Medicaid for millions, misery for the middle class



For months, Republicans and Democrats alike have insisted on keeping the Medicaid subsidy scam alive — even as it drives inflation and enriches the health care cartel. With the Biden-era expansion of Obamacare “marketplace” subsidies set to expire in December, both parties want to renew them. But this moment offers Republicans a rare opportunity: Finally lower health care costs for Americans not living on government handouts.

Obamacare buried the middle class

The ill-named Affordable Care Act helped Republicans win more elections than any issue in recent memory. But since 2016, the party has run from the fight. The result: Individual plans became unaffordable for anyone not getting subsidies, and employer-based coverage got gutted. Workers earn less in take-home pay and pay more for thinner plans.

The signature feature of Obamacare was turning catastrophic coverage into a luxury item.

Rather than continually shielding consumers from Obamacare’s price hikes with subsidies, why not repeal the mandates that caused the pain in the first place?

The numbers speak for themselves. In 2013, just before Obamacare took full effect, the average unsubsidized premium for individual coverage was $197 per month. By 2017, it had nearly doubled to $393. Family plans saw a 140% jump in that same period, from $426 to $1,021. Today, a typical family policy without subsidies costs $2,000 to $2,500 per month.

According to the Kaiser Family Foundation, average family premiums climbed from $13,770 in 2010 to $25,572 in 2024 — an 85% increase. And that “Cadillac plan” price tag now buys you higher deductibles and fewer benefits than a cheap pre-Obamacare policy.

Younger workers don’t even know what hit them. They’ve inherited a system designed to fleece them and can’t afford to opt out.

Even employer-based insurance has suffered. Since 2014, family premiums have risen 52%, while workers’ share has jumped 31%. Deductibles for individual plans have increased 53%, reaching $1,787 in 2024. Americans now pay more out of pocket for less protection.

This wasn’t an accident. It was baked into the law. Obamacare banned insurers from pricing plans based on risk, age, or gender. That shifted costs from older, sicker Americans to younger, healthier ones. Those who don’t qualify for subsidies pay top dollar for a bloated, mandatory benefits package they didn’t ask for.

Meanwhile, over 70 million lower-income Americans got dumped onto Medicaid — and Republicans went along with it. If Medicaid expansion is the new baseline, then at least fix the rest of the system for the middle class.

Caught in the middle

The political class loves to talk about the millions who gained “coverage” through Medicaid expansion and premium tax credits. They ignore the millions who earn too much to qualify for substantial assistance but too little to afford the staggering premiums.

These Americans are Obamacare’s silent victims — and they’re forced to choose between health coverage and other basic needs.

Subsidies don’t solve the problem. They mask it. The real crisis is the cost of health care itself.

Republicans already get hammered for supposedly “cutting Medicaid,” even when they’re only targeting fraud. They pay the political price for Obamacare without reaping any of the reform benefits. So why not go on offense and start dismantling the cartel?

Demand real reform

Instead of rubber-stamping another round of subsidies, Republicans should demand one simple trade-off: Let states offer unregulated, cheaper health care plans.

Don’t extend subsidies for the wealthy or the idle. And if temporary subsidies are unavoidable, they should be tied to an overhaul next year.

The signature feature of Obamacare was turning catastrophic coverage into a luxury item. Letting states revive affordable catastrophic plans would free up cash for direct primary care — and crack the cartel’s grip on pricing.

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Yurii Karvatskyi via iStock/Getty Images

And that’s just the beginning. Congress should allow health savings accounts, self-employment deductions, and employer exclusions to apply to alternative options like health-sharing ministries and concierge care. Workers should be able to use HSA funds to pay their own premiums or direct care memberships.

Employers should receive the same tax benefits for contributing to an employee’s HSA as they would for funding a traditional insurance plan. That gives workers real purchasing power and puts pressure on the cartel to compete.

Break the cartel. Rebuild the market.

Even if Republicans won’t fully repeal Obamacare, they must scrap the ban on physician-owned hospitals. That carve-out handed a monopoly to corporate health systems and helped bankrupt rural hospitals — a crisis both parties now pretend to solve with more subsidies.

You can’t subsidize your way out of a bottomless pit of inflationary grift. The only real solution is to let Americans escape the sinkhole that turned affordable health care into unaffordable sick care.

This is the GOP’s last chance to fix what it failed to kill. Make it count.

Time to redraw America’s borders — cities, counties, and beyond



Maps of the United States haven’t moved much lately. They should.

A cursory glance at historical maps over time — whether in the U.S. or globally — shows the dynamic movement of political boundaries. Since the birth of the United States, new states have been carved out of existing ones, county lines redrawn, and so on. Nowadays, though, aside from the occasional annexation or incorporation, boundaries have become relatively static.

Next time a state like Illinois comes crawling to Congress for a bailout, federal lawmakers should make border reorganization part of the deal.

That’s a sign of stagnation, not dynamism. And it needs to change.

Similar to how failing public schools precipitated the school choice movement, the failure of municipalities is spawning a growing movement for secession, annexation, and political reorganization.

Liberating red America

The municipal secession movement already has its “Lexington and Concord moment” in Baton Rouge and St. George, Louisiana. Fueled by failing schools and rampant crime, a section of East Baton Rouge Parish began its long, litigative battle for secession. In 2024, its work paid off. The parish successfully seceded from the consolidated county government, forging the new city of St. George, Louisiana, which is now the fifth most populous city in the state.

It won’t be the last.

Several local secession movements are emerging in conservative regions across the nation that are under the thumb of Democrat governments, with little hope of initiating regime change at the ballot box due to current districting laws.

The “Greater Idaho” movement, for example, is growing in conservative Eastern Oregon, now encompassing 13 counties that have approved measures to secede from deep-blue Oregon and be annexed by Idaho.

In rural Illinois, 33 counties have passed referenda seeking to leave the state entirely. Some want to form a new state, and others propose annexation by Indiana. Lawmakers in Indiana even established a formal boundary adjustment commission earlier this month to explore the idea.

Northern California’s long-standing movement to form a new “State of Jefferson” could one day merge with similar efforts in Southern Oregon.

Unchaining red municipalities

At the municipal level in large, deep-blue cities, purple-red neighborhoods like Staten Island in New York City or Buckhead in Atlanta could lead the charge for de-annexation.

Even in ultra-liberal cities like Austin, the de-annexation movement is gaining ground. The Lost Creek neighborhood, forcibly annexed in 2015, had had enough. Higher taxes, dismal city services, and left-wing pathologies drove residents to demand freedom. The Texas legislature intervened, passing a bill that allowed Lost Creek to vote itself out. It did — and won. More neighborhoods may follow.

This is the way it should be done, with the state stepping in to rescue disaffected neighborhoods from mismanaged cities.

Where cities have collapsed — Detroit and Baltimore come to mind — state governments should consider carving up failed urban zones and allowing them to reorganize under fresh charters. Let those areas be resettled under new leadership, new institutions, and new expectations.

In places where Democrat stronghold cities dominate entire counties — often electing radical officials who impose their ideologies on rural areas — states must step in.

In Harris County, Texas, radical leftist Lina Hidalgo runs the show from Houston. In Travis County, home to Austin, Soros-backed District Attorney José Garza applies “justice” as his donors see fit.

County residents who live outside of the big cities calling the shots would be much better served by county officials who reflect their values — not the radicals deeply planted in their city halls. They deserve a way out.

Bankruptcy poses an opportunity

States and municipalities filing for bankruptcy pose a tremendous opportunity to redraw the lines. In 2023, for example, Wisconsin’s GOP-controlled legislature bailed out bankrupt Milwaukee. The legislature could have liberated neighborhoods that never wanted to be annexed by Milwaukee in the first place. They missed the opportunity, however.

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Photo by Matt Gush via Getty Images

Next time a state like Illinois comes crawling to Congress for a bailout, federal lawmakers should make border reorganization part of the deal. Downstate counties could be annexed by neighboring red states. Bailout in, blue control out.

During the Civil War, when Virginia seceded from the Union, West Virginia was born — its counties carved out and reorganized under federal protection. Today, as California’s officials promise to defy federal law and actively rebel against national authority, it may be time to ask: If rebellion defines California’s government, why not liberate its non-rebellious counties?

Beyond the US

Even national boundaries are up for reconsideration, too. That may sound radical, but it’s happened before.

Canada’s strange political experiment is showing signs of collapse. The ruling class in Ottawa derides the very existence of their country — obsessed with “stolen land” narratives and hostile to their own national culture. Their last remaining shred of civic unity is anti-Americanism.

But not all Canadians share that view.

The prairie provinces — Alberta and Saskatchewan — stand apart. Their culture, economy, and values are more closely aligned with those of the American Midwest than with those of Toronto or Quebec. Suffocating under anti-energy, anti-farmer policies, Alberta, in particular, is ripe for annexation.

Let’s add another star or two to the flag. The cowboy provinces would be a better fit in the U.S. anyway.

No borders are forever

Existing city, county, state, and national borders are not sacrosanct. If history is any guide, they will eventually change.

The only question is whether we’ll wait until the change is forced upon us — or whether we’ll act while there’s still time to do it peacefully and deliberately.

The map will change. Let’s make sure it changes for the better.

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Chicago-dweller Adam Kotsko, a faculty member at the Shimer Great Books School of North Central College, has publicly opined that individuals should not reside in rural settings.

"In discussions of reducing car dependency, one often hears, 'What about people in remote rural areas?' And my gut instinct is -- people shouldn't be living there in the first place. The solution is to give them generous grants to relocate among other humans," tweeted Kotsko, who is also the author of multiple books.

"'But what if they like living in remote rural areas?' Sorry, you can't always get what you want. A lot of people would like to live in dense, transit-rich settings but can't -- either because they can't afford it or it simply doesn't exist where they are," he tweeted. "And if this sounds harsh -- don't worry, it will never happen, because our governmental institutions are INSANELY biased in favor of rural areas. They'll be fine. I'm just a guy over here having an opinion," he added. He also wrote, "'Isn't it mean to imply that rural people's lifestyle is bad and wrong?' As someone who lives in Chicago, all I can say to that is: cry me a river."

\u201c"But what if they like living in remote rural areas?" Sorry, you can't always get what you want. A lot of people would like to live in dense, transit-rich settings but can't -- either because they can't afford it or it simply doesn't exist where they are.\u201d
— Adam Kotsko (@Adam Kotsko) 1661094042

Kotsko said that in his understanding, individuals living in sparsely populated areas are poverty stricken and "essentially trapped."

"My understanding is also that a lot of people in remote rural areas are desperately poor and essentially trapped there," Kotsko tweeted.

Kotsko also issued a series of tweets discussing ideas about such an urban-centric society.

"My ideal land use distribution (based heavily on KSR): all agricultural land is collectively owned and scientifically managed to balance quantity, quality, and variety of food against sustainability and ethical practices. No single-family or corporate for-profit farms," he declared. "Young adults have to do a period of public service, and one option would be a 'tour of duty' as a farm worker for a few years. Everyone would at least know someone who knows firsthand what goes into food production," Kotsko continued.

"The overwhelming majority of people live in a handful of ultradense urban cores, connected by high-speed rail. No car-based suburban communities exist. A handful of people stay in rural areas full-time to manage the work brigades or run wilderness retreats or whatever," he added. "The human footprint would be vastly less in this system -- all land not used for agriculture would be left wild. Another public service option would be dismantling the suburbs -- stripping copper wire and other useable resources, removing toxins, then leaving them to rot."

\u201cThe human footprint would be vastly less in this system -- all land not used for agriculture would be left wild. Another public service option would be dismantling the suburbs -- stripping copper wire and other useable resources, removing toxins, then leaving them to rot.\u201d
— Adam Kotsko (@Adam Kotsko) 1661174131

Rural populations decline in America for the first time in recorded history



For the first time in history, America’s rural population has declined.

A recently concluded study from the University of New Hampshire’s Carsey School of Public Policy found that the population of rural America dropped by nearly 300,000 between 2010 and 2020. This marks a 0.06% population decline and the first decline in America’s rural population in recorded history.

The study’s head researcher and author, Kenneth Johnson, told The Hill that “actual size of the loss isn’t particularly a big deal” but “the fact that it actually happened, that rural America, as a whole lost population, reflects a significant change.”

Johnson emphasized that it is important to try to analyze what this decrease means when assessing long-term demographic change.

Johnson asked, “Is it just a short-term thing, or is it a longer-term thing?”

Researchers are alarmed by this decrease, in part, because it indicates a reversal of immense growth in rural communities in recent decades.

From 2000 to 2010 there was a 1.5 million-person increase in rural population, and from 1990 to 2000 there was a 3.4 million increase.

The study posits that population increase is a consequence of the “balance” between births and deaths as well as migration patterns to and from rural areas.

Johnson’s study notes that the Great Recession of 2008 economically “froze” many American in place. Unemployment, housing debt, and a generally weak economy discouraged Americans from moving to rural parts of the country from urban areas.

It also found that rural populations, typically having older populations, experienced more deaths than births as fertility rates plummeted throughout the country.

Johnson wrote, “Natural increase [in population] declined because there were fewer births and more deaths. In 2020, fertility rates hit records lows and there were the fewest births since 1979. At the same time, deaths were at record highs because of population aging and growing deaths of despair (including from drug overdoses and suicide).”

In recent years, fentanyl overdoses have drastically increased as the synthetic opioid poured across America’s southern border. Fentanyl overdose has, in fact, become the leading cause of death among Americans ages 18-45.

Johnson suggests that rural population loss is likely to continue. He said, “If rural outmigration is ongoing, and deaths continue to exceed births in many rural areas due to low fertility and higher mortality among the aging rural population, then population losses are likely to continue in much of rural America.”

The study concludes by stating that “the demographic changes that are reshaping nonmetropolitan areas are important to contemporary policy making intended to increase the viability of rural communities and enhance their contribution to the nation’s material, environmental, and social well-being.”

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