covered
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roughly half to three quarters of emergency medical Medicaid costs,
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but not ninety or one hundred percent, which in some
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cases the percentage was just slightly higher than ninety percent
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that they were able to get reimbursed for. The logic
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was simple, if states want to provide care to undocumented immigrants, fine,
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but they should have to have some skin in the game.
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Very true, which is why you have states like California
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who allowed for Medicaid to be given to illegal immigrants
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because they were these increased rates through the hospitals and
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and things like that. Not only that, but they were
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also providing which I'll cover here in a minute. They
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were messing with something called the provider tax. They really
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just had found a way to be able to work
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around federal law. Well, of course, they really hated when
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the Big Beautiful Bill actually passed and actually went through
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the Senate and went through the House. It had it
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went through the democratic process, but they hated it because
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it cut off there. It cut off their gravy. They
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ran a gravy train. They were able to get everything
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that they really wanted. They were able to give free
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health care illegals, they were able to get them to
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qualify for their their state Medicaid programs. They were able
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to do everything that they felt was necessary at the
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expense of a federal taxpayer. Technically, we're going to cover
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the We're to move on to the next section, because
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I could go into the rip into California for a
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long time over this because they did. They used loopholes,
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tax loopholes, everything that they could to be able to
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make it to where the federal taxpayer was paying more
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into their Medicaid program into their state run Medicaid program,
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which they then took that money and allocated it to
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get illegal healthcare. The One Big Beautiful Bill also reintroduced
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the idea of work requirements for certain Medicaid rollies, something
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the Trump administration had pushed and courts had repeatedly struck
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down at the state level. The bill required able body
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adults without dependence those aged nineteen to sixty four to work, volunteer,
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or study at least eighty hours per month. This law
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exempted the elderly, pregnant women, people with disabilities, caregivers of
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dependence and the medically frail so ablebody meant exactly what
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it sounds like, adult capable of employment, not incapacitated, and
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not caring for dependence. It was about linking welfare to work,
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a principle that goes back to the nineteen ninety six
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Clinton welfare reforms. A Democrat provider tax caps and verification.
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This is what I was just talking about earlier. The
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one Big Beautiful Bill at capped state provider taxes, preventing
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states from taxing hospitals just to inflate federal matching rates.
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Entiten eligibility verification in redetermination rules to prevent fraud. In short,
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the Big Beautiful Bill wasn't anti healthcare. It was anti
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abuse because what they were doing is they were taxing hospitals,
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taxing providers a certain rate as high I think I
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believe it was as high as even eight percent. And
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then then what they were doing is they were taking
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those funds, they were using them for their medicaid, but
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then they were also giving them back to hospitals as refunds.
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So they were reporting to the federal government that they
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were recovering this amount of money from provider taxes, and
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then once they were receiving their federal funds, they would
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turn around and give that money that provider tax back
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to the provider, so through grants or trying to make
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it as legal as possible. A year later, we're in
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a budget standoff, and instead of debating this topic openly