The Minimal Responsibilities And Unintended Consequences Of Medicaid Work Requirements
The Trump administration unveiled a rule implementing the Medicaid work requirements included in last year’s budget reconciliation law.The Trump administration unveiled a rule implementing the Medicaid work requirements included in last year’s budget reconciliation law.Medicare red tape turned insurers into villains
Imagine your doctor diagnoses you with Alzheimer’s disease, evaluates your needs and risks, and recommends a tailored treatment plan to extend your healthy years. Who should have the final say over whether you pursue that care: you, your family, and your doctor — or an insurance company that has never met you?
For most Americans, the answer is obvious. Doctors and patients should make care decisions.
If policymakers want fewer insurance denials, they should stop creating incentives for them.
Yet in many cases, insurers end up with the final say.
New polling from Market Institute and President Trump’s pollster Fabrizio Ward found that 89% of registered voters believe doctors often choose not to prescribe Alzheimer’s tests or treatments because they know insurers are unlikely to cover them and patients cannot afford to pay out of pocket.
Voters are recognizing a real trend. Alzheimer’s patients have made headlines for benefiting from new treatments, only to receive abrupt coverage denials from their insurance companies.
Treatment allowed one patient, Lori Baetz, to return to her daily routine. When coverage was pulled back, she deteriorated, even getting lost in her own neighborhood. Lori’s neurologist, Dr. Cara Leahy, wrote that her patients are repeatedly denied coverage. Similar denials are happening across the country, including in New Jersey and North Carolina, and across insurers.
Thousands of Americans find these delays and denials unjust. In fact, a shocking 41% of young Americans said the murder of UnitedHealthcare CEO Brian Thompson was “acceptable.” One voter from a Market Institute focus group said of insurance companies, “They just want to wear you down ... so you just give up.”
Americans’ frustration is understandable. But insurance companies are often following rules set by the federal government.
The real culprits are the behind-the-scenes government policies that encourage insurers to delay and deny coverage.
The clearest example is a Biden-era Medicare policy known as Coverage with Evidence Development.
After the Food and Drug Administration approved a new generation of Alzheimer’s therapies, the Centers for Medicare and Medicaid Services took the unprecedented step of limiting Medicare coverage unless patients participated in government-approved studies and met additional requirements.
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That created a second layer of red tape after the FDA had already deemed the therapies safe and effective.
The decision sent a powerful signal throughout the health care system. When Medicare, the nation’s largest health care payer, treats FDA approval as insufficient, private insurers follow.
When Lori’s coverage was denied despite her positive response to treatment, the company described the therapy as “investigational/experimental,” even though the FDA had approved it. The company was following Medicare’s lead. When Medicare treats approved therapies as experimental by requiring additional paperwork and registration, insurers can cite the government’s own policy when denying coverage.
That bad policy worsens the financial and human cost of Alzheimer’s disease.
The lifetime cost of caring for a person with Alzheimer’s exceeds $400,000, with families shouldering roughly 70% of that burden through unpaid caregiving and out-of-pocket expenses.
Meanwhile, Medicare spends roughly $174 billion annually on Alzheimer’s patients, while Medicaid spends another $72 billion, much of it on long-term care. As Alzheimer’s cases double over the next few decades, those costs will continue to climb.
The good news is that treatment could help curb those mounting costs by keeping Americans independent and in the workforce longer.
According to USC Schaeffer research, providing treatment before symptoms fully emerge could add a full year of life, reduce nursing home stays by nearly two years, and lower medical spending by roughly $48,000 per patient. That means more Americans remaining independent, fewer families crushed by caregiving burdens, and more workers preserving their economic productivity.
Every patient who remains independent, stays out of a nursing home, or delays the need for full-time care represents both a human victory and an economic one.
If policymakers want fewer insurance denials, they should stop creating incentives for them.
The FDA is charged with determining whether a therapy is safe and effective. Once it does, CMS should not erect a second regulatory barrier that encourages insurers to do the same.
Until that changes, Americans will continue blaming insurance companies for behavior government policy encourages.
Trump is keeping his word on health care costs
For years, Washington insiders from both parties talked a big game about lowering health care costs. Yet somehow, the bills kept rising, families kept struggling, and the real power players in the system kept getting a free pass. Not anymore.
The Trump administration’s Department of Justice is finally taking aim at one of the biggest and most overlooked drivers of high health care costs: anticompetitive contracting by dominant hospital systems.
Hospitals are businesses first and foremost — and like any business, they’re out to maximize profits.
The recent lawsuits against giants like New York Presbyterian and Ohio Health are a clear signal that the era of unchecked hospital power is coming to an end.
Let’s be honest about what’s been happening. In city after city, hospital markets have quietly consolidated until competition barely exists. When nearly all metro areas have highly concentrated hospital systems, those systems use their leverage to lock in contracts that guarantee them top-tier placement in insurance networks while blocking efforts to guide patients toward more affordable care.
These so-called “anti-steering” provisions might sound technical, but their impact is simple: higher prices and fewer choices for American families.
When insurers and employers cannot design plans that reward lower-cost, high-quality providers, patients are forced into more expensive options whether they realize it or not. Workers pay more in premiums. Businesses face higher costs. Taxpayers pick up the tab through government programs.
What makes the Trump DOJ’s actions so important is that they are willing to challenge institutions that have long been treated as untouchable. Hospitals often enjoy a halo effect in their communities, and many do lifesaving work. But that does not give them the right to use their market dominance to shut out competition and inflate prices.
Hospitals are businesses first and foremost — and like any business, they’re out to maximize profits.
By going after these restrictive contracts, the administration is restoring something that has been missing from health care for far too long: real competition. When plans have the flexibility to exclude overpriced systems or steer patients toward better-value options, the entire market starts to work the way it is supposed to.
We already have evidence this works. Plans that avoid the most expensive hospital systems can significantly reduce costs — without negatively impacting the quality of the care being delivered — and even modest steering can deliver meaningful savings. In a system as large as American health care, those savings translate into billions of dollars and real relief for families.
Predictably, the corporate hospital industry is pushing back, claiming these lawsuits are misguided. But that is what you hear whenever someone finally challenges entrenched interests. The same voices that benefited from the status quo are now being asked to compete on a level playing field, and they do not like it.
RELATED: Tax-exempt hospitals are not putting their patients first
Instead of protecting powerful institutions, the Trump administration is standing up for patients, workers, and employers who have been footing the bill for far too long. It is a reminder that markets only work when competition is protected, and that means enforcing the rules when they are violated.
For decades, Americans have been told that health care costs are just too complicated to fix. But sometimes the problem is simpler than the experts admit. When a few dominant players can write the rules, everyone else loses. President Trump and the Department of Justice are finally rewriting that script.
Draining the swamp is not just about Washington politics. It is about rooting out the hidden arrangements and insider advantages that drive up costs across our economy, including in health care.
By taking on anticompetitive hospital contracting, the Trump administration is proving that no industry is above scrutiny.
That is a win for competition, a win for affordability, and most importantly, a win for the American people.
Christians win BIG: New York caves on forcing nuns and churches to fund abortion after knockout SCOTUS ruling
Christian organizations spent nearly a decade fighting New York's requirement that they pay for abortions. They came out victorious on Friday, thanks in part to a U.S. Supreme Court ruling in June.
In January 2017, then-Gov. Andrew Cuomo announced that the Empire State would require employers to not only pay for contraceptive drugs and devices but for "all medically necessary abortion services."
Cuomo, a Catholic, said that the mandate was one of a number of regulatory actions that would "help ensure that whatever happens at the federal level, women in our state will have cost-free access to reproductive health care."
'The state has given up its disgraceful campaign.'
While there was a religious exemption built into the mandate, it was extremely narrow.
As satisfaction of the mandate would violate their deeply held religious beliefs, a coalition of Christian groups ineligible for the exemption — including the Roman Catholic Dioceses of Albany and Ogdensburg, the Anglican Sisterhood of St. Mary, Our Savior's Lutheran Church, and First Bible Baptist Church — sued the State of New York, claiming it violated the First Amendment's free exercise clause and both religion clauses.
After years of legal setbacks, the Christian plaintiffs' fight was renewed in late 2021 when the U.S. Supreme Court vacated a mandate-affirming ruling by the state appellate court and ordered it to reconsider the case in light of its 2021 decision in Fulton v. Philadelphia. In Fulton, the SCOTUS ruled that the City of Philadelphia had violated Catholic Social Services' free exercise of religion by requiring the foster care agency to endorse homosexual couples as foster parents.
Again, the state appellate court considered the case, and again it ruled against the plaintiffs and in favor of the abortion mandate.
The Supreme Court took up the Christian groups' subsequent appeal, and in June 2025, it ordered the Court of Appeals of New York to reconsider the case in light of its June 5 ruling in Catholic Charities Bureau, Inc. v. Wisconsin Labor. In that particular case, the high court unanimously held that by denying the Catholic Charities Bureau a tax exemption that is available for religious entities, Wisconsin had violated the First Amendment.
Justice Sonia Sotomayor said in the opinion for the court, "When the government distinguishes among religions based on theological differences in their provision of services, it imposes a denominational preference that must satisfy the highest level of judicial scrutiny."
That Supreme Court ruling boded poorly for New York, whose abortion mandate had a similarly narrow and problematic religious exemption.
On Friday, New York agreed to surrender its effort to coerce the Christian plaintiffs into funding abortions.
"For nearly a decade, New York bureaucrats tried to strong-arm nuns into paying for abortions because they serve all those in need," said Lori Windham, senior counsel at Becket and attorney for the plaintiffs, in a statement. "At long last, the state has given up its disgraceful campaign. This victory confirms that the government cannot punish religious ministries for living out their faith by serving everyone."
"The Supreme Court has made it abundantly clear that religious groups shouldn't be bullied for staying true to their faith," Windham added.
Per the terms of the settlement with self-identified Catholic Gov. Kathy Hochul's administration, the following entities will now be recognized as religious employers, thereby securing exemptions from the mandate: the Roman Catholic Dioceses of Albany and Ogdensburg and the Catholic Charities thereof; St. Gregory the Great Roman Catholic Church Society of Amherst; First Bible Baptist Church; Our Savior's Lutheran Church of Albany; Teresian House Nursing Home Company, Inc.; Teresian House Housing Corporation; and Depaul Housing Management Corporation.
The Sisterhood of Mary and the Catholic Charities of the Diocese of Brooklyn have dropped their free exercise claims against the state.
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The Republican Party Deserves Their Bad Election Night
Zombie political culture is still eating brains.Analysis: How diversity dogma and H-1B visas sank a proud American brand
The United Services Automobile Association is one of the most venerable names in banking and insurance, a company that prides itself on its service to members of the military and their families. In recent years, however, USAA has run into serious financial trouble due to a combination of mismanagement, fashionable diversity, equity, and inclusion policies, and the firm’s increasing reliance on incompetent and untrustworthy H-1B workers, most of whom are from India.
A significant number of current and former USAA employees have come forward to discuss what they describe as a toxic workplace culture, which has led to an alarming number of employee suicides, and the company's outsourcing of critical functions to H-1Bs and Indian consultancies, putting at risk the financial data of its customers, which include high-ranking members of the U.S. armed forces.
What began as a cost-cutting strategy in the early 2000s now threatens the stability of an institution long trusted by veterans.
Insiders granted anonymity to avoid retaliation say USAA’s decline began in the 2000s under then-CEO Robert G. Davis, who outsourced IT and other core functions to H-1B contracting firms such as Tata Consultancy Services. Those firms imposed contracts requiring USAA to maintain minimum staffing levels, creating chronic overstaffing. Idle contractors were reportedly assigned “busywork” to meet quotas, with conference rooms converted into laptop farms where workers sat “packed like sardines.”
One insider described the result as “incredibly incompetent” operations. Projects that U.S.-based employees could complete on time were instead handed to H-1B contractors who often lacked the necessary skills and required retraining.
From cost-cutting to collapse
At the same time, USAA repeatedly laid off American staff and replaced them with foreign workers, driving labor costs higher and eroding institutional knowledge. Davis retired abruptly in 2007, but his successors continued his policies, expanding USAA’s offshore footprint with new IT centers in Guadalajara, Mexico, and Chennai, India.
Insiders say H-1B contractors at USAA often lack basic programming skills, compounding inefficiency. In one case, a credit card processing problem baffled contractors for six months until the company brought back a retired American employee, who solved the problem in a matter of days. The constant visa turnover worsens the issue. Skilled H-1Bs leave after six years, draining institutional knowledge. Turnover is even higher at USAA’s Guadalajara facility, where Indian employees reportedly fear cartel violence.
Bureaucratic bloat magnifies these problems. Each team has dual directors, and many systems rely on outdated software. That dysfunction has drawn scrutiny from federal regulators, who fined USAA for failed audits and violations of anti-money-laundering laws. Those failures forced the company to sell off divisions, including real estate, and pushed USAA into persistent losses through much of the decade.
Customers have also felt the effects. Many complain that poorly trained H-1B staff struggle to handle basic service requests. One customer said resolving a fraud alert took hours — and that he now contacts USAA’s top executives directly to get results.
Security risks and cultural decay
USAA’s growing dependence on H-1B contractors and overseas labor has created potential security and compliance risks, according to multiple insiders. The company has outsourced anti-money laundering work to Tata Consultancy Services, which reportedly performs much of that work in India. As a result, the personal financial data of U.S. service members and veterans may be stored or processed abroad.
USAA also shares customer data — including names, addresses, and birth dates — with LexisNexis, with no option for customers to opt out. One customer said he only discovered this practice after receiving a notice in the mail.
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Inside the company, these policies have coincided with a marked decline in morale. Mass layoffs of veteran employees have preceded at least three suicides, including one who shot himself in a company parking lot. A former director described intervening to stop another potential suicide. Tensions intensified during the COVID-19 pandemic, when USAA defied Texas Republican Gov. Greg Abbott’s executive order banning vaccine mandates.
Employees describe a sharp cultural shift away from USAA’s traditional military ethos toward a mishmash of corporate diversity programming. The company has hosted Diwali celebrations and mandatory DEI events while facing allegations of religious discrimination against Christian employees. One former employee has taken a case to arbitration. Internal surveys reportedly show employee satisfaction at just 33%.
An institution on the brink
Analysts say the company’s reliance on foreign labor and internal instability have eroded its reputation for customer service and financial stewardship. What began as a cost-cutting strategy in the early 2000s now threatens the stability of an institution long trusted by veterans.
Whether USAA can recover will depend on its ability to restore confidence — both among employees and the members it was established to serve.
The maligned and misunderstood player that Big Pharma wants gone
Last week, a bipartisan group of senators introduced legislation on drug prices that specifically targets pharmacy benefit managers, exactly as Big Pharma prefers. Pharmaceutical companies have spent years trying to convince the public and policymakers that PBMs are the bad guys in the prescription supply chain, shadowy middlemen inflating prices and hurting innovation. That narrative is convenient, but it is also wrong. PBMs are introducing competition, eliminating waste, and driving down prices.
Which is precisely why Big Pharma wants them out of the way.
The truth is that pharmacy benefit managers are effective. And that is exactly why drugmakers are going after them.
The pharmaceutical industry spends more money than any other sector to sway government policy. In 2024, it poured $90 million into campaign contributions and nearly $400 million into lobbying — much of it through former government officials now on the payroll. Drugmakers also shelled out a whopping $11 billion on advertising, a sum that conveniently buys more than consumer attention. It pressures media outlets to look the other way, a racket the Trump administration is finally moving to rein in.
After the black eye of the opioid crisis and the COVID-19 debacle, Big Pharma needs a scapegoat for high drug prices. It found one in a quiet, little-known player most Americans have never heard of, much less understood.
But the numbers are clear. A recent study shows pharmacy benefit managers deliver at least $145 billion in net value every year, even after costs. Compared with a system where manufacturers dictate prices, PBMs create an additional $192 billion in value across the economy. That money doesn’t vanish into corporate coffers. It flows back into businesses, households, and the wallets of working Americans.
PBMs accomplish this by negotiating directly with manufacturers and pharmacies. They aggregate buying power for millions of people. They secure rebates and discounts that most individual plans could never get on their own. In 2020, PBM-managed rebate structures created $51 billion in value for patients and plan sponsors. That is a competitive market in action.
PBMs are expected to save health plans and consumers about $1.2 trillion over the next 10 years, averaging $1,154 per person per year. And for every dollar spent on PBM services, the system saves $10 in return. By steering patients toward generics and bio-similars, PBMs helped the health system save $445 billion in 2023 alone. That is what efficiency looks like.
Perhaps more importantly, they improve health outcomes. When patients can afford their prescriptions, they are more likely to take them. That means fewer hospitalizations and fewer emergency room visits. PBM-driven programs have led to as much as a 16% increase in medication adherence and a 10% drop in inpatient admissions.
RELATED:How MAHA can really save American lives
It’s an obvious good to have healthier Americans. But it’s also good for a productive economy.
By lowering premiums and drug costs in public programs, PBMs save taxpayers money as well. This alone accounts for $47 billion in annual savings. And by accelerating patient access to new therapies early in the patent cycle, PBMs support pharmaceutical innovation instead of stifling it.
PBMs currently manage 95% of retail prescriptions and serve 91% of plan participants. That’s because they work. Businesses in the free market use services they value. And they value PBMs because they allow employers to offer more affordable coverage without sacrificing quality.
The truth is that PBMs are effective. And that is exactly why drugmakers are going after them. PBMs bring down net prices and demand accountability. That cuts into Big Pharma’s profit margins. So the industry has launched a campaign to reframe PBMs as a problem rather than a solution.
For example, a Biden-era Federal Trade Commission report that painted PBMs in a negative light should be viewed with skepticism. Even FTC Commissioner Melissa Holyoak emphasized that the report ignores the hard evidence of PBM-driven savings and warned that it was “a premature and deficient report,” adding, “Our job is not to score cheap points for transient political favor.”
“Though facile arguments that rely on ideologically loaded buzzwords such as ‘control’ or ‘power’ may stir emotions and make for entertaining social media posts and television interviews, ideological buzzwords are no substitute for rational, evidence-based research,” Holyoak said.
Sadly, some lawmakers are swallowing Big Pharma’s spin. Bills moving at both the federal and state level would gut PBMs — and hand drugmakers exactly what they want. Even a Brookings Institution analysis found that targeting PBMs won’t lower costs and would only weaken bargaining power against manufacturers.
That isn’t reform. It’s malpractice. Weakening the only players who force price discipline amounts to doing Big Pharma’s bidding at the expense of patients.
This fight isn’t about patients versus middlemen. It’s about competition versus monopoly. It’s about market discipline versus unchecked corporate power.
PBMs work because they negotiate, they drive better drug choices, and they deliver real value. When the most powerful industry in America is desperate to kill them off, you don’t need a think tank study to see what’s at stake. That fact alone tells you everything you need to know.
How Leftist Clubs For Government Employees Work Against Red State Voters
There are dozens of organizations representing what effectively amounts to a left-wing shadow government guiding states in an increasingly leftist direction.How leadership failures fueled the flames in the Golden State
America is no stranger to natural disasters. But it’s not the fires, floods, or earthquakes that are the most devastating — it’s the repeated failures to learn from them, prevent them, and take responsibility for the damage.
My heart goes out to the families who have lost homes, cherished memories, and livelihoods. But if we’re going to help California rebuild and prevent future disasters, we need to confront some uncomfortable truths about leadership, responsibility, and priorities.
California — ironically, in the name of environmentalism — continues to ignore solutions that would protect both the environment and its residents.
While Californians continue to face heart-wrenching losses, those who have the power to enact change are mired in bureaucracy, regulation, and ideologies that do nothing to protect lives or preserve the land. The result? A state that keeps burning, year after year.
Where did all the water go?
We all know that water is essential to life. When NASA searches for signs of life on other planets, it looks for water. Yet, California has spent decades neglecting its water infrastructure. The state hasn’t built a new major reservoir since 1979 — over 40 years ago. Back then, California’s population was roughly half what it is today. Despite massive population growth, the state’s water storage capacity has remained frozen in time, woefully inadequate for current needs.
Moreover, billions of gallons of rainwater flow straight into the ocean every year because no infrastructure exists to capture and store it. Imagine how different things could be if California had built reservoirs, aqueducts, and desalination plants to secure water for its dry seasons.
Water is life, but the state’s failure to prioritize this essential resource has put lives and ecosystems at risk.
Misplaced priorities and critical leadership failure
This neglect of critical infrastructure is part of a larger failure of vision, and in California, the consequences of that failure are on full display.
Consider the progressive leadership in Los Angeles, where the mayor cut the fire department’s budget to fund programs for the homeless, funneling money to NGOs with little oversight. While helping the homeless is a worthy cause, it cannot come at the expense of protecting lives and property from catastrophic fires. Leadership must put safety and well-being over political agendas, and that’s not happening in Los Angeles.
The same misplaced priorities extend to environmental policies. Progressive leaders have blocked sensible forest management practices, prioritizing dead trees over living creatures. They reject controlled burns, forest thinning, and other commonsense measures, bowing to the demands of activists rather than considering real solutions that would protect those they govern.
California’s wildfire crisis is, in many ways, a man-made disaster. Yes, factors like Southern California’s dry climate, strong Santa Ana winds, and little rain play a role, but the biggest contributing factor is poor land management.
The forests are choked with dry brush, dead trees, and vegetation that turn every spark into a potential inferno. The crisis could have been mitigated — if only the state had made forest management and fire prevention a higher priority.
Finland and Sweden, for example, understand the importance of maintaining healthy forests. These countries have perfected the art of clearing underbrush and thinning trees sustainably, turning potential fire fuel into biomass energy. This approach not only reduces the risk of wildfires, but it also creates jobs, boosts the economy, and improves the ecosystem. And yet, California — ironically, in the name of environmentalism — continues to ignore these solutions that would protect both the environment and its residents.
We need to stop pretending that something as devastating as the Palisades and Eaton fires are just “part of life” and hold leaders accountable.
Insurance rules put California residents at risk
California faces another major and often overlooked liability when it comes to natural disasters: insurance.
California’s ongoing disasters make the state an uninsurable risk. Insurance companies are pulling out because the odds of widespread devastation are just too high. This creates a vicious cycle: With private insurers gone, the government steps in to subsidize high-risk areas. This enables people to rebuild in fire-prone zones, perpetuating the destruction. The solution isn’t more government intervention; it’s better decision-making.
This doesn’t mean abandoning people to their fate, but we must address the root of the problem: California’s inadequate disaster preparedness and poor land management. If the state continues to resist commonsense solutions like forest thinning, controlled burns, and better zoning laws, no amount of insurance or government assistance will ever be enough to mitigate the losses. The cycle will repeat until the costs — financial and human — become unbearable. It’s time to stop pretending the risk isn’t real and start making decisions that reflect the reality of California’s landscape.
What’s the solution? California’s government needs to put its people over harmful political agendas that put its residents at risk. Start by managing your forests. Implement controlled burns, remove dead trees, and clear underbrush.
But how you vote matters. California’s progressive policies have focused on political correctness and ideology instead of practical, lifesaving solutions. Until voters hold leaders accountable, the cycle of destruction will persist.
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