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Republican Strategy to Undermine the Affordable Care Act: A Stealth Approach

3 Jun

Republicans have adopted a significantly different strategy in 2025 compared to their failed 2017 “repeal and replace” efforts, implementing what healthcare experts describe as a stealth dismantling of the Affordable Care Act through legislative and regulatory changes that avoid direct repeal messaging while achieving similar coverage reductions.

Strategic Rebranding: Avoiding Direct Repeal Language

The primary Republican strategy involves carefully avoiding the inflammatory “repeal and replace” terminology that generated massive public opposition in 2017[1][2]. Instead, congressional Republicans are pursuing changes to the ACA that would result in 10.7 million fewer Americans having health insurance through marketplaces and Medicaid, while maintaining that they are not technically repealing Obama’s signature healthcare law[1]. This approach represents what Matt Salo, executive director of the National Association of Medicaid Directors, calls “a stealth repeal and replace” where “they’re being clever about it without using the term”[1].

Targeting Core ACA Components Through Administrative Burden

The second key strategy focuses on systematically weakening the twin pillars of Medicaid expansion and federally subsidized insurance marketplaces through increased administrative requirements and eligibility restrictions[1]. House Republicans have identified over $800 billion in savings over the next decade from Medicaid and marketplaces, with the Congressional Budget Office projecting that 7.6 million fewer individuals would be enrolled in Medicaid and 3.1 million fewer in marketplaces within a decade[1]. The proposal includes requiring states to verify Medicaid expansion eligibility every six months rather than annually, eliminating year-round enrollment for low-income marketplace participants, requiring additional documentation from applicants, and reducing the open enrollment period by one month[1].

Justifying Cuts Through “Fraud and Waste” Messaging

Republicans are framing their healthcare cuts as targeting inefficiencies, fraud, and ineligible recipients rather than legitimate beneficiaries[1][3]. The White House argues that reductions would primarily affect undocumented immigrants and able-bodied people who should not be on Medicaid[4]. Dr. Mehmet Oz, Trump’s CMS administrator, maintains there are “no cuts to Medicaid” and that proposals focus on work requirements to “future proof” the program[3]. However, reliable estimates show that fraud within Medicaid is primarily committed by providers rather than recipients, and the entities responsible for identifying fraud would receive no additional funding under GOP proposals[1].

Financing Tax Cuts Through Healthcare Spending Reductions

The underlying motivation for these healthcare changes stems from the necessity to fund extensions of Trump’s tax cuts through budget reconciliation[1]. The animosity toward the ACA among Republicans is secondary to their need to offset the costs of tax reductions, with the healthcare cuts serving as a primary funding mechanism for the broader “One Big Beautiful Bill”[5][6].

This summary is directly from perplexity.ai.

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  1. https://www.washingtonpost.com/health/2025/06/02/shhh-republicans-are-trying-repeal-obamacare-again-sort/        
  2. https://kffhealthnews.org/morning-breakout/republicans-are-quietly-working-to-undermine-key-parts-of-obamacare/
  3. https://www.politico.com/news/2025/05/30/dr-oz-claim-gop-cutting-medicaid-00375618 
  4. https://thehill.com/policy/healthcare/5329416-democrats-criticize-trump-budget-medicare-cuts/
  5. https://www.politico.com/live-updates/2025/05/20/congress/gop-megabill-to-save-congress-nearly-800-billion-but-cut-coverage-00359606
  6. https://www.yahoo.com/news/mike-johnson-russ-vought-continue-162121425.html

What is the impact of the current budget proposal passed by the US House on healthcare in Washington state?

2 Jun

The One Big Beautiful Bill Act (H.R. 1 in the 119th Congress), passed by the House of Representatives in May 2025, would significantly impact healthcare coverage in Washington State, potentially making it one of the most affected states in the nation. According to Congressional Budget Office (CBO) estimates, Washington faces particularly severe consequences due to its robust Medicaid expansion under the Affordable Care Act[1].

Nationally, the CBO projects that 13.7 million more Americans will become uninsured by 2034 due to the bill’s provisions combined with the expiration of enhanced ACA premium tax credits[4][5]. Given Washington’s current uninsured rate of 4.7% in 2022—an all-time low—and the state’s heavy reliance on federal Medicaid funding, Washington residents would likely experience a substantial increase in the uninsured rate.

Washington State could experience a dramatic 25% decrease in Medicaid enrollment, representing one of the steepest declines nationally[1]. With current Medicaid/CHIP enrollment at approximately 1.84 million Washingtonians as of October 2024[2], this translates to roughly 460,000 residents losing Medicaid coverage. The state would also face a 15% reduction in federal Medicaid funding, among the highest cuts in the country[1].

The bill introduces several provisions that would disproportionately affect Washington residents. Work requirements for able-bodied Medicaid expansion adults, requiring 80 hours per month of work, volunteering, or school attendance, would be implemented beginning in 2026[3]. Additionally, the legislation mandates more frequent eligibility redeterminations every six months rather than annually for expansion populations, creating additional administrative barriers[3][1].

The legislation would effectively reverse much of the coverage gains Washington achieved through aggressive Medicaid expansion and robust implementation of ACA marketplace provisions, potentially pushing the state’s uninsured population back toward pre-ACA levels.

What can you do to help change this trend? Check out Health Care for All Washington and join the effort to make universal health care real in Washington!

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  1. https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/   
  2. https://www.healthinsurance.org/medicaid/washington/
  3. https://www.sheppardhealthlaw.com/2025/05/articles/federal-healthcare-legislation/house-passed-budget-bill-the-one-big-beautiful-bill-act-includes-major-changes-to-medicaid/ 
  4. https://www.kff.org/uninsured/
  5. https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/

How Primary Care and Community Organizing Can Bring Us Universal Health Care Now

1 Jun


by Ron Lovell, HCFA-WA Board Member

At our May 2nd Wednesday Speaker Series, we heard an inspiring presentation by Dr. Michael Fine, writer, community organizer, family physician, and President of Primary Care for All Americans.  His talk was based on his experience with organizing primary care clinics in several cities in the eastern United States. Read on for a recap and/or view his complete presentation on our YouTube channel.

First, Dr. Fine outlined the failures of the U.S. healthcare market, emphasizing poor health outcomes, high costs, and deep health disparities. He argued the root cause is inadequate access to robust primary care for all Americans, noting only 43% of adults have a meaningful primary care relationship. He highlighted primary care’s proven ability to reduce costs and improve public health, drawing comparisons to other essential community services like police, fire, and education.

He then described successful community-based models (e.g., Scituate, Rhode Island) and advocated for building a social movement, starting locally, to ensure universal primary care. He detailed strategies such as community meetings, local workgroups, playbooks, and local funding. He stressed the need for a massive increase in primary care workforce and fairer reimbursement models, calling for a shift from fee-for-service to per-person payments.

HCFA-WA volunteer Dr. John Sobeck led the Q&A Session. He was joined by Primary Care Innovator Dr. Garrison Bliss who addressed these questions:

  • the critical shortage of primary care providers and the need to expand training and residencies
  • the imbalance in reimbursement that drives clinicians away from primary care
  • panel sizes for sustainable primary care practice (ideally 300-500 patients per doctor).
  • funding models, including local government and employer-based approaches
  • concerns about cherry-picking patients and ensuring equitable access
  • the role of direct primary care and its affordability for communities
  • incentivizing new graduates to serve in underserved areas, including loan forgiveness and community support
  • collaboration between organizations (Health Care for All-Washington, Whole Washington) toward single-payer and universal healthcare goals

Key Takeaways:

  • Universal primary care is essential, affordable, and achievable through community organizing.
  • The U.S. must address workforce shortages, payment reform, and health disparities.
  • Social movements, not just legislation, are needed to drive systemic healthcare change.
  • Ongoing community engagement, collaboration, and advocacy are critical for progress.

For more details on Dr. Fine’s work, please see this additional resource: The Path to Health Care for All Starts with Community-based Primary Care

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Sea Level Rise – the slow rise elephant

20 May

The world has pledged to restrict global warming to 1.5 degrees Celsius above pre-industrial levels to stave off the most catastrophic impacts of climate change.

However, not only is this limit speeding out of reach — the world is currently on track for up to 2.9 degrees of warming by 2100. But the most alarming finding of the study, published Tuesday in the journal Communications Earth and Environment, is that 1.5 might not even be good enough to save the ice sheets.

Read the full story here:https://www.cnn.com/2025/05/20/climate/ice-sheets-sea-level-rise

But this is not new information, my friend, John Englander has written about this for a long time. Two books give background and what is needed to minimize sea level rise.

Book TitleAuthorFirst PublishedLatest EditionFocus Areas
High Tide on Main Street: Rising Sea Level and the Coming Coastal CrisisJohn Englander20122nd EditionScience of sea level rise, economic and societal impacts, adaptation strategies
Moving to Higher Ground: Rising Sea Level and the Path ForwardJohn Englander2021N/AFurther guidance on adaptation and planning

High Tide on Main Street remains a foundational work on understanding and preparing for the realities of sea level rise. The updated second edition ensures readers have access to the most current science and practical advice for adaptation, making it a crucial resource for anyone concerned about coastal futures

And there is more: https://sealevelrise.org/forecast/

Sea level has risen over 6 inches nationally since 1950, but recently, its rate of increase has accelerated. In the last five years, sea level has risen 66% faster than the historical rate, and is now rising by an average of one inch every five years. While it took 60 years for the sea level to rise about 6 inches nationally, scientists now forecast that in just the next 20 years, the sea will have risen by another 6 inches.

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SOULPACT: A Philosophy for Mindful Living

20 May

SOULPACT emerged in the early 2020s as a response to the increasing complexity and fragmentation of modern life. Created by psychologist Dr. Elena Mercer and philosopher Thomas Chen, this holistic life philosophy offers a framework for achieving balance and fulfillment through eight interconnected principles.

The Birth of a New Paradigm

The concept was born during a series of dialogues between Mercer and Chen at the Institute for Mindful Living in 2023. Both had independently observed how people struggled with information overload, decision fatigue, and a pervasive sense of disconnection. They recognized that existing wellness frameworks often addressed symptoms rather than root causes.

“We wanted to create something that honored the whole person and provided practical guidance for navigating life’s complexities,” explains Dr. Mercer. “Each letter in SOULPACT represents a fundamental aspect of human experience that, when harmonized, creates a life of meaning and joy.”

The Eight Principles

Simplicity forms the foundation of SOULPACT, advocating for the elimination of unnecessary complexity in thought and action. This creates space for Opportunity – the recognition and pursuit of possibilities aligned with one’s values.  Uniqueness celebrates individual differences and talents, while Love encompasses compassion for self and others.

Purpose provides direction and meaning, answering the fundamental question of “why.” Abundance shifts focus from scarcity to gratitude and generosity, while Calm cultivates inner peace regardless of external circumstances. Finally, Time emphasizes mindful presence and intentional choices about how we spend our moments.

A Growing Movement

Since its introduction, SOULPACT has gained traction in wellness communities, corporate settings, and educational institutions. Practitioners report improved well-being, greater clarity in decision-making, and deeper connections in relationships.

“SOULPACT isn’t about adding more to your life,” Chen notes. “It’s about distilling life to its essential elements and experiencing each fully. When these eight principles are in harmony, we discover that what we’ve been searching for has been within us all along.”

There is no single organization dedicated to SOULPACT: it is a concept that anyone can use to achieve a peaceful tranquility while still actively engaging in the chaos we find ourselves in.

I have not found a single reference that focuses on the SOULPACT concept, but here are some resources that explore the concepts:

Simplicity: The Laws of Simplicity by John Maeda offers practical guidance on reducing complexity and focusing on what matters most.

Purpose and Meaning: Man’s Search for Meaning by Viktor E. Frankl and A New Earth: Awakening to Your Life’s Purpose by Eckhart Tolle are highly regarded for their exploration of meaning, purpose, and mindful living.

Abundance and Mindfulness: The Power of Now by Eckhart Tolle and The Art of Happiness by the Dalai Lama focus on cultivating presence, gratitude, and inner peace.

Love and Uniqueness: The Four Agreements by Don Miguel Ruiz and The Untethered Soul by Michael A. Singer discuss self-love, authenticity, and living true to oneself.

Calm and Time: Peace Is Every Step by Thich Nhat Hanh and Zen Mind, Beginner’s Mind by Shunryu Suzuki emphasize mindfulness, calm, and living in the present moment.

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Test JetPak

20 May

This is the first post from JetPak for WordPress.

Opening Words

27 Jan

After having this account for several years, I have decided to begin writing, more or less, random articles as I am moved to create them.

Hello world!

9 Aug

Welcome to WordPress.com. After you read this, you should delete and write your own post, with a new title above. Or hit Add New on the left (of the admin dashboard) to start a fresh post.

Here are some suggestions for your first post.

  1. You can find new ideas for what to blog about by reading the Daily Post.
  2. Add PressThis to your browser. It creates a new blog post for you about any interesting  page you read on the web.
  3. Make some changes to this page, and then hit preview on the right. You can always preview any post or edit it before you share it to the world.
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