On the menu today: Last night, American Eagle Flight 5342 from Wichita carrying 60 passengers and four crew collided in midair with an Army Black Hawk helicopter near Reagan National Airport; authorities believe there were no survivors.
The president of the United States, offering his now characteristic words of support and reassurance on Truth Social, shortly after midnight:
The airplane was on a perfect and routine line of approach to the airport. The helicopter was going straight at the airplane for an extended period of time. It is a CLEAR NIGHT, the lights on the plane were blazing, why didn’t the helicopter go up or down, or turn. Why didn’t the control tower tell the helicopter what to do instead of asking if they saw the plane. This is a bad situation that looks like it should have been prevented. NOT GOOD!!!
Earlier Wednesday, Robert F. Kennedy Jr. had his first of two days of confirmation hearings.
While everyone else was focused on vaccines and abortion, a lesser-known Republican senator asked Kennedy some very basic questions about Medicaid and Medicare. Kennedy’s answers were not reassuring — not just because he still has left-wing instincts, as our Phil Klein lays out, but because it’s not clear that Kennedy has much familiarity with these programs. Which raises the question: If he hasn’t been studying and getting familiar with how the Medicaid and Medicare programs work since he was nominated way back in November 15 . . . what has he been doing all this time?
RFK Jr. Didn’t Do His Homework
Would we all be better off if we renamed Medicare “Old People Care” and Medicaid “Poor People Care”?
As of 2023, there were 67 million Americans enrolled in Medicare, or roughly 20 percent of the U.S. population. It is the second largest program in the federal budget: 2023 Medicare expenditures, net of offsetting receipts, totaled $839 billion — representing 14 percent of total federal spending.
Medicaid provided health insurance for about 91 million Americans, or about 27 percent of the U.S. population. In 2022, Medicaid cost the federal government $592 billion, though spending that year was still elevated because of some continued pandemic relief spending. According to the Peter Peterson Foundation, nearly 60 percent of all American children are covered through Medicaid and a related program, the Children’s Health Insurance Program (CHIP). Medicaid was the largest single payer of long-term services and supports (58 percent) in 2022, which includes spending for nursing homes, home health services, residential care facilities, and waivers for other home and community-based services.
In the state of New Mexico, roughly one-third of the population is covered by Medicaid; it’s just under a third in Louisiana, 28.5 percent in New York, 28.3 percent in Kentucky, 28.2 percent in West Virginia, 27.4 percent in Arkansas, 26.8 percent in California, and 24.1 percent in Mississippi.
The condition and long-term stability of the Medicaid program ought to be a high priority for plenty of Republican senators.
Senator Bill Cassidy of Louisiana is a Republican and a doctor. He’s sometimes described as a moderate, but he’s hardly a RINO; in Trump’s first term, Cassidy voted with Trump’s position 89.1 percent of the time.
I don’t think Cassidy set out to make Robert F. Kennedy Jr. look unprepared and ill-informed about Medicaid and Medicare. In fact, his questions were pretty open-ended — some might even characterize them as softballs. “What thoughts do you have regarding Medicaid reform?” is really not a “gotcha” question.
You can watch Cassidy’s questioning of Kennedy, or you can read it.
Cassidy: Mr. Kennedy, President Trump has sworn to protect Medicare. Republicans are exploring reforms to Medicaid that could help pay for Trump administration priorities. With this context, what will you do about dual eligibles?
Kennedy: About—
Cassidy: Dual-eligibles.
Kennedy: Well, dual-eligibles are not right now served very well under the system. Those are people who are eligible for both Medicaid and Medicare. And I, you know, I suppose my answer to that is to make sure that the programs are consolidated, that they are integrated, and that care is integrated. I look forward to working with you, Dr. Cassidy, on making sure that we take good care of people who are dual-eligible.
There are 12.5 million people who are jointly enrolled in Medicare and Medicaid; nearly half are “people of color,” nearly half have some limitation in their daily activities, and they are dirt poor; 87 percent had an income of less than $20,000. On paper, these people should have the best of both worlds, in reality they often face confusion about what program covers what cost:
Cassidy: How would we — how do you propose that we integrate those programs? Does Medicare pay more, Medicare pay less, Medicaid pay more, Medicaid pay less? How do we do that?
Kennedy: I’m not exactly sure because I’m not in there. I mean, it is difficult to integrate them because Medicaid — Medicare is under fee for service, paid for by employer taxes. Medicaid is fully paid for federal government and it’s not fee for service.
That is . . . not correct. From the Medicaid website:
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). States must ensure they can fund their share of Medicaid expenditures for the care and services available under their state plan.
States can establish their own Medicaid provider payment rates within federal requirements, and generally pay for services through fee-for-service or managed care arrangements.
Did Kennedy say “Medicare” when he meant “Medicaid,” and vice versa? Again, should we just switch it to “Old People Care” and “Poor People Care” to help people keep it straight?
Cassidy: Republicans again are looking at ways to potentially reform Medicaid to help, you know, pay for President Trump’s priorities, but to improve outcomes. What thoughts do you have regarding Medicaid reform?
Kennedy: Well, Medicaid is not working for Americans, and it’s specifically not working for the target population. Most Americans like myself, I’m on Medicare Advantage, and I’m very happy with it.
Again, Medicaid and Medicare are two different programs; Medicare Advantage is a form of health insurance offered by Medicare-approved private companies that must follow rules set by Medicare.
In other words, Cassidy asked about Poor People Care, and Kennedy answered by saying he’s very happy with his version of Old People Care.
In his answer, Kennedy went on to say, “Most people who are on Medicaid are not happy. The premiums are too high, the deductibles are too high.”
Kennedy’s first assertion is debatable; in late 2023, 83 percent of Medicaid enrollees rated the overall performance of Medicaid positively. But let’s assume these enrollees’ experience could always be better, and focus on Kennedy’s assertions that Medicaid enrollees believe their premiums and deductibles are too high.
NBC News writes, “People on Medicaid generally aren’t charged premiums or deductibles at all,” and that’s not quite right. As Medicaid.gov itself makes clear, “States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on the individual state’s payment for that service.”
But these costs are often really nominal. As Phil observed yesterday, “Ohio’s program, for instance, charges $3 per non-emergency hospital visit, and $2 for brand name prescription drug refills.”
And note that quite a few patients on Medicaid are exempt from copays — children, pregnant women, people who are terminally ill (including those in hospice), and Medicaid recipients who are living in an institution. Quite a few services are exempt from copays as well — emergency services, family planning services like contraceptives, pregnancy-related medical services, preventative services (like immunizations, screenings, clinical and behavioral interventions, and counseling).
Are there some individuals on Medicaid who would say their premiums or deductibles are too high? Sure. But most people on Medicaid are getting their health care for prices that most Americans would find astonishingly inexpensive. You can find the Medicaid Income Eligibility Chart for 2025 here.
Medicaid and Medicare spending are two of the fastest-growing parts of the federal budget. But Kennedy’s gut instinct is that for those on Medicaid, “premiums are too high, the deductibles are too high.” The problem with these programs is a familiar one, too little money coming in, too much money going out. Kennedy’s diagnosis is that it’s charging the patients too little.
Maybe the lack of specificity in these answers will unnerve Cassidy. But conservatives back home in Louisiana want Cassidy to vote for Kennedy.
Medicaid and Medicare make up 85 percent of the budget for the Department of Health and Human Services in this fiscal year. If you want to be HHS secretary, you probably should do some homework on the basics of how Medicaid and Medicare work.
This is a separate matter from whether you love Kennedy’s stances on vaccines or not, or abortion, or any other issue. Kennedy has clearly spent a lot of time thinking about gender dysphoria among teenagers and how “the capacity for these chemicals that we are just raining down on our children right now to induce these very profound sexual changes in them.”
He just hasn’t spent much time thinking about Medicaid or Medicare, which is what HHS actually runs.
The largest institution that RFK Jr. has run is the nonprofit Children’s Health Defense, which has 58 employees and a budget that peaked at $23 million.
The Department of Health and Human Services has more than 80,000 employees and a budget of $1.8 trillion; once again, that is not a typo, that is a deliberate “tr.” And again, most of that spending is on Medicaid and Medicare.
Kennedy likely hasn’t spent much time thinking about Medicaid or Medicare, in large part because President Trump doesn’t talk much about Medicaid or Medicare, either. In the end, most of the MAGA movement doesn’t care that much about Medicaid, Medicare, or any other entitlement programs.
One of the doubts about Kennedy that hasn’t gotten enough attention is that he’s a 71-year-old celebrity lawyer who’s mostly been running for president and doing interviews for a long time. As the New York Times laid out back in 2023, for years, most of Kennedy’s earnings “came from law firms — a total of $7 million for lending them his name, connections and expertise to sue major companies.” He also made money from “board positions and advisory gigs, side deals with law firms, book contracts and an exhausting schedule of paid speeches, once upward of 60 a year by his own count.”
As a job, running a cabinet department comparably stinks — it’s endless meetings with bureaucrats who are dragging their feet on doing what you want them to do and giving you excuses. (I literally wrote the book on this.) Even if Kennedy does get confirmed, it’s not difficult to see him realizing he hates the actual work of being a cabinet secretary and wants to go back to being a celebrity activist and is out by the midterms.
ADDENDUM: In case you missed it yesterday, there are plenty of good reasons to vote against the confirmation of Tulsi Gabbard, but the New York Times’ purported bombshell that two Hezbollah operatives allegedly said she met “the big guy” back in 2017 is not one of them.