Pasayten's Methow Valley Bulletin Board

I always think about how the "health care for undocumented immigrants" thing is always blown up and misrepresented. In fairness though, the tangle of laws that govern all that make it pretty confusing for a normal person trying to figure out what the deal really is.

The 1986 EMTALA law requires that emergency rooms at nearly all hospital treat anyone who shows up, regardless of the ability to pay and regardless of immigration status. I'd note that a Republican (Ronald Wilson Reagan) was president in 1986 and he advocated pretty strongly for this law.

From a practical standpoint, in a medical emergency, a lot of people might not have access to documents that prove their citizenship with them in the ER and getting those documents together would take time. In a medical emergency when lifesaving care is required you often won't have that time. So you have a choice between letting people you might not approve of getting emergency health care and letting people who otherwise would be entitled to that health care die because their paperwork might not be in order.

So Trump is going to "partner" with Pfizer to create "Trump Rx", so you can buy prescription drugs at "most favored nation status" directly from Pfizer, through Trump, not your Medicare or Healthcare provider. Sounds good?
No.
Even at a reduced price, the drugs will still be far more expensive than the copay charged through your Healthcare provider. And it will NOT apply to the deductible for your maximum out of pocket expenses.
Medicare copayments are already capped under federal law at $4 for preferred drugs and $8 for non-preferred drugs — and are often even lower.
That matters when you are buying something like Xeljanz (which treats autoimmune conditions) at $6,000. Even at a 40% discount, that is still out of reach for most of us.
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So of COURSE the CEO of Pfizer was all smiles when he made the "deal" with Trump. His company makes a better much profit than it would having to work through Medicare, Medicaid, and the Heathcare system - and with no paperwork headaches, since the customer will pay Pfizer directly, at the moment of purchase. No billing, no waiting, no haggling.
Not only that, Pfizer no longer has to worry about the 100% tariff Trump is putting on pharmaceuticals. Not that Pfizer was going to pay it - WE WERE. That tariff would have DOUBLED the costs of those medications.
That 100% tariff is still in effect for all the OTHER Pharmaceutical companies. Unless and until they make the same "deal" with Trump.
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BUT - do you really trust Trump to manage your healthcare to begin with? He made this "deal" with absolutely no idea how this was supposed to work. It is just another "concept of an idea". To maybe begin in 2026.
Maybe. Sometime. If he doesn't get sidetracked by something else. Remember Covid, and those free testing stations that were going to go in every Walmart parking lot? In two weeks? And then in another two weeks?
Does he really have the motivation to HELP Americans with healthcare expenses? Especially considering his opposition to the Inflation Reduction Act - which capped insulin at $35 for Medicare patients. This was supposed to go into effect for ALL patients needing insulin. We are still waiting.
And then there are the cuts to Medicaid and the Affordable Care Act in his "Big Beautiful Bill". THAT is the reason he refused to negotiate with Democrats, and just approved the SHUT DOWN of the federal government.
He WANTS those cuts to our healthcare to happen.
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NO, DEMOCRATS DO NOT WANT FREE HEALTHCARE FOR ILLEGAL ALIENS - THAT IS A LIE.
NON-CITIZENS DO NOT EVEN QUALIFY FOR MEDICAID OR MEDICARE IN THE FIRST PLACE.
DEMOCRATS WANT THE REPUBLICAN CUTS TO MEDICAID AND THE AFFORDABLE CARE ACT TO NOT GO INTO EFFECT. THAT IS WHAT THEY ARE HOLDING OUT FOR!
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And one MORE thing to give us pause. What if Trump decides to hand off his big beautiful "Trump Rx" scheme to Robert F Kennedy Jr to run?
There he is, grinning happily in the picture with Trump. Right there.
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Photo - Pfizer CEO Albert Bourla joined President Trump, RFK Jr and "Dr Oz" at an Oval Office announcement Tuesday about the administration’s effort to lower drug prices.
Glee Violette

Canadian Covid study. NO IT WAS NOT JUST ANOTHER FLU

"A massive new peer-reviewed review (161 studies, 2+ million patients) makes it clear.
COVID-19 isn’t just a respiratory infection.
It’s a multi-system disease leaving lasting scars on lungs, heart, brain, kidneys, and more.
Among hospitalized patients the numbers are stark.
Lungs - 78% affected
Heart - 32%
Nervous system - 43%
Kidneys - 28%
Months later, 10-35% still live with organ dysfunction.
Why? The virus triggers:
a cytokine storm (immune system fire),
endothelial injury (blood vessels damaged),micro-clots that choke tiny capillaries.
In hospital wards we’ve seen it all.
Lungs scarred, oxygen capacity never the same.
Hearts inflamed, misfiring into arrhythmias.
Brains hit with strokes, encephalitis, or lingering brain fog.
Kidneys failing, some never recovering.
Immune systems knocked off balance, even turning against the body.
Variants changed the picture but not the playbook.
Delta hit harder in the lungs.
Omicron shifted to upper airways, with less loss of smell/taste.
But the core mechanisms - vascular injury, inflammation, clotting - remain.
But what about those who never set foot in a hospital?
This is where the story often gets dismissed.
No oxygen, no ICU, you’re fine.
Except - many aren’t.
The data on mild cases is harder to pin down - studies use different definitions, follow people for different lengths of time.
That’s why this review doesn’t give hard percentages for non-hospitalized patients.
Still, the evidence is consistent:
Even after mild COVID, people report and show measurable changes.
Lungs - lingering breathlessness, chronic cough, exercise intolerance, even post-COVID asthma.
Heart - chest pain, palpitations, POTS-like dysautonomia.
Brain - brain fog, memory lapses, persistent loss of smell/taste, neuropathy.
Kidneys - subtle declines in function (protein in urine, lower eGFR).
Gut & liver - IBS-like symptoms, altered gut microbiome, sometimes persistent enzyme elevation.
Immune & hormones - crushing fatigue, new autoantibodies, disrupted menstrual cycles, lowered testosterone.
Mental health - anxiety, depression, PTSD, insomnia, slowed cognition.
The difference isn’t whether damage exists.
The difference is how it shows up.
Hospitalized - dramatic, organ failure, visible on scans.
Mild cases - quieter, widespread dysregulation that chips away at quality of life.
The authors conclusion is blunt -
COVID-19 is a multi-system infection with silent aftermaths.
It requires long-term monitoring, multi-disciplinary care, and targeted therapies.
This was never just the flu.
Ochilov at al., Silent Invasion: COVID-19’s Hidden Damage to Human Organs 2025.
Silent Invasion: COVID-19′s Hidden Damage to Human Organs
Background: SARS-CoV-2, originally described as a respiratory pathogen, has been identified as a multisystem disease with complex and interconnected pathophysiological processes.
Methods: The PRISMA f…
https://www.mdpi.com/2673-8112/5/9/156
The cost isn’t just human.
Ongoing disability, reduced productivity, long-term medical care - COVID’s hidden damage is already reshaping healthcare systems and economies.
The price tag will echo for decades. @szupraha @ZdravkoOnline
None of this was inevitable.
With stronger public health response - better prevention, ventilation, vacc strategies - we could have reduced both the human and economic toll.
Ignoring COVID’s long shadow only compounds the loss."

Explainer for what's happening and how we got here
https://paulkrugman.substack.com/p/unde ... irect=true

I’m writing this quickly, because of travel: If all goes well, I’ll be somewhere over the Atlantic when this post goes up. But I thought I’d write something about what Democrats are demanding as their price for avoiding a federal government shutdown, why I think that’s the right issue, and why Republicans probably won’t agree.

Even though the Affordable Care Act, aka Obamacare, has been in effect for more than a decade, I’m not sure how many people understand how it works. So let’s review the basics.

The ACA rests on two legs. It was supposed to be three, but Republicans sawed off one of them, the requirement that you buy insurance or face a penalty. But it has still done a lot of good. By the end of the Biden administration, the percentage of Americans without health insurance was lower than it has ever been:
Source: KFF

Part of this improvement was due to an expansion of Medicaid — which will face savage cuts under the One Big Beautiful Bill, but not until after the midterms. However, the other main piece of the ACA, subsidized insurance plans offered on government-run exchanges, will take a body blow in a few months unless Republicans do something totally uncharacteristic — provide help to Americans who need it.

The way the ACA works is that insurance companies are prohibited from discriminating based on medical history — they have to offer the same plans, at the same prices, to healthy people and less healthy people. They can’t charge you more if you have a preexisting condition. The goal of that prohibition is to make sure that health care is available and affordable to those who need it most.

However, just prohibiting discrimination based on medical history works very badly unless backed by additional measures — states that have tried it know this from bitter experience. If everyone pays the same premiums, people who are currently healthy tend not to buy policies, so that insurers face a bad risk pool. This means high premiums, which leads to even more healthy people dropping out, which makes the risk pool even worse. So you end up with a “death spiral” in which very few people buy insurance unless they get it through their employer.

The ACA, however, coupled the prohibition on discrimination with subsidies that cap premiums at a certain percentage of your income (on a sliding scale that depends on how high your income is.) These subsidies make it possible for lower-income Americans to afford insurance. They also, crucially, encourage healthy people to stay in the market, holding overall premiums down. As I said, there was also supposed to be a penalty for going uninsured. But even without that penalty, the system turns out to mostly work.

The original, 2010 version of the ACA was, however, underpowered. The subsidies were too small, and they cut off suddenly for people whose income rose above a relatively low threshold (400 percent of the poverty line.)

What the Biden administration did was to make the subsidies more generous and also end the cutoff. The invaluable Charles Gaba has a table showing the differences:

A table with numbers and a number of people
Source: Charles Gaba

In this table, “% FPL” means income as a percentage of the federal poverty line. The two right columns show the caps on premiums net of subsidies under the original ACA and under the enhanced version introduced by Biden’s Inflation Reduction Act.

Now comes the key point: Biden had very limited political room for maneuver, since he only had 50 Senators and couldn’t afford to lose a single vote. So he was constrained by the most conservative Democrats — basically Joe Manchin — and while they were willing to expand the ACA subsidies, they did so only on a temporary basis, extending through 2025.

Now the enhanced subsidies are about to expire, and the financial hit to many Americans will be apocalyptic. Gaba estimates what will happen to the insurance premiums net of subsidy for different groups in different states. Here, for example, is what will happen in Ohio:

Many people will face huge increases in their insurance costs. And these increases will be magnified by the effects on the risk pool: some healthy people will be dropping out, raising premiums for those who remain.

In other words, millions of Americans will soon be screaming about unaffordable health care.

In a way, I’m surprised that Republicans didn’t decide to keep the enhanced, Biden subsidies in place for another year, just to delay the pain until after the midterms. But they didn’t, probably because they have such a strong aversion to helping Americans in need that they couldn’t even bring themselves to play cynical politics on the issue.

This aversion to doing anything decent is why the government will probably shut down Wednesday. For Republicans need Democratic votes to keep the government open, and Democrats have made retaining enhanced subsidies their price for cooperating.

What will happen then? I have no idea. But I think the Democrats made the right choice when they made health insurance premiums — rather than, say, tariffs — their key demand.

Why? Because doing so puts the onus for rising premiums squarely where it belongs — on Republicans. If Democrats weren’t putting this issue front and center, the usual suspects might be able to convince many voters that someone else — immigrants, Antifa, George Soros, whatever — was responsible for their soaring health costs. That will be much harder now.

Again, I have no idea how this will play out. But it looks to me as if Democrats have chosen good ground on which to make their stand.

Meanwhile, Trump has other plans for $ rather than use it to provide affordable health care
https://scontent-sea5-1.xx.fbcdn.net/v/ ... e=68DAFE66

Whoa. We are on the "evil" United Health Care Rx plan. Haven't got a notice like that...yet.
Well, this is what ya get, with an uncaring, out of touch admin. The MAGA crowd may not know what hit them.

For those in the ACA articles are coming out today that rates could soar (think double) unless subsidies are reinstated.
For those on Medicaid, access and pricing is precarious
For those on Medicare like me, I just got a notice from my prescription portion that the rate will increase from $39 a month to $89 a month, that's more than double.

https://fortune.com/2025/09/24/american ... t-in-2026/