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NoneWith Donald Trump’s return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act’s Medicaid expansion is back on the chopping block. More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News, and the Georgetown University Center for Children and Families. That’s because the states have trigger laws that would swiftly end their Medicaid expansions if federal funding falls. The states are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia. The 2010 Affordable Care Act encouraged states to expand Medicaid programs to cover more low-income Americans who didn’t get health insurance through their jobs. Forty states and the District of Columbia agreed, extending health insurance since 2014 to an estimated 21 million people and helping drive the U.S. uninsured rate to record lows. In exchange, the federal government pays 90 percent of the cost to cover the expanded population. That’s far higher than the federal match for other Medicaid beneficiaries, which averages about 57 percent nationwide. Conservative policy groups, which generally have opposed the ACA, say the program costs too much and covers too many people. Democrats say the Medicaid expansion has saved lives and helped communities by widening coverage to people who could not afford private insurance. If Congress cuts federal funding, Medicaid expansion would be at risk in all states that have opted into it — even those without trigger laws — because state legislatures would be forced to make up the difference, said Renuka Tipirneni, an associate professor at the University of Michigan’s School of Public Health. Decisions to keep or roll back the expansion “would depend on the politics at the state level,” Tipirneni said. For instance, Michigan approved a trigger as part of its Medicaid expansion in 2013, when it was controlled by a Republican governor and legislature. Last year, with the government controlled by Democrats, the state eliminated its funding trigger. Six of the nine states with trigger laws — Arizona, Arkansas, Indiana, Montana, North Carolina, and Utah — went for Trump in the 2024 election. Most of the nine states’ triggers kick in if federal funding falls below the 90-percent threshold. Arizona’s trigger would eliminate its expansion if funding falls below 80 percent. Montana’s law rolls back expansion below 90-percent funding but allows it to continue if lawmakers identify additional funding. Under state law, Montana lawmakers must reauthorize its Medicaid expansion in 2025 or the expansion will end. Across the states with triggers, between 3.1 million and 3.7 million people would swiftly lose their coverage, researchers at KFF and the Georgetown center estimate. The difference depends on how states treat people who were added to Medicaid before the ACA expansion; they may continue to qualify even if the expansion ends. Three other states — Iowa, Idaho, and New Mexico— have laws that require their governments to mitigate the financial impact of losing federal Medicaid expansion funding but would not automatically end expansions. With those three states included, about 4.3 million Medicaid expansion enrollees would be at risk of losing coverage, according to KFF. The ACA allowed Medicaid expansions to adults with incomes up to 138 percent of the federal poverty level, or about $20,783 for an individual in 2024. Nearly a quarter of the 81 million people enrolled in Medicaid nationally are in the program due to expansions. “With a reduction in the expansion match rate, it is likely that all states would need to evaluate whether to continue expansion coverage because it would require a significant increase in state spending,” said Robin Rudowitz, vice president and director of the Program on Medicaid and the Uninsured at KFF. “If states drop coverage, it is likely that there would be an increase in the number of uninsured, and that would limit access to care across red and blue states that have adopted expansion.” States rarely cut eligibility for social programs such as Medicaid once it’s been granted. The triggers make it politically easier for state lawmakers to end Medicaid expansion because they would not have to take any new action to cut coverage, said Edwin Park, a research professor at the Georgetown University Center for Children and Families. To see the impact of trigger laws, consider what happened after the Supreme Court in 2022 struck down Roe v. Wade and, with it, the constitutional right to an abortion. Conservative lawmakers in 13 states had crafted trigger laws that would automatically implement bans in the event a national right to abortion were struck down. Those state laws resulted in restrictions taking effect immediately after the court ruling, or shortly thereafter. States adopted triggers as part of Medicaid expansion to win over lawmakers skeptical of putting state dollars on the hook for a federal program unpopular with most Republicans. It’s unclear what Trump and congressional Republicans will do with Medicaid after he takes office in January, but one indicator could be a recent recommendation from the Paragon Health Institute, a leading conservative policy organization led by former Trump health adviser Brian Blase. Paragon has proposed that starting in 2026 the federal government would phase down the 90 percent federal match for expansion until 2034, when it would reach parity with each state’s federal match for its traditional enrollees. Under that plan, states could still get ACA Medicaid expansion funding but restrict coverage to enrollees with incomes up to the federal poverty level. Currently, to receive expansion funding, states must offer coverage to everyone up to 138 percent of the poverty level. Daniel Derksen, director of the Center for Rural Health at the University of Arizona, said it’s unlikely Arizona would move to eliminate its trigger and make up for lost federal funds. “It would be a tough sell right now as it would put a big strain on the budget,” he said. Medicaid has been in the crosshairs of Republicans in Washington before. Republican congressional leaders in 2017 proposed legislation to cut federal expansion funding, a move that would have shifted billions in costs to states. That plan, part of a strategy to repeal Obamacare, ultimately failed.'I thought she'd be better off without me': Mum shares battle with postnatal depression
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Syrian rebels who overthrew the dictatorship of Bashar al-Assad on Sunday are reportedly executing their opponents, imposing Islamic sharia law, and threatening non-Muslim minorities, including the Kurdish population in the north. Videos are circulating on social media showing Syrian rebels killing people associated with the regime — some of whom may have been part of the state security services, and others who appear to have been ordinary employees. The New York Times reported Tuesday: Islamic State forces on Tuesday killed 54 people in the Homs region in central Syria who had been part of the Syrian government’s military and fled during the collapse of the Assad regime, according to the Syrian Observatory of Human Rights, a British-based monitoring group. The killings highlight the chaos in Syria as various rebel factions operate in different regions. One video also shows thousands of smashed bottles of liquor at the duty free store of the Damascus airport, where Islamist rebels apparently enforced the Islamic ban on alcohol by force, as Islamists did in Lebanon in the 1980s. In addition, Islamist rebels, backed by Turkey, have been threatening Kurdish communities, backed by the U.S. The Times reported that the Syrian rebels are fighting with Kurdish militias: Fierce fighting was underway on Tuesday between rebels supported by Turkey and U.S.-backed, Kurdish-led forces near Kobani, a town in northern Syria with historic and symbolic significance for American involvement in the region. The fight illustrates how, even as rebels try to build a government after taking Damascus, armed groups with competing interests are still fighting for territory and power, trying to fill the vacuum left by a collapsed regime and, in this case, pitting proxies of the United States and Turkey against each other. U.S. Central Command commanding officer General Erik Kurilla actually visited Syria on Tuesday, reviewing the current state of preparations among U.S. troops and the U.S.-backed Syrian Democratic Forces (SDF). Meanwhile, the Israel Defense Forces (IDF) conducted hundreds of airstrikes on Syrian army positions and arms stockpiles, destroying what was left of the military Assad abandoned, preventing it from falling into rebel hands. Joel B. Pollak is Senior Editor-at-Large at Breitbart News and the host of Breitbart News Sunday on Sirius XM Patriot on Sunday evenings from 7 p.m. to 10 p.m. ET (4 p.m. to 7 p.m. PT). He is the author of The Agenda: What Trump Should Do in His First 100 Days , available for pre-order on Amazon. He is also the author of The Trumpian Virtues: The Lessons and Legacy of Donald Trump’s Presidency , now available on Audible. He is a winner of the 2018 Robert Novak Journalism Alumni Fellowship. Follow him on Twitter at @joelpollak .
FITCHBURG — John Jeffrey, 71, of Fitchburg is proud supporter of anything Fitchburg High, particularly its football and basketball teams. Jeffrey is a proud FHS graduate, Class of 1971, who played on Hall of Fame coach Doug Grutchfield’s first basketball team in 1970-71, considers legendary FHS Hall of Fame running back Barry MacLean a close, personal friend, and boasts about how his maternal uncle, Dominic Ricci, scored the game-winning touchdown against Leominster in the 1941 Thanksgiving game at then-10-year-old Doyle Field. Knowing all that, one may do a double take upon reading the following: regardless of Saturday’s Chicken Bowl result — a 34-0 Leominster win over Fitchburg at Historic Crocker Field — Jeffrey would have a big smile on his face, since he had grandsons, a pair of first cousins, on both sidelines. The story is incredible, and requires a genealogy flow chart chart to figure it out. In 1978, Jeffrey and his wife had identical twin daughters, Sara and Jill. While they were brought up on the Fitchburg-Leominster rivalry, they attended Gardner High. Sara eventually met and married Craig Lashua of Fitchburg, while Jill married Scott Chester of Leominster. Eagle-eyed Blue Devil readers are quick to take note of that marriage, as Scott Chester is a legendary LHS standout athlete from the early 1980s who scored nine TDs in back-to-back Blue Devil Super Bowl wins, and his father, the late David Chester, was himself a four-sport Leominster luminary from the mid-1950s, who scored 54 points against Fitchburg in basketball, the most points ever scored by one player against the Red Raiders, in 1955. Both Scott and David are Leominster High Hall of Famers. And if you know your local sports history, you’ll know that Craig Lashua’s uncle, Ray, was himself a standout Red Raider grid player under Ed Sullivan; Ray Lashua had 10 point-afters in his senior year of 1954, and a safety against Gardner in their October 1953 meeting. Jill’s marriage to Scott gave birth to Masyn Chester, currently a junior at Leominster High. Masyn has played special teams on the Leominster first team and has been a leader on the Blue Devil JV squad. Much like his old man and paternal grandfather, Masyn is speed personified, and he has been key in the success Leominster has had at this level in 2024. In a game against Shrewsbury a month ago, Masyn Chester scored the go-ahead touchdown in what turned out a 16-8 Blue and White victory. A week prior, Masyn scored three times, rushed for 150 yards and had 50 receiving yards in a JV win over Wachusett. Sara’s marriage gave birth to Cole Lashua, currently an eighth grader at Longsjo Middle School; due to numbers, FHS sought a waiver from the MIAA to allow eighth graders from Academy Street and Memorial Middle School to play on the Red Raider second team. Cole is a big, strong kid who stepped into the quarterback role partway through the season, and has also shown — on video captured by his maternal grandfather — to be a defensive beast who flows like water to the football. While Fitchburg has not been successful in terms of win and losses at the JV level, no one expected them to be world beaters: with a good portion of the team as eighth graders, FHS officials were just expecting the boys to get used to the speed of the high school game, giving those young men vital experience against bigger, stronger — and older — kids. The JV kids FHS faced were as many as four years older than the middle schoolers. Saturday afternoon’s annual sub-varsity grid tilt between the archrivals was the first time the maternal first cousins met on the field in a meaningful manner—and may be the only time. Next year, Masyn and the Blue Devils will come to the corner of Circle and Broad again, this time on a Thursday morning, to do battle with the Red and Gray. And Cole will be there, too, on Fitchburg High’s sideline as a freshman. Freshmen aren’t guaranteed varsity action. That meant the combined Jeffrey, Lashua, and Chester clans savored Saturday — again, regardless of the outcome. The cousins did connect on one first-half play Saturday, as Masyn grabbed a 20-yard Jeddiel Melendez pass at the Fitchburg 1, with Cole grabbing him and preventing him from getting into the end zone. Suffice it to say, “Gunka” Jeffrey will always remember Saturday—the day he has patiently waited for for a long time.
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