Subject: Re: BBB will reduce the deficit!
The "slashing" will be felt mostly by able bodied recipients who are healthy and should be working and by illegal immigrants who shouldn't be here in the first place.

The other main category of people who will mostly feel the effects of this are those who rely on the same hospitals and other medical providers (mostly in rural and exurban areas) that will get crushed by this change. The population that will lose their Medicaid coverage is still going to need medical care. They're still going to get sick, they're still going to get into accidents. They're still going to go to the hospital. And they're still going to get treated for emergency care there.

What's going to change is that the hospital will no longer get reimbursed for that care under Medicaid. The hospital is going to have to eat the loss of coverage. Prior to the ACA Medicaid expansion, this was done through massive Disproportionate Share Hospital payments (DSH) - bulk payments from the federal government to reimburse hospitals with high rates of uninsured patients to reimburse those losses. The change under the Medicaid expansion wasn't entirely new federal payments to cover the medical costs of health able-bodied uninsured folks - a lot of it was just shifting money from the DSH bucket to the Medicaid bucket. The hope (and somewhat the experience) was that by giving these folks actual insurance, rather than just paying the hospital, that the recipients would have better health outcomes and overall costs would be lower, and that the medical infrastructure in poor and rural areas would improve.

That's why you're seeing resistance to the Medicaid changes from Senators in states with large rural populations, and of course from hospitals. If Medicaid eligibility is restricted and the DSH funds are not reinstated, it's going to be a big problem for many rural hospitals, as well as those serving areas with a disproportionate number of poor people using their facilities.

Going to be a lot of collateral damage from this one, in the short term. In the longer term, of course, the savings from the Medicaid cuts will be entirely illusory - there will have to be a later reinstatement of DSH payments (or something like it), else you'd see a wave of hospital closures throughout the country. That's not going to be allowed to happen, but the funding will be restored in a different bill (and probably in a way that can be blamed on Democrats). And we'll be back to the pre-ACA days - where the federal government still spends a ton of money on medical services for the healthy able-bodied (but poor) uninsured, just not by providing them actual health insurance through Medicaid.