healthcare

Just days after the fatal shooting of a Minnesota woman by a federal immigration agent, the Trump administration’s immigration policy was a top focus of California gubernatorial candidates at two forums Saturday in Southern California.

The death of Renee Nicole Good, a 37-year-old mother of three, inflamed the nation’s deep political divide and led to widespread protests in Los Angeles and across the country about President Trump’s combative immigration policies.

Former Assembly majority leader Ian Calderon, speaking at a labor forum featuring Democratic candidates in Los Angeles, said that federal agents aren’t above the law.

“You come into our state and you break one of our … laws, you’re going to be criminally charged. That’s it,” he said.

Federal officials said the deadly shooting was an act of self defense.

Rep. Eric Swalwell (D-Dublin) noted that the president of the labor union that organized the candidate forum, David Huerta, was injured and arrested during the Trump administration’s raids on undocumented people in Los Angeles in June.

“Ms. Good should be alive today. David, that could have been you, the way they’re conducting themselves,” he said to Huerta, who was moderating the event. “You’re now lucky if all they did was drag you by the hair or throw you in an unmarked van, or deport a 6-year-old U.S. citizen battling stage four cancer.”

Roughly 40 miles south at a separate candidate forum featuring the top two Republicans in the race, GOP candidate and Riverside County Sheriff Chad Bianco said politicians who support so-called “sanctuary state” policies should be voted out of office.

“I wish it was the 1960s, 70s, and 80s — we’d take them behind the shed and beat … them,” he said.

“We’re in a church!” an audience member was heard yelling during a livestream of the event.

California Democratic leaders in 2017 passed a landmark “sanctuary state” law that limits cooperation between local and federal immigration officers, a policy that was a reaction to the first Trump administration’s efforts to ramp up deportations.

After the campaign to replace termed-out Gov. Gavin Newsom was largely obscured last year by natural disasters, immigration raids and the special election to redraw California’s congressional districts, the 2026 governor’s race is now in the spotlight.

Eight Democratic candidates appeared at a forum sponsored by SEIU United Service Workers West, which represents more than 45,000 janitors, security officers, airport service employees and other workers in California.

Many of the union’s members are immigrants, and a number of the candidates referred to their familial roots as they addressed the audience of about 250 people — with an additional 8,000 watching online.

“As the son of immigrants, thank you for everything you did for your children, your grandchildren, to give them that chance,” former U.S. Health and Human Services Secretary Xavier Becerra told two airport workers who asked the candidates questions about cuts to state services for immigrants.

“I will make sure you have the right to access the doctor you and your family need. I will make sure you have a right to have a home that will keep you safe and off the streets. I will make sure that I treat you the way I would treat my parents, because you worked hard the way they did.”

The Democrats broadly agreed on most of the pressing issues facing California, so they tried to differentiate themselves based on their records and their priorities.

Candidates for California’s next governor including Tony Thurmond, speaking at left, participate in the 2026 Gubernatorial Candidate Forum in Los Angeles on Saturday.

(Christina House/Los Angeles Times)

“I firmly believe that your campaign says something about who you will be when you lead. The fact that I don’t take corporate contributions is a point of pride for me, but it’s also my chance to tell you something about who I am and who I will fight for,” said former Rep. Katie Porter.

“Look, we’ve had celebrity governors. We’ve had governors who are kids of other governors, and we’ve had governors who look hot with slicked back hair and barn jackets. You know what? We haven’t had a governor in a skirt. I think it’s just about … time.”

Former Los Angeles Mayor Antonio Villaraigosa, seated next to Porter, deadpanned, “If you vote for me, I’ll wear a skirt, I promise.”

Villaraigosa frequently spoke about his roots in the labor movement, including a farmworker boycott when he was 15 years old.

“I’ve been fighting for immigrants my entire life. I have fought for you the entire time I’ve been in public life,” he said. “I know [you] are doing the work, working in our buildings, working at the airport, working at the stadiums. I’ve talked to you. I’ve worked with you. I’ve fought for you my entire life. I’m not a Johnny-come-lately to this unit.”

The candidates were not asked about a proposed ballot measure to tax the assets of billionaires that one of SEIU-USWW’s sister unions is trying to put on the November ballot. The controversial proposal has divided Democrats and prompted some of the state’s wealthiest residents to move out of the state, or at least threaten to do so.

But several of the candidates talked about closing tax loopholes and making sure the wealthy and businesses pay their fair share of taxes.

“We’re going to hold corporations and billionaires accountable. We’re going to be sure that we are returning power to the workers who know how to grow this economy,” said former state Controller Betty Yee.

State Supt. of Public Instruction Tony Thurmond highlighted his proposal to tax billionaires to fund affordable housing, healthcare and education.

“And then I’m going to give you, everyone in this room and California working people, a tax credit so you have more money in your pocket, a couple hundred dollars a month, every month, for the rising cost of gas and groceries,” he said.

Billionaire hedge fund founder Tom Steyer said closing corporate tax loopholes would result in $15 billion to $20 billion in new annual state revenue that he would spend on education and healthcare programs.

“When we look at where we’re going, it’s not about caring, because everyone on this stage cares. It’s not about values. It’s about results,” he said, pointing to his backing of successful ballot measures to close a corporate tax loophole, raise tobacco taxes, and stop oil-industry-backed efforts to roll back environmental law.

“I have beaten these special interests, every single time with the SEIU,” he said. “We’ve done it. We’ve been winning. We need to keep fighting together. We need to keep winning together.”

Republican gubernatorial candidates were not invited to the labor gathering. But two of the state’s top GOP contenders were among the five candidates who appeared Saturday afternoon at a “Patriots for Freedom” gubernatorial forum at Calvary Chapel WestGrove in Orange County. Immigration, federal enforcement and homelessness were also among the hot topics there.

Days after Bianco met with unhoused people on Skid Row in downtown Los Angeles and Newsom touted a 9% decrease in the number of unsheltered homeless people during his final state of the state address, Bianco said that he would make it a “crime” for anyone to utter the word “homeless,” arguing that those on the street are suffering from drug- and alcohol-induced psychosis, not a lack of shelter.

Former Fox News commentator Steve Hilton criticized the “attacks on our law enforcement offices, on our ICE agents who are doing their job protecting our country.”

“We are sick of it,” he said at the Garden Grove church while he also questioned the state’s decision to spend billions of dollars for healthcare for low-income undocumented individuals. State Democrats voted last year to halt the enrollment of additional undocumented adults in the state’s Medi-Cal program starting this year.

R. Scott Gemmill, the creator and showrunner of “The Pitt,” has always felt comfortable in a hospital.

He initially had ambitions of going into medicine — he studied gerontology, which explores the processes and problems of aging, and did some volunteer work at hospitals. He also took a nurse assistant course.

“I really thought I was going to try and get into a med school,” he said recently while seated in the recognizable lobby of the show’s fictional hospital set on the Warner Bros. lot in Burbank. “I just wanted to have a job and medicine seemed like there was always going to be a need. I’m comfortable in a hospital. I wish I followed through on a certain level because I loved that ability to go in and solve problems. But my writing kicked in and that’s it — I never went back.”

But in TV land’s school of medicine, Gemmill has gone far. He did a rotation at Chicago’s County General Hospital, joining the writing staff of NBC’s popular medical drama “ER” in its sixth season. And now his turn at Pittsburgh Trauma Medical Center, through HBO Max’s “The Pitt,” has been a breakout success, revitalizing the medical drama genre with a fresh spin on the format — each episode tracks one hour in a shift — and energizing its audience with a traditional weekly rollout. The Emmy-winning series returned Thursday for its second season that revolves around a shift on the Fourth of July. But the fireworks arrived well before that, with HBO Max announcing on the eve of the show’s premiere that the drama has been renewed for a third season.

In the hiatus before shooting began on this season’s finale, Gemmill, whose other TV credits include “Jag” and “NCIS: Los Angeles,” talked about the show’s momentum heading into the new season, navigating how personal to get with characters, and introducing a new doctor to the mix.

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1. Noah Wyle as Dr. Robby in Season 2 of “The Pitt.” (Warrick Page / HBO Max) 2. From left: Sepideh Moafi as Dr. Baran Al-Hashimi, Taylor Dearden as Dr. Melissa King, Katherine LaNasa as charge nurse Dana Evans, Gerran Howell as Dr. Dennis Whitaker and Supriya Ganesh as Dr. Samira Mohan in “The Pitt.” (Warrick Page / HBO Max)

You started breaking Season 2 last January, as people were discovering the show week to week. People love to be critical of sophomore seasons of a breakout hit. How did that shape the second season for you and the writers?

It was weird because we wrote [Season 1] without any feedback. Not just wrote it — we shot it and produced it. We had started thinking about Season 2 before people had responded. It was a slow build. I felt like the healthcare professionals found us first, then spread through word of mouth. We were just moving forward with what we thought were the next stages of these characters’ lives. It wasn’t until later on that the accolades came and there was more pressure then. When we first started, we didn’t know if anybody was going to watch or not. We had finished it without any pressure whatsoever because nobody had weighed in on it. It was a very rarefied situation, which was nice. We hope for the best. And it seemed to work out OK. There’s a little bit of concern going into the second season because we were successful, you wonder, can you maintain that? But we try not to focus on that, and just really focus on the characters and the stories and do what we did the first season — tell really authentic, strong stories.

The season picks up 10 months after that initial shift where we met everyone. How did you decide on the time jump, landing on July 4?

It really came from wanting to have Langdon [Patrick Ball] back, so I knew he had to do about 10 months of rehab. Then we were looking at what time of year would that be. We’re also somewhat limited by when we shoot in Pittsburgh. We decided to do the Fourth of July because it comes with a bunch of shenanigans.

Season 2 opens with a helmet-less Robby riding in on a motorcycle.

The motorcycle goes back to some part of Robby’s past. We don’t really talk about it, but it has a link to his father, and his father being a tinkerer of old cars and Robby needing a vacation, a hiatus of sorts. Pennsylvania is a no-helmet law [state]. And some of us who have motorcycles sometimes enjoy riding them without a motor helmet. It’s not a smart thing to do, and it speaks to Robby’s current attitude of a certain amount of carelessness on his part.

Yes, we learn that he’s going to be taking a three-month sabbatical. How soon will we discover what led to that? Is it an amalgamation of different things?

Yeah, he’s long overdue for a vacation. He knows that something’s not working in his life and this is one way he thinks that he can fix things.

How did you land on Head-Smashed-In Buffalo Jump in Canada as his choice for a getaway?

It was a place I knew about and it just sounded like an interesting place for him to go that has some foreboding associations with it.

A new doctor, Baran Al-Hashimi (Sepideh Moafi), center, is brought in to oversee the ER unit on the eve of Dr. Robby’s (Noah Wyle) three-month sabbatical.

(Warrick Page / HBO Max)

The season introduces a new character, Dr. Baran Al-Hashimi, played by Sepideh Moafi, who’s going to be taking over when Robby is out. She’s an advocate of generative AI and trying to get everyone on board with this idea of saving time with charting. What were your conversations with doctors in the field about that topic and what intrigued you about how healthcare professionals are thinking about this technology?

She’s someone who’s a little different with her approach, a little more contemporary and forward, as opposed to Robby; he bridges contemporary medicine and old-school medicine with his relationship that he had with Dr. Adamson, who showed him a lot of the old-school techniques that he still has in his wheelhouse if he needs them. AI is pretty much here to stay and it’s infiltrating every aspect of our lives — medicine is no exception. I would say it’s still in its infancy in the ER, but there are ways that it’s trying to be implemented. Like any other tool, it has potential to be used wisely and potential for disaster. We’re not really exploring the disastrous side of it yet but just what the realities are. The fear is that it will make the doctors more efficient, especially with things like charting, but then will that time go back to the patients or will they just have to see more patients? And so they’ll have even less time. That’s the challenge at this point.

How do you feel about it in your own industry?

I try not to think about it. I guess I’m probably in denial more than anything. I don’t have any place for it and I don’t really want to really know too much about it at this point.

We see a lightness to Robby this season. He’s involved in a situationship at work. This is a workplace drama. It hasn’t shown us the interior lives of its staff beyond the nuggets they share during their shift. How much do you want the viewers to know about them versus how much do you want your actors to just understand their characters?

It comes with the job. He’s not a monk. He’s in a relationship of convenience more than anything. I don’t think he’s a long-term planner. The fact that he hasn’t had a vacation in forever is proof of that. Robby is very good at putting on a good face until he’s not. I think what we’ll see over the course of the season is that facade start to slide.

It’s a process. The 15-hour nature of the show limits how much of that information you can dole out organically, but it also allows you to be authentic in terms of how much you actually learn about someone in a day. Most of us not just spilling our guts and saying our life story to the people we work with. As we start the season, we’ll think about: What is the journey we’re going to take this character on, and what information needs to be learned in order to achieve that? And then what medical stories will help maybe bring that out. You do it in little layers.

Is there something coming up that you think will be particularly illuminating?

There’s some stuff about Robby. We pulled back a lot on it, but we’ll learn a little bit about him. We’ll learn some things about Whitaker [Gerran Howell]. We know what Langdon is going through, his marriage.

After taking leave to seek treatment for prescription drug addiction, Dr. Frank Langdon (Patrick Ball) returns to work in “The Pitt.”

(Warrick Page / HBO Max)

To stay on Langdon — physicians and people in the healthcare profession are vulnerable to addiction for a variety of reasons. What was important for you in that storyline and what did you want to explore through him?

To show somebody who’s made a mistake and was doing their best to hide it as is sometimes the pattern of behavior. I don’t think most people enjoy their addiction. So, seeing someone who’s doing their best to try and heal themselves. Just because you’re going through the program and doing the steps, it doesn’t mean everyone’s going to welcome you back with open arms. There are still some bad feelings and you have to mend some bridges and fences along the way.

It’s not just Robby and Langdon. Langdon feels he owes a sort of mea culpa to almost everyone he works with, especially Santos [Isa Briones]. And whether or not she’s willing to accept that is debatable. Robby, obviously, has some really strong feelings about it because Langdon was his student, and he made Robby look kind of stupid. Robby is angry at himself for not seeing it.

How are you figuring out who’s going to shuffle in and out?

Some of it’s based on the reality; for instance — I was thinking of this today — next season would be Whitaker’s third year, so he has one more year to stay here, and then he would have to go. It’s really about where they are in their careers and what makes the most sense story-wise.

I want to talk about some of the procedures and cases that we’ll see this season because they’re pretty gnarly. Do you keep a log of cases and try to figure out how they can fit into the story as you go?

We never really start with the medicine. Sometimes we say the medicine is the wallpaper that reflects everything in the room, but what’s going on between the characters is really what’s at stake, and it’s either something going on between them and the patient, between the doctors and nurses, or internally. Ideally, it touches on a little bit of everything.

When we came back, I probably had 150 ideas of just cases. I don’t know how many of them we actually did. We had never done a hot toddler story, [where a child was overheated] but that is something that’s a real problem. That was one where we knew we were going to try and do that story, but whose is it going to be? Who does it reflect most? Then we work backwards into it. We pull from everywhere — things we think of, things we’ve heard, things we imagine. We don’t really do ripped-from-the-headlines, but we do things that seem like that because a lot of times we’re talking to professionals, asking them what was concerning them. What do they worry about? We’re extrapolating their concerns. That’s what happened with [Season 1’s] measles story. There was no measles outbreak when we wrote that story, but we knew, based on what was going on, that there would be eventually, and we just happened that the timing was in our favor.

Is there like a line you won’t cross in terms of squirm factor? Have you had to pull back?

I don’t think so, because we’ve never done anything for the sake of that. We’ve never done anything that’s not done in the ER. As long as it serves a story and a character, then I think it’s fair. We do something big for the finale that Abbot [Shawn Hatosy] and Robby are doing with a bunch of others — it takes all hands on deck. I’m interested to see how that comes out, and I’ve seen elements of it now that are terrific.

Can you share more of what kinds of topics or cases we’ll be seeing this season?

We did a sexual assault, [and] we’re looking at how budget cuts are affecting healthcare. There’s a story about someone who’s been rationing their insulin and the downsides of that.

When the One Big Beautiful Bill Act was signed into law by the president, did you have a lot of calls with professionals?

Oh, yeah, because it’s a huge issue. You figure out with the changes in the Affordable Care Act, if you suddenly have 8 to 10 million people that don’t have insurance, what’s going to happen is they’re going to stop going to their doctors. Anything that was an issue is going to get exacerbated by not being treated. So, where do they end up? Well, they’re going to end up in the ER, but they’re going to be even sicker than they would have been. We’re going to get more people, and their conditions are going to be worse. It only makes what’s already a strained system even more likely to break. Because we were just starting to shoot in the summertime, we could make some adjustments, but I don’t remember going back and changing things. We saw it coming.

I know there had been some discussion about an ICE story? Will we see that this season?

Yes, we have some ICE agents show up, and how that affects people in the hospital. That’s been a tricky one to try and get right without being heavy-handed and being fair to everyone on both sides of that conversation. What else do we do this year? Some fun stuff. The kind of things you would expect over the Fourth of July weekend.

How do you feel about the shipping that’s taking shape with “The Pitt” fan base?

I’m not on social media, I’m not really a part of that. My writers would tell me about things like that. The Langdon-Mel of it — I’m like, he’s married. That’s more of a big brother relationship. And Abbot and Robby — I just sort of shake my head. Our show’s not really like that. It’s not a show where people are sneaking off to have sex in a closet or anything. Those things are very subtle. And we do see a little bit this season between a couple of people, but it’s very much secondary because it’s not something we actually see, per se.

Just as he did last season, Noah Wyle is writing again this season. He’s also directing. Tell me what it’s like when you have the lead of your show involved in different aspects of the show’s creative elements?

It’s really great because he’s up to speed on everything. And because he is the centerpiece of the show, I rely on Noah a lot for guidance and help figuring out how to steer through all the icebergs. He’s a good writer and he’s a good director, and it just adds a whole other level to the writers room, in terms of the connection between us and the set. He’s there right up until, basically, we start shooting. Even when we are shooting, if he has a day off, he’s in the room or we’ll do meetings at lunchtime so he can join in and weigh in. It was Noah’s idea to do the Shema prayer for his breakdown. That was a very coordinated effort because I knew I was asking a lot of him. That’s what’s really nice about having Noah be a writer and a director. He has the vernacular to have these conversations about what he needs from me to get him to where he needs to be. It’s a very symbiotic relationship.

R. Scott Gemmill on the pressure that comes with having a breakout hit: “There’s a little bit of concern going into the second season because we were successful, you wonder, can you maintain that? But we try not to focus on that, and just really focus on the characters and the stories and do what we did the first season — tell really authentic, strong stories.”

(Christina House / Los Angeles Times)

Do you ever worry about him being overextended?

Yes. That’s why I don’t mind when he has a day off. But he’s just gonna fill it with work.

In Hollywood, when something’s a success, there’s an immediate impulse to figure out a way to broaden that success. Has there been talks of spinoffs, ways to build out the universe?

No, not really. We’ve talked about doing a night shift. In time, maybe that’s something we’ll explore. The show still has lots of life in it, so I wouldn’t want to distract from what we’re doing now. But I think there’s a potential to do all the craziness that comes out at night.

Like Dr. Al-Hashimi, you’ve had experience being the newcomer joining a well-oiled machine. Tell me about becoming a writer on “ER” in Season 6.

I hated it when I first went on. They had done so many stories already, and there were multiple stories told per episode, so they had gone through so many stories that it seemed like anything I suggested was already done. They all felt like Ivy League professors and I was a college dropout; I felt like I so didn’t belong there. I remember calling my wife and saying, “I hate this. This is horrible. I should never have left ‘Jag.’” But over time, I found my way and found my voice on the show.

That was the season with one of the episodes I revisit often — when Dr. Carter (Wyle) gets stabbed.

I remember having a big debate over whether Kellie Martin’s eyes should be open or closed. I was adamant that she had to have her eyes open. I’m glad I won, but that was intense. The whole show was very intense.

George Clooney has teased that he would be open to the idea of appearing on “The Pitt.” Could you see a world where that happens?

I take that with a grain of salt but, hey, I’m up for anything. I’ll try anything once.

What I appreciated about the season finale last year, especially in this world of TV where you feel like you need to have this epic cliffhanger, was how true to life it felt. Since you’ll be shooting the finale in January, what can you share about how you’re thinking about it?

There’s something really fun at the end of this season. I hope that we do it as a little Easter egg for the fans in the finale, so I’m looking forward to doing that.

WASHINGTON — In a remarkable rebuke of Republican leadership, the House passed legislation Thursday, in a 230-196 vote, that would extend expired healthcare subsidies for those who get coverage through the Affordable Care Act as renegade GOP lawmakers joined essentially all Democrats in voting for the measure.

Forcing the issue to a vote came about after a handful of Republicans signed on to a so-called “discharge petition” to unlock debate, bypassing objections from House Speaker Mike Johnson. The bill now goes to the Senate, where pressure is building for a similar bipartisan compromise.

Together, the rare political coalitions are rushing to resolve the standoff over the enhanced tax credits that were put in place during the COVID-19 crisis but expired late last year after no agreement was reached during the government shutdown.

“The affordability crisis is not a ‘hoax,’ it is very real — despite what Donald Trump has had to say,” said House Democratic Leader Hakeem Jeffries, invoking the president’s remarks.

“Democrats made clear before the government was shut down that we were in this affordability fight until we win this affordability fight,” he said. “Today we have an opportunity to take a meaningful step forward.”

Ahead of voting, the nonpartisan Congressional Budget Office estimated that the bill, which would provide a three-year extension of the subsidy, would increase the nation’s deficit by about $80.6 billion over the decade. It would increase the number of people with health insurance by 100,000 this year, 3 million in 2027, 4 million in 2028 and 1.1 million in 2029, the CBO said.

Growing support for extending ACA subsidies

Johnson (R-La.) worked for months to prevent this situation. His office argued Thursday that federal healthcare funding from the COVID-19 era is ripe with fraud, pointing to an investigation in Minnesota, and urged a no vote.

On the floor, Republicans argued that the subsidies as structured have contributed to fraud and that the chamber should be focused on lowering health insurance costs for the broader population.

“Only 7% of the population relies on Obamacare marketplace plans. This chamber should be about helping 100% of Americans,” said Rep. Jason Smith (R-Mo.), chair of the House Ways and Means Committee.

While the momentum from the vote shows the growing support for the tax breaks that have helped some 22 million Americans have access to health insurance, the Senate would be under no requirement to take up the House bill.

Instead, a small group of senators from both parties has been working on an alternative plan that could find support in both chambers and become law. Senate Majority Leader John Thune (R-S.D.) said that for any plan to find support in his chamber, it will need to have income limits to ensure that the financial aid is focused on those who most need the help. He and other Republicans also want to ensure that beneficiaries would have to at least pay a nominal amount for their coverage.

Finally, Thune said there would need to be some expansion of health savings accounts, which allow people to save money and withdraw it tax-free as long as the money is spent on qualified medical expenses.

Sen. Jeanne Shaheen (D-N.H.), who is part of the negotiations on reforms and subsidies for the Affordable Care Act, said there is agreement on addressing fraud in healthcare.

“We recognize that we have millions of people in this country who are going to lose — are losing, have lost — their health insurance because they can’t afford the premiums,” Shaheen said. “And so we’re trying to see if we can’t get to some agreement that’s going to help, and the sooner we can do that, the better.”

Trump has pushed Republicans to send money directly to Americans for health savings accounts so they can bypass the federal government and handle insurance on their own. Democrats largely reject this idea as insufficient for covering the high costs of healthcare.

Republicans bypass their leaders

The action by Republicans to force a vote has been an affront to Johnson and his leadership team, who essentially lost control of what comes to the House floor as the Republican lawmakers joined Democrats for the workaround.

After last year’s government shutdown failed to resolve the issue, Johnson had discussed allowing more politically vulnerable GOP lawmakers a chance to vote on another healthcare bill that would temporarily extend the subsidies while also adding changes.

But after days of discussions, Johnson and the GOP leadership sided with the more conservative wing, which has assailed the subsidies as propping up ACA, which they consider a failed government program. He offered a modest proposal of healthcare reforms that was approved, but has stalled.

It was then that rank-and-file lawmakers took matters into their own hands, as many of their constituents faced soaring health insurance premiums beginning this month.

Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York, signed the Democrats’ petition, pushing it to the magic number of 218 needed to force a House vote. All four represent key swing districts whose races will help determine which party takes charge of the House next year.

Trump encourages GOP to take on healthcare issue

What started as a long shot effort by Democrats to offer a discharge petition has become a political vindication of the Democrats’ government shutdown strategy as they fought to preserve the healthcare funds.

Democrats are making clear that the higher health insurance costs many Americans are facing will be a political centerpiece of their efforts to retake the majority in the House and Senate in the fall elections.

Trump, during a lengthy speech this week to House GOP lawmakers, encouraged his party to take control of the healthcare debate — an issue that has stymied Republicans since he tried, and failed, to repeal Obamacare during his first term.

Mascaro and Freking write for the Associated Press. AP writer Matt Brown contributed to this report.

Caracas, January 6, 2025 (venezuelanalysis.com) – The Brazilian government will send medical equipment and medicine to Venezuela in the wake of the January 3 US bombings against military sites and other infrastructure.

Brazilian Health Minister Alexandre Padilha made the announcement Tuesday, invoking humanitarian reasons as well as regional health concerns, after medicine warehouses in Venezuela’s La Guaira state were destroyed by the US attacks.

“We are trying to mobilize, via the public healthcare sector and private companies, dialysis supplies and medicines to support the Venezuelan people after this distribution center was targeted,” Padilha said in a press conference.

The minister recalled Venezuelan solidarity in shipping oxygen to the Brazilian city of Manaus in 2021 during a coronavirus crisis. Venezuela’s eastern neighbor will also deploy healthcare professionals as part of its solidarity efforts.

The offer of assistance follows the Lula da Silva government’s firm condemnation of the US strikes and kidnapping of Venezuelan President Nicolás Maduro and First Lady Cilia Flores as “unacceptable” and a “dangerous precedent for the international community.”

According to local reports, the warehouses belonging to the Venezuelan Social Security Institute (IVSS) were destroyed during the US bombing of La Guaira port in the early hours of Saturday.

In a statement, the IVSS reported that the lost supplies were destined for renal patients and denounced the “terrorist character of the US government” in targeting healthcare facilities.

Nelare Bermúdez, from La Guaira state’s healthcare authority, said that three-months worth of medicines for renal patients had been lost. Nevertheless, she vowed that authorities will work to ensure that healthcare services are not affected.

Venezuela has an estimated 16,000 patients suffering from chronic kidney conditions. The direct destruction of supplies adds to difficulties chronic patients already face under US sanctions. A 2018 CEPR report found that 300,000 Venezuelans with heart and other conditions were at risk as a consequence of US economic coercive measures.

In recent years, sanctions have also seen Venezuelan authorities face prohibitions, delays and overpricing in acquiring medical equipment and medicines. During the Covid-19 pandemic, Venezuela suffered delays in securing necessary vaccines.

Washington’s January 3 attacks have killed a reported 80 people, with 32 Cuban nationals confirmed dead. Venezuelan authorities have yet to disclose information on damages and casualties from the strikes.

On Tuesday, Acting President Delcy Rodríguez decreed seven days of mourning in honor of the Venezuelans killed in the US military operation.

“Our young martyrs gave their lives to defend our country,” Rodríguez told reporters. “My heart was broken by the images of the fallen bodies but I know they sacrificed themselves for the values of this nation.”

Rodríguez was sworn in on Monday after the Supreme Court declared a “temporary absence” in the Venezuelan presidency. Maduro, as well as First Lady and legislator Cilia Flores, pleaded not guilty to charges including cocaine importation conspiracy during their arraignment hearing on January 5.

The USmilitary operations followed months of buildup and regime-change threats from the Trump administration. The US president has threatened Rodríguez and the Venezuelan government to accept US demands, including favorable oil deals.

[UPDATE: Venezuelan authorities reported the arrival of a shipment with supplies for dialysis patients on Tuesday night at Maiquetía airport but did not specify its origin and contents.]

WASHINGTON — Lawmakers are returning to Washington this week confronting the fallout from the stunning capture of Venezuelan President Nicolás Maduro — and familiar complaints about the Trump administration deciding to bypass Congress on military operations that have led to this moment.

Democratic leaders are demanding the administration immediately brief Congress. Republican leaders indicated over the weekend those plans are being scheduled, but some lawmakers expressed frustration Sunday that the details have been slow to arrive.

President Trump told the nation Saturday that the United States intends to “run” Venezuela and take control over the country’s oil operations now that Maduro has been captured and brought to New York to stand trial in a criminal case centered on narco-terrorism charges.

The administration did not brief Congress ahead of the actions, leaving Democrats and some Republicans expressing public frustration with the decision to sideline Congress.

“Congress should have been informed about the operation earlier and needs to be involved as this situation evolves,” Sen. Susan Collins (R-Maine) said in a social media post Saturday.

Appearing on the Sunday news shows, Senate Minority Leader Chuck Schumer and House Minority Leader Hakeem Jeffries, both of New York, ticked through a growing list of unknowns — and laid out plans for their party to try and reassert Congress’ authority over acts of war.

“The problem here is that there are so many unanswered questions,” Schumer said on ABC’s “This Week.” “How long do they intend to be there? How many troops do we need after one day? After one week? After one year? How much is it going to cost and what are the boundaries?”

Jeffries told NBC’s “Meet the Press” that he was worried about Trump running Venezuela, saying he has “done a terrible job running the United States of America” and should be focused on the job at home.

In the coming days, Jeffries said Democrats will prioritize legislative action to try and put a check on the administration, “to ensure that no further military steps occur absent explicit congressional approval.”

As discussions over Venezuela loom, lawmakers also face major decisions on how to address rising costs of healthcare, prevent another government shutdown and deal with the Trump administration’s handling of the Epstein files.

Much of the unfinished business reflects a Congress that opted to punt some of its toughest and most politically divisive decisions into the new year, a move that could slow negotiations as lawmakers may be reluctant to give the other side high-profile policy wins in the lead-up to the 2026 midterm elections.

First and foremost, Congress faces the monumental task of averting yet another government shutdown — just two months after the longest shutdown in U.S. history ended. Lawmakers have until Jan. 30 to pass spending bills needed to keep the federal government open. Both chambers are scheduled to be in session for three weeks before the shutdown deadline — with the House slated to be out of session the week immediately before.

Lawmakers were able to resolve key funding disputes late last year, including funding for Supplemental Nutrition Assistance Program benefits, also known as food stamps, and other government programs. But disagreements over healthcare spending remain a major sticking point in budget negotiations, intensified now that millions of Americans are facing higher healthcare costs after lawmakers allowed Affordable Care Act tax credits to expire on Thursday.

“We can still find a solution to this,” said Rep. Kevin Kiley (R-Rocklin), who has proposed legislation to extend the tax credits for two years. “We need to come up with ways to make people whole. That needs to be a top priority as soon as we get back.”

Despite that urgency, Republican efforts to be the author of broad healthcare reforms have gotten little traction.

Underscoring the political pressure over the issue, four moderate House Republicans late last year defied party leadership and joined House Democrats to force a floor vote on a three-year extension of the subsidies. That vote is expected to take place in the coming weeks. Even if the House effort succeeds, its prospects remain dim in the Senate, where Republicans last month blocked a three-year extension.

Meanwhile, President Trump is proposing giving more money directly to people for their healthcare, rather than to insurance companies. A White House official said the administration is also pursuing reforms to lower the cost of prescription drugs.

Trump said last month that he plans to summon a group of healthcare executives to Washington early in the year to pressure them to lower costs.

“I’m going to call in the insurance companies that are making so much money, and they have to make less, a lot less,” Trump said during an Oval Office announcement. “I’m going to see if they get their price down, to put it very bluntly. And I think that is a very big statement.”

There is an expectation that Trump’s increasing hostility to insurance companies will play a role in any Republican healthcare reform proposal. If Congress does not act, the president is expected to leverage the “bully pulpit” to pressure drug and insurance companies to lower healthcare prices for consumers through executive action, said Nick Iarossi, a Trump fundraiser.

“The president is locked in on the affordability message and I believe anything he can accomplish unilaterally without Congress he will do to provide relief to consumers,” Iarossi said.

While lawmakers negotiate government funding and healthcare policy, the continuing Epstein saga is expected to take up significant bandwidth.

Democrats and a few Republicans have been unhappy with the Department of Justice’s decision to heavily redact or withhold documents from a legally mandated release of files related to its investigation of Jeffrey Epstein, a convicted sex offender who died in a Manhattan jail awaiting trial on sex trafficking charges.

Some are weighing options for holding Atty. Gen. Pam Bondi accountable.

Rep. Ro Khanna (D-Fremont), who co-sponsored the law that mandated the release with Rep. Thomas Massie (R-Ky.), said he and Massie will bring contempt charges against Bondi in an attempt to force her to comply with the law.

“The survivors and the public demand transparency and justice,” Khanna said in a statement.

Under a law passed by Congress and signed by Trump, the Justice Department was required to release all Epstein files by Dec. 19, and released about 100,000 pages on that day. In the days that followed, the Justice Department said more than 5.2 million documents have been discovered and need to be reviewed.

“We have lawyers working around the clock to review and make the legally required redactions to protect victims, and we will release the documents as soon as possible,” the Justice Department said in a social media post on Dec. 24. “Due to the mass volume of material, this process may take a few more weeks.”

Rep. Robert Garcia, the top Democrat on the House Oversight Committee, told MS NOW last week that pressure to address the matter will come to a head in the new year when lawmakers are back at work.

“When we get back to Congress here in this next week, we’re going to find out really quick if Republicans are serious about actually putting away and taking on pedophiles and some of the worst people and traffickers in modern history, or if they’re going to bend the knee to Donald Trump,” said Garcia, of Long Beach.

Millions of Americans are facing a huge increase in the amount they have to pay for health insurance.

A dispute about government subsides for healthcare was one of the major issues that led to a 43-day shutdown of the US government last year – the longest in history.

But even when the shutdown ended, Republicans and Democrats failed to agree on and extension of the the subsidies.

As the clock struck midnight on January 1 – the health costs for 24 million people rose dramatically

So, what’s the impact for those in need? And how much politics is involved?

Presenter: James Bays

Guests:

Lindsay Allen – Health Economist and Policy Researcher at the Feinberg School of Medicine at Northwestern University

Neel Shah – Physician and Chief Medical Officer of Maven Clinic

Rinah Shah – Political Strategist and Geopolitical analyst

Dec. 29 (UPI) — The Trump administration on Monday announced it will distribute $50 billion dollars to expand access to rural healthcare across all 50 states with investments in growing the workforce, modernizing facilities and introducing new models of care delivery.

States are set to receive first-year awards next year of roughly $200 million under the Rural Health Transformation Program, which Congress authorized earlier this year as part of the Working Families Tax Cuts bill, the Centers for Medicare and Medicaid Services said in a press release.

“More than 60 million Americans living in rural areas have the right to equal access to quality care,” said Robert F. Kennedy, Jr., secretary of the Department of Health and Human Services.

“This historic investment puts local hospitals, clinics and health workers in control of their communities’ health care,” Kennedy said.

The CMS is set to distribute the $50 billion dollars over the next five years, from 2026 through 2030, as part of the program established by the bill, which is more commonly known as the One Big Beautiful Bill Act.

Each year, $5 billion will be distributed equally to each of the 50 states, while another $5 billion will be allocated based on the proportion of rural health facilities, situations at specific facilities in the state and other factors, the agency said on the program website.

The CMS announced each state’s 2026 allocation — Washington, D.C., and U.S. territories are not eligible for the funds — in the release, with the awards ranging from New Jersey’s $147 million to Texas’ $281 million.

The funds are meant to accomplish a range of goals to “make rural America healthy again,” including:

• expanding access to preventive, primary, maternal and behavioral health services;
• strengthening, growing and sustaining the clinical work force in rural areas;
• modernizing health infrastructure and technology;
• driving structural efficiency through streamlining operations and working to make more services available locally;
• and testing new primary care and value-based care models of delivery and payment.

The announcement comes after the American Hospital Association estimated earlier this year that rural hospitals could lose $50.4 billion in revenue from federal Medicaid funds over the next 10 years.

The reason is based on a Congressional Budget Office estimate earlier this year that the $1 trillion that was cut from Medicaid in the One Big Beautiful Bill Act could result in more than 7.8 million more people across the country becoming uninsured.

This loss of Medicaid coverage for patients affects revenue for healthcare providers, and the effects will be felt most acutely in rural areas.

These areas of the country currently include an estimated 16.1 million people with Medicaid coverage. Sparsely populated states such as Montana, Wyoming and Alaska have more than 50% of Medicaid recipients living in rural areas, the American Hospital Association says.

For many rural health facilities, a mixture of Medicare and Medicaid patients help them stay open, Sarah Hohman, director of government affairs for the National Association of Rural Health Clinics, told UPI in July.

“If the coverage losses pan out as they are estimated, that would mean that they are treating fewer patients that are covered by insurance,” Hohman said. “The more you have uncompensated care and individuals not able to pay, your balance gets concerning pretty quickly. That really threatens the financial viability in these areas.”

The Trump administration made work requirements for low-income people receiving government assistance a priority in 2025.

The departments of Health and Human Services, Agriculture and Housing and Urban Development have worked to usher in stricter employment conditions to receive healthcare, food aid and rental assistance benefits funded by the federal government.

The idea is that public assistance discourages optimal participation in the labor market and that imposing work requirements not only leads to self-sufficiency, but also benefits the broader economy.

“It strengthens families and communities as it gives new life to start-ups and growing businesses,” the Cabinet secretaries wrote in a New York Times essay in May about work requirements.

Yet many economists say there is no clear evidence such mandates have that effect. There’s concern these new policies that make benefits contingent on work could ultimately come at a cost in other ways, from hindering existing employment to heavy administrative burdens or simply proving unpopular politically.

Here is a look at how work requirements could affect the millions of people who rely on the Supplemental Nutrition Assistance Program (SNAP), Medicaid and HUD-subsidized housing:

SNAP

What President Trumprefers to as his “Big Beautiful Bill” in July expanded the USDA’s work requirements policy for SNAP recipients who are able-bodied adults without dependents.

Previously, adults older than 54, as well as parents with children under age 18, at home were exempted from SNAP’s 80-hours monthly work requirement. Now, adults up to age 64 and parents of children between the age of 14 and 17 have to prove they’re working, volunteering or job training if they are on SNAP for more than three months.

The new law also cuts exemptions for people who are homeless, veterans and young people who have aged out of foster care. There are also significant restrictions on waivers for states and regions based on how high the local unemployment rates are.

The Pew Research Center, citing the most recent census survey data from 2023, notes 61% of adult SNAP recipients had not been employed that year, and that the national average benefit as of May was $188.45 per person or $350.89 per household.

Ismael Cid Martinez, an economist at the Economic Policy Institute, said the people who qualify for SNAP are likely working low-wage jobs that tend to be less stable because they are more tied to the nation’s macroeconomics. That means when the economy weakens, it’s the low-wage workers whose hours are cut and jobs are eliminated, which in turn heightens their need for government support. Restricting such benefits could threaten their ability to get back to work altogether, Martinez said.

“These are some of the matters that tie in together to explain the economy and [how] the labor market is connected to these benefits,” Martinez said. “None of us really show up into an economy on our own.”

Angela Rachidi, a researcher at the conservative think tank American Enterprise Institute, said she expects the poverty rate to decline as a result of the work requirements but even that wouldn’t ultimately affect the labor force.

“[E]ven if every nonworking SNAP adult subject to a work requirement started working, it would not impact the labor market much,” Rachidi said by email.

Medicaid

Trump’s big bill over the summer also created new requirements, starting in 2027, for low-income 19- to 64-year-olds enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion or through a waiver program to complete 80 hours of work, job training, education or volunteering per month. There are several exemptions, including for those who are caregivers, have disabilities, have recently left prison or jail or are pregnant or postpartum.

The nonpartisan Congressional Budget Office has predicted that millions of people will lose healthcare because of the requirements.

Nationally, most people on Medicaid already work. The majority of experts on a Cornell Health Policy Center panel said that new national requirements won’t lead to large increases in employment rates among working adults on Medicaid, and that many working people would lose healthcare because of administrative difficulties proving they work.

Georgia is currently the only state with a Medicaid program that imposes work requirements, which Gov. Brian Kemp created instead of expanding Medicaid. The program, called Georgia Pathways, has come under fire for enrolling far fewer people than expected and creating large administrative costs.

Critics say many working people struggle to enroll and log their hours online, with some getting kicked out of coverage at times because of administrative errors.

And research released recently from the United Kingdom-based research group BMJ comparing Georgia with other states that did not expand Medicaid found Georgia Pathways did not increase employment during the first 15 months, nor did it improve access to Medicaid.

Kemp’s office blames high administrative costs and startup challenges on delays because of legal battles with former President Biden’s administration. A spokesperson said 19,383 Georgians have received coverage since the program began.

HUD

HUD in July also proposed a rule change that would allow public housing authorities across the country to institute work requirements, as well as time limits.

In a leaked draft of that rule change, HUD spells out how housing authorities can choose to opt in and voluntarily implement work requirements of up to 40 hours a week for people getting rental assistance, including adult tenants in public housing and Section 8 voucher-holders.

HUD also identified two states — Arkansas and Wisconsin — where it could trigger implementation based on existing state laws if and when the HUD rule change is approved. The proposal remains in regulatory review and would be subject to a public comment period.

HUD spokesman Matthew Maley declined to comment on the leaked documents, which broadly define the age of work-eligible people being up to age 61, with exemptions for people with disabilities and those who are in school or are pregnant. Primary caregivers of disabled people and children under 6 years old are also exempted.

HUD’s proposed rule change also notes that it is only defining the upper limits of the policy, allowing flexibility for local agencies to further define their individual programs with additional exemptions.

In a review of how housing authorities have tested work requirements over time, researchers at New York University found few successful examples, noting only one case where there were modest increases in employment — in Charlotte, N.C. — as compared to seven other regions where work requirements were changed or discontinued “because they were deemed punitive or hard to administer.”

Ho and Kramon write for the Associated Press.

Dec. 22 (UPI) — The former CEO of a healthcare software company in Arizona was sentenced to 15 years in prison and ordered to pay more than $452 million in restitution for conspiring to defraud Medicare for $1 billion, the U.S. Department of Justice said Monday.

Gary Cox, 79, of Maricopa County, was found guilty in June of healthcare fraud in which he generated false doctors’ orders to support fraudulent claims for various medical items.

He was sentenced Friday in the Southern District of Florida.

“This just sentence is the result of one of the largest telemarketing Medicare fraud cases ever tried to verdict,” Acting Assistant Attorney General Matthew R. Galeotti of the Justice Department’s Criminal Division said in a statement. “Telemedicine scammers who use junk mailers, spam calls and the internet to target senior citizens steal taxpayer money and harm vulnerable populations. The Criminal Division will continue dedicating substantial resources to the fight against telemedicine and medical equipment frauds that drain our health care benefit programs.”

Cox was convicted of conspiracy to commit healthcare fraud and wire fraud, three counts of healthcare fraud, conspiracy to pay and receive healthcare kickbacks, and conspiracy to defraud the United States and make false statements in connection with healthcare matters.

Cox was the CEO of Power Mobility Doctor Rx, LLC.

Prosecutors say Cox and his co-conspirators targeted several hundred thousand Medicare beneficiaries who provided personally identifiable information and agreed to accept medically unnecessary orthotic braces, pain creams and other items through misleading mailers, television advertisements and calls from offshore call centers, the Justice Department said.

Cox connected pharmacies, durable medical equipment suppliers and marketers with telemedicine companies to accept illegal kickbacks and bribes in exchange for signed doctors’ orders transmitted using the DMERx platform.

Prosecutors said DMERx falsely said that a doctor had examined and treated the Medicare beneficiaries when, in fact, purported telemedicine companies paid doctors to sign the orders without regard to medical necessity. It was based on a brief telephone call with the beneficiary or no interaction with the beneficiary, the Justice Department said.

These doctors’ orders billed Medicare and other insurers more than $1 billion with Medicare and the insurers paying more than $360 million based on these claims.

The scheme was concealed through sham contracts and elimination from doctors’ orders in which one co-conspirator described as “dangerous words” that might cause Medicare to audit the scheme’s DME suppliers.

“This sentence sends a clear message: Those who exploit telemedicine to prey on seniors and steal from taxpayer-funded health care programs will be held accountable,” said Christian J. Schrank, deputy inspector general for investigations of the U.S. Department of Health and Human Services.

“This scheme was a massive betrayal of trust, built on deception and greed. Our investigators, working with law enforcement partners, dismantled this billion-dollar fraud operation that targeted vulnerable patients and undermined the integrity of Medicare. We will not relent in our mission to protect the public and safeguard Medicare and other federal health care programs from fraud, waste, and abuse.”

Before his sentencing, friends of the defendant submitted letters to the judge vouching for Cox’s good character.

“It is my belief, based on all my life experiences both good and bad that Gary is not a person that would take advantage of or cheat another,” one letter said.

Since March 2007, the Justice Department’s Fraud Section, operating nine strike forces in 27 federal districts, has charged more than 5,800 defendants, who collectively have billed federal healthcare programs and private insurers more than $30 billion.

“Together with our partners, the FBI will aggressively pursue those who defraud taxpayer-funded health care programs,” Rebecca Day, acting assistant director of the FBI’s Criminal Investigative Division, said. “Programs like Medicare are intended to help the most vulnerable among us, and fraud schemes like the one orchestrated by the defendant can jeopardize the delivery of critical care to those who need it the most.”

Approximately 69.4 million Americans are enrolled in the federal health insurance, which is primarily for people aged 65 and older. It also covers younger people with long-term disability, end-stage renal disease or ALS.

Medicare fraud, mistakes and abuse cost the program an estimated $60 billion annually.

“Medicare numbers are more valuable than Social Security numbers because if they have all the right documentation, the Medicare claim has to go through, there are rules and regulations around that,” Nancy Moore, director of Indiana Senior Medicare Patrol, told WRTV-TV in June.

“One of the best ways to look out for fraud is to read your summary notices, your EOB if you’re on Medicare Advantage, or your Medicare summary notice. If you notice a charge for something you never received or didn’t need. That’s when you should call us to report it.”

Consumers can also report suspected medical identity theft to the Health & Human Services fraud hotline at 800-447-8477 (800-HHS-TIPS) or the National Insurance Crime Bureau at 800-835-6422.

Folks, who was supposed to be watching grandpa last night? Because he got out, got on TV and … It. Was. Not. Good.

For 18 long minutes Wednesday evening, we were subjected to a rant by President Trump that predictably careened from immigrants (bad) to jobs (good), rarely slowing down for reality. But jumbled between the vitriol and venom was a vision of American healthcare that would have horror villainess M3GAN shaking in her Mary Janes — a vision that we all should be afraid of because it would take us back to a dark era when insurance couldn’t be counted on.

Trump’s remarks offered only a sketchy outline, per usual, in which the costs of health insurance premiums may be lower — but it will be because the coverage is terrible. Yes, you’ll save money. But so what? A cheap car without wheels is not a deal.

“The money should go to the people,” Trump said of his sort-of plan.

The money he vaguely was alluding to is the government subsidies that make insurance under the Affordable Care Act affordable. After antics and a mini-rebellion by four Republicans also on Wednesday, Congress basically failed to do anything meaningful on healthcare — pretty much ensuring those subsidies will disappear with the New Year.

Starting in January, premiums for too many people are going to leap skyward without the subsidies, jumping by an average of $1,016 according to the health policy research group KFF.

That’s bad enough. But Trump would like to make it worse.

The Affordable Care Act is about much more than those subsidies. Before it took effect in 2014, insurance companies in many states could deny coverage for preexisting conditions. This didn’t have to be big-ticket stuff like cancer. A kid with asthma? A mom with colitis? Those were the kind of routine but chronic problems that prevented millions from obtaining insurance — and therefore care.

Obamacare required that policies sold on its exchange did not discriminate. In addition, the ACA required plans to limit out-of-pocket costs and end lifetime dollar caps, and provide a baseline of coverage that included essentials such as maternity care. Those standards put pressure on all plans to include more, even those offered through large employers.

Trump would like to undo much of that. He instead wants to fall back on the stunt he loves the most — send a check!

What he is suggesting by sending subsidy money directly to consumers also most likely would open the market to plans without the regulation of the ACA. So yes, small businesses or even groups of individuals might be able to band together to buy insurance, but there likely would be fewer rules about what — or whom — it has to cover.

Most people aren’t savvy or careful enough to understand the limitations of their insurance before it matters. So it has a $2-million lifetime cap? That sounds like a lot until your kid needs a treatment that eats through that in a couple of months. Then what?

Trump suggested people pay for it themselves, out of health savings accounts funded by that subsidy check sent directly to taxpayers. Because that definitely will work, and people won’t spend the money on groceries or rent, and what they do save certainly will cover any medical expenses.

“You’ll get much better healthcare at a much lower price,” Trump claimed Wednesday. “The only losers will be insurance companies that have gotten rich, and the Democrat Party, which is totally controlled by those same insurance companies. They will not be happy, but that’s OK with me because you, the people, are finally going to be getting great healthcare at a lower cost.”

He then bizarrely tried to blame the expiring subsidies on Democrats.

Democrats “are demanding those increases and it’s their fault,” he said. “It is not the Republicans’ fault. It’s the Democrats’ fault. It’s the Unaffordable Care Act, and everybody knew it.”

It seems like Trump just wants to lower costs at the expense of quality. Here’s where I take issue with the Democrats. I am not here to defend insurance companies or our healthcare system. Both clearly need reform.

But why are the Democrats failing to explain what “The money should go to the people” will mean?

I get that affordability is the message, and as someone who bought both a steak and a carton of milk this week, I understand just how powerful that issue is.

Still, everyone, Democrat or Republican, wants decent healthcare they can afford, and the peace of mind of knowing if something terrible happens, they will have access to help. There is no American who gladly would pay for insurance each month, no matter how low the premium, that is going to leave them without care when they or their loved ones need it most.

Grandpa Trump doesn’t have this worry, since he has the best healthcare our tax dollars can buy.

But when he promises to send a check instead of providing governance and regulation of one of the most critical purchases in our lives, the message is sickening: My victory in exchange for your well-being.

An expanded federal healthcare subsidy that grew out of the pandemic looks all but certain to expire on December 31, as Republican leaders in the United States faced a rebellion from within their own ranks.

On Wednesday, four centrist Republicans in the House of Representatives broke with their party’s leadership to support a Democratic-backed extension for the healthcare subsidies under the Affordable Care Act (ACA), sometimes called “Obamacare”.

By a vote of 204 to 203, the House voted to stop the last-minute move by Democrats, aided by four Republicans, to force quick votes on a three-year extension of the Affordable Care Act subsidy.

Democrats loudly protested, accusing Republican leadership of gavelling an end to the vote prematurely while some members were still trying to vote.

“That’s outrageous,” Democratic Representative Jim McGovern of Massachusetts yelled at Republican leadership.

Some of the 24 million Americans who buy their health insurance through the ACA programme could face sharply higher costs beginning on January 1 without action by Congress.

Twenty-six House members had not yet voted – and some were actively trying to do so – when the House Republican leadership gavelled the vote closed on Wednesday. It is rare but not unprecedented for House leadership to cut a contested vote short.

Democratic Representative Rosa DeLauro of Connecticut said the decision prevented some Democrats from voting.

“Listen, it’s playing games when people’s lives are at stake,” DeLauro said. “They jettisoned it.”

It was the latest episode of congressional discord over the subsidies, which are slated to expire at the end of the year.

The vote also offered another key test to the Republican leadership of House Speaker Mike Johnson. Normally, Johnson determines which bills to bring to a House vote, but recently, his power has been circumvented by a series of “discharge petitions”, wherein a majority of representatives sign a petition to force a vote.

In a series of quickfire manoeuvres on Wednesday, Democrats resorted to one such discharge petition to force a vote on the healthcare subsidies in the new year.

They were joined by the four centrist Republicans: Mike Lawler of New York and Brian Fitzpatrick, Robert Bresnahan and Ryan MacKenzie of Pennsylvania.

The Democratic proposal would see the subsidies extended for three years.

But Republicans have largely rallied around their own proposal, a bill called the Lower Health Care Premiums for All Americans Act. It would reduce some insurance premiums, though critics argue it would raise others, and it would also reduce healthcare subsidies overall.

The nonpartisan Congressional Budget Office (CBO) on Tuesday said the legislation would decrease the number of people with health insurance by an average of 100,000 per year through 2035.

Its money-saving provisions would reduce federal deficits by $35.6bn, the CBO said.

Republicans have a narrow 220-seat majority in the 435-seat House of Representatives, and Democrats are hoping to flip the chamber to their control in the 2026 midterm elections.

Three of the four Republicans who sided with the Democrats over the discharge petition are from the swing state of Pennsylvania, where voters could lean right or left.

Affordability has emerged as a central question ahead of the 2026 midterms.

Even if the Republican-controlled House manages to pass a healthcare bill this week, it is unlikely to be taken up by the Senate before Congress begins a looming end-of-year recess that would stop legislative action until January 5.

By then, millions of Americans will be looking at significantly more expensive health insurance premiums that could prompt some to go without coverage.

Wednesday’s House floor battle could embolden Democrats and some Republicans to revisit the issue in January, even though higher premiums will already be in the pipeline.

Referring to the House debate, moderate Republican Senator Lisa Murkowski told reporters: “I think that that will help prompt a response here in the Senate after the first of the new year, and I’m looking forward to that.”

The ACA subsidies were a major point of friction earlier this year as well, during the historic 43-day government shutdown.

Democrats had hoped to extend the subsidies during the debate over government spending, but Republican leaders refused to take up the issue until a continuing budget resolution was passed first.