Miriam Goldstein
@hubbgold.bsky.social
Health policy (not, unfortunately, ocean science…!)
Reposted by Miriam Goldstein
Lawmakers in Florida (a non-expansion state) are apparently considering a Medicaid work requirements bill.
Except Florida's income eligibility thresholds are so low that forcing people to meet an 80-hour/month requirement would force them off of the program.
floridaphoenix.com/2026/02/03/m...
Except Florida's income eligibility thresholds are so low that forcing people to meet an 80-hour/month requirement would force them off of the program.
floridaphoenix.com/2026/02/03/m...
February 3, 2026 at 9:29 PM
Lawmakers in Florida (a non-expansion state) are apparently considering a Medicaid work requirements bill.
Except Florida's income eligibility thresholds are so low that forcing people to meet an 80-hour/month requirement would force them off of the program.
floridaphoenix.com/2026/02/03/m...
Except Florida's income eligibility thresholds are so low that forcing people to meet an 80-hour/month requirement would force them off of the program.
floridaphoenix.com/2026/02/03/m...
Reposted by Miriam Goldstein
A federal appeals court has paused an injunction barring immigration agents from “retaliating” against peaceful protesters and observers in Minnesota.
This photo from today shows a federal agent spraying a protester on the ground with a chemical irritant.
This photo from today shows a federal agent spraying a protester on the ground with a chemical irritant.
Live: Appeals court pauses order mandating ICE not ‘retaliate’ against protesters
A federal judge previously issued an injunction meant to prevent immigration agents from detaining and pepper-spraying ‘peaceful’ observers.
bit.ly
January 21, 2026 at 9:24 PM
A federal appeals court has paused an injunction barring immigration agents from “retaliating” against peaceful protesters and observers in Minnesota.
This photo from today shows a federal agent spraying a protester on the ground with a chemical irritant.
This photo from today shows a federal agent spraying a protester on the ground with a chemical irritant.
Reposted by Miriam Goldstein
It looks like Trump’s “buy your own insurance“ plan would largely do away with pre-x protections and the Marketplaces, but not insurance companies he doesn’t like who would still provide most of the coverage.
Fact Sheet: President Donald J. Trump Calls on Congress to Enact The Great Healthcare Plan
CALLING ON CONGRESS TO LOWER HEALTHCARE COSTS: Today, President Donald J. Trump called on Congress to enact the Great Healthcare Plan, a comprehensive
www.whitehouse.gov
January 15, 2026 at 5:44 PM
It looks like Trump’s “buy your own insurance“ plan would largely do away with pre-x protections and the Marketplaces, but not insurance companies he doesn’t like who would still provide most of the coverage.
Reposted by Miriam Goldstein
Instead of giving money to insurance companies, Trump wants to give money to you, so you can spend it on crappy, unregulated products from insurance companies (in which they spend 50% of revenue on medical bills, rather than the ACA's statutory 80%).
January 15, 2026 at 5:52 PM
Instead of giving money to insurance companies, Trump wants to give money to you, so you can spend it on crappy, unregulated products from insurance companies (in which they spend 50% of revenue on medical bills, rather than the ACA's statutory 80%).
Reposted by Miriam Goldstein
President Trump is suggesting here that people could use government subsidies to buy insurance that doesn’t comply with ACA rules, including coverage of pre-existing conditions. That could lower costs for healthy people, but send the ACA marketplace into a death spiral.
January 15, 2026 at 5:10 PM
President Trump is suggesting here that people could use government subsidies to buy insurance that doesn’t comply with ACA rules, including coverage of pre-existing conditions. That could lower costs for healthy people, but send the ACA marketplace into a death spiral.
Reposted by Miriam Goldstein
OUT: Helping you pay for health care.
IN: Helping oil companies pay for their infrastructure in a foreign country.
IN: Helping oil companies pay for their infrastructure in a foreign country.
January 6, 2026 at 12:14 AM
OUT: Helping you pay for health care.
IN: Helping oil companies pay for their infrastructure in a foreign country.
IN: Helping oil companies pay for their infrastructure in a foreign country.
Reposted by Miriam Goldstein
The end of ACA enhanced premium tax credits, and an average out-of-pocket premium increase of 114% for 22 million people, has been hypothetical. Now it is real.
December 31, 2025 at 8:20 PM
The end of ACA enhanced premium tax credits, and an average out-of-pocket premium increase of 114% for 22 million people, has been hypothetical. Now it is real.
Reposted by Miriam Goldstein
CMS touts Nebraska being first to launch Big Ugly Bill work reporting requirements by...misspelling the name of the state.
acasignups.net/25/12/26/cms...
acasignups.net/25/12/26/cms...
CMS touts Nebraska being first to launch Big Ugly Bill Medicaid work reporting requirements by misspelling the name of the state.
As of March 2025, around 72,000 Nebraska residents were enrolled in Medicaid via the ACA's expansion of the program. Last summer, after Congressional Republicans passed their Big Ugly Bill, I warned p...
acasignups.net
December 26, 2025 at 6:13 PM
CMS touts Nebraska being first to launch Big Ugly Bill work reporting requirements by...misspelling the name of the state.
acasignups.net/25/12/26/cms...
acasignups.net/25/12/26/cms...
Reposted by Miriam Goldstein
Happy holidays (not!) to Medicaid expansion enrollees in Nebraska as the state becomes the 1st state to "go early" on the new punitive work reporting requirement.
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
Nebraska to become first state implementing Medicaid work requirements
Nebraska will become the first state in the nation to implement federal Medicaid work requirements, with enforcement beginning May 1, 2026, Governor Jim Pillen announced during a press conference with...
www.1011now.com
December 17, 2025 at 8:38 PM
Happy holidays (not!) to Medicaid expansion enrollees in Nebraska as the state becomes the 1st state to "go early" on the new punitive work reporting requirement.
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
Reposted by Miriam Goldstein
The GOP health care bill that Mike Johnson allowed to proceed from the Rules Committee does not extend ePTCs.
It does, however, appropriate CSRs — but only in states with strict restrictions on abortion coverage, which has the paradoxical effect of specifically punishing enrollees in red states.
It does, however, appropriate CSRs — but only in states with strict restrictions on abortion coverage, which has the paradoxical effect of specifically punishing enrollees in red states.
December 17, 2025 at 2:47 AM
The GOP health care bill that Mike Johnson allowed to proceed from the Rules Committee does not extend ePTCs.
It does, however, appropriate CSRs — but only in states with strict restrictions on abortion coverage, which has the paradoxical effect of specifically punishing enrollees in red states.
It does, however, appropriate CSRs — but only in states with strict restrictions on abortion coverage, which has the paradoxical effect of specifically punishing enrollees in red states.
Reposted by Miriam Goldstein
Why Florida is ground zero for coming ObamaCare storm
Florida will be hit harder than any other state if ObamaCare subsidies expire at the end of the year. More than 1.5 million Floridians could lose healthcare as monthly payments skyrocket.
thehill.com/policy/healt...
Florida will be hit harder than any other state if ObamaCare subsidies expire at the end of the year. More than 1.5 million Floridians could lose healthcare as monthly payments skyrocket.
thehill.com/policy/healt...
thehill.com
December 15, 2025 at 11:53 AM
Why Florida is ground zero for coming ObamaCare storm
Florida will be hit harder than any other state if ObamaCare subsidies expire at the end of the year. More than 1.5 million Floridians could lose healthcare as monthly payments skyrocket.
thehill.com/policy/healt...
Florida will be hit harder than any other state if ObamaCare subsidies expire at the end of the year. More than 1.5 million Floridians could lose healthcare as monthly payments skyrocket.
thehill.com/policy/healt...
Reposted by Miriam Goldstein
A few thoughts on new Medicaid work req guidance from CMS
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
The Trump Administration has released preliminary guidance on mandatory Medicaid work requirements. We will read and share thoughts soon here and on our website ccf.georgetown.edu
medicaid.gov/federal-poli...
medicaid.gov/federal-poli...
medicaid.gov
December 8, 2025 at 11:05 PM
A few thoughts on new Medicaid work req guidance from CMS
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Reposted by Miriam Goldstein
Pending Medicaid work rules exempt people deemed “medically frail.” Lacking clear federal guidance, state officials are trying to interpret the rules to ensure people don’t unfairly lose health coverage. kffhealthnews.org/news/article...
Medicaid Work Rules Exempt the ‘Medically Frail.’ Deciding Who Qualifies Is Tricky. - KFF Health News
People on Medicaid deemed “medically frail” won’t need to meet new federal requirements that enrollees work 80 hours a month or perform another approved activity. But state officials are grappling wit...
kffhealthnews.org
December 1, 2025 at 11:55 PM
Pending Medicaid work rules exempt people deemed “medically frail.” Lacking clear federal guidance, state officials are trying to interpret the rules to ensure people don’t unfairly lose health coverage. kffhealthnews.org/news/article...
Reposted by Miriam Goldstein
Reports that the White House is working on a proposal to extend premium tax credit enhancements shows the Administration is acknowledging the urgent need to address premium spikes for millions of marketplace enrollees. But big questions remain.🧵
November 24, 2025 at 10:18 PM
Reports that the White House is working on a proposal to extend premium tax credit enhancements shows the Administration is acknowledging the urgent need to address premium spikes for millions of marketplace enrollees. But big questions remain.🧵
Reposted by Miriam Goldstein
📣 Trump apparently set to reverse himself on #ACA tax credits...but with several poison pills included...
acasignups.net/25/11/24/tru...
acasignups.net/25/11/24/tru...
Trump set to reverse himself on tax credits...but with several poison pills included
Via Politico this morning, a mixed bag of good & bad news on the enhanced ACA tax credit saga today: The White House expects to soon unveil a health policy framework that includes a two-year extension...
acasignups.net
November 24, 2025 at 9:49 PM
📣 Trump apparently set to reverse himself on #ACA tax credits...but with several poison pills included...
acasignups.net/25/11/24/tru...
acasignups.net/25/11/24/tru...
Reposted by Miriam Goldstein
If you're 60, live in Crested Butte, CO, and earn $63k, you can get a Bronze plan in the Colorado Marketplace for as little as $36/month this year.
Next year, if Congress doesn't extend the subsidy enhancements, the lowest-cost plan will be $1,282/month www.healthinsurance.org/aca-marketpl...
Next year, if Congress doesn't extend the subsidy enhancements, the lowest-cost plan will be $1,282/month www.healthinsurance.org/aca-marketpl...
Colorado ACA Health Insurance Marketplace
Explore the ACA health insurance Marketplace in Colorado for 2026 coverage. Discover available plans, eligibility requirements, enrollment dates, and how to apply for coverage.
www.healthinsurance.org
November 14, 2025 at 1:17 AM
If you're 60, live in Crested Butte, CO, and earn $63k, you can get a Bronze plan in the Colorado Marketplace for as little as $36/month this year.
Next year, if Congress doesn't extend the subsidy enhancements, the lowest-cost plan will be $1,282/month www.healthinsurance.org/aca-marketpl...
Next year, if Congress doesn't extend the subsidy enhancements, the lowest-cost plan will be $1,282/month www.healthinsurance.org/aca-marketpl...
Reposted by Miriam Goldstein
In all the years I have worked in health policy GOP/conservative proposals always boil down to the same ideas: block grant/cap #Medicaid, Medicare premium support, unregulated individual health insurance markets and tax-favored accounts like Health Savings Accounts. So we’re back to HSAs this week.
November 11, 2025 at 1:07 PM
In all the years I have worked in health policy GOP/conservative proposals always boil down to the same ideas: block grant/cap #Medicaid, Medicare premium support, unregulated individual health insurance markets and tax-favored accounts like Health Savings Accounts. So we’re back to HSAs this week.
Reposted by Miriam Goldstein
Republicans waged a relentless, decades-long campaign to privatize Medicare and Medicaid
They fought even mild efforts to expand public insurance
Now they are objecting to extending extra ACA subsidies, supposedly because money flows to private insurers
We are supposed to take this seriously?
They fought even mild efforts to expand public insurance
Now they are objecting to extending extra ACA subsidies, supposedly because money flows to private insurers
We are supposed to take this seriously?
November 8, 2025 at 7:56 PM
Republicans waged a relentless, decades-long campaign to privatize Medicare and Medicaid
They fought even mild efforts to expand public insurance
Now they are objecting to extending extra ACA subsidies, supposedly because money flows to private insurers
We are supposed to take this seriously?
They fought even mild efforts to expand public insurance
Now they are objecting to extending extra ACA subsidies, supposedly because money flows to private insurers
We are supposed to take this seriously?
Reposted by Miriam Goldstein
It’s not just that they don’t have to turn off SNAP benefits — they’re not legally allowed to. They legally must use the contingency fund.
The admin is pretending they can’t use it even though their own guidance from a month ago (that they’ve since deleted) contradicts that.
The admin is pretending they can’t use it even though their own guidance from a month ago (that they’ve since deleted) contradicts that.
Yes, they’re using the shutdown to turn off SNAP benefits.
No, they don’t have to.
No, they don’t have to.
October 27, 2025 at 7:40 PM
It’s not just that they don’t have to turn off SNAP benefits — they’re not legally allowed to. They legally must use the contingency fund.
The admin is pretending they can’t use it even though their own guidance from a month ago (that they’ve since deleted) contradicts that.
The admin is pretending they can’t use it even though their own guidance from a month ago (that they’ve since deleted) contradicts that.
Reposted by Miriam Goldstein
🚨The rule is likely to be the largest-ever cut to Social Security Disability Insurance.
🚨The rule would particularly hurt older workers.
🚨The rule will likely cause disproportionate harm to people living in the South and Appalachia.
www.cbpp.org/blog/trump-a...
🚨The rule would particularly hurt older workers.
🚨The rule will likely cause disproportionate harm to people living in the South and Appalachia.
www.cbpp.org/blog/trump-a...
Trump Administration Plans Deep Cuts to Social Security Disability Insurance, Particularly for Older Workers
Despite repeatedly promising not to cut Social Security, the Trump Administration is reportedly preparing a proposed rule that could reduce the share of applicants who qualify for Social Security...
www.cbpp.org
October 18, 2025 at 4:58 AM
🚨The rule is likely to be the largest-ever cut to Social Security Disability Insurance.
🚨The rule would particularly hurt older workers.
🚨The rule will likely cause disproportionate harm to people living in the South and Appalachia.
www.cbpp.org/blog/trump-a...
🚨The rule would particularly hurt older workers.
🚨The rule will likely cause disproportionate harm to people living in the South and Appalachia.
www.cbpp.org/blog/trump-a...
Reposted by Miriam Goldstein
New reporting: many apparently fired at CDC in 'error'. This is a failure by design given that the admin does not care about fulfilling agency missions. This is the kind of error that should have political consequences.
Unserious people cause real-world harm.
🎁
www.nytimes.com/2025/10/11/h...
Unserious people cause real-world harm.
🎁
www.nytimes.com/2025/10/11/h...
Trump Administration Will Rehire Scores of Experts Fired in Error
www.nytimes.com
October 11, 2025 at 10:35 PM
New reporting: many apparently fired at CDC in 'error'. This is a failure by design given that the admin does not care about fulfilling agency missions. This is the kind of error that should have political consequences.
Unserious people cause real-world harm.
🎁
www.nytimes.com/2025/10/11/h...
Unserious people cause real-world harm.
🎁
www.nytimes.com/2025/10/11/h...
Reposted by Miriam Goldstein
There are reports that the *entire* office of special education at the US Dept of Education has been cut. These hardworking folks ensure kids with disabilities get equal access to a quality education.
America’s children deserve better than this.
America’s children deserve better than this.
October 11, 2025 at 4:51 PM
There are reports that the *entire* office of special education at the US Dept of Education has been cut. These hardworking folks ensure kids with disabilities get equal access to a quality education.
America’s children deserve better than this.
America’s children deserve better than this.
Reposted by Miriam Goldstein
Roberts is presiding over, and driving, a stunning collapse in faith in the U.S. Supreme Court, not just among the public, but among federal judges.
What a failure. The Titanic captain of chief justices.
What a failure. The Titanic captain of chief justices.
“More than three dozen federal judges have told The New York Times that the Supreme Court’s flurry of brief, opaque emergency orders in cases related to the Trump administration have left them confused about how to proceed in those matters and are hurting the judiciary’s image with the public.”
Federal Judges, Warning of ‘Judicial Crisis,’ Fault Supreme Court’s Emergency Orders
www.nytimes.com
October 11, 2025 at 3:42 PM
Roberts is presiding over, and driving, a stunning collapse in faith in the U.S. Supreme Court, not just among the public, but among federal judges.
What a failure. The Titanic captain of chief justices.
What a failure. The Titanic captain of chief justices.
Reposted by Miriam Goldstein
NEW: @CDCgov hit hard by massive firings that several staff describe to me as a “bloodbath.”
Among those RIFd:
—leadership of the center for immunization and respiratory diseases;
—leadership of global health center
—leadership of the measles outbreak response; 1/4
Among those RIFd:
—leadership of the center for immunization and respiratory diseases;
—leadership of global health center
—leadership of the measles outbreak response; 1/4
October 11, 2025 at 12:49 PM
NEW: @CDCgov hit hard by massive firings that several staff describe to me as a “bloodbath.”
Among those RIFd:
—leadership of the center for immunization and respiratory diseases;
—leadership of global health center
—leadership of the measles outbreak response; 1/4
Among those RIFd:
—leadership of the center for immunization and respiratory diseases;
—leadership of global health center
—leadership of the measles outbreak response; 1/4
Reposted by Miriam Goldstein
BREAKING: Friday night massacre underway at CDC. Doznes of "disease detectives," high-level scientists, entire Washington staff and editors of the MMWR (Morbidity and Mortality Weekly Report) have all been RIFed and received the following notice:
October 11, 2025 at 2:10 AM
BREAKING: Friday night massacre underway at CDC. Doznes of "disease detectives," high-level scientists, entire Washington staff and editors of the MMWR (Morbidity and Mortality Weekly Report) have all been RIFed and received the following notice: