10/5/26 - More cuts, and how much is too much?

Good afternoon!

How are you all today? Let's get right to the links, which I'm carrying over from what I had planned to share on Thursday when I was nursing a cold.

HHS cancels health insurance of 760,000 individuals enrolled in healthcare.gov plans

Selena Simmons-Duffin, National Public Radio - September 22, 2026

"SIMMONS-DUFFIN: Yeah, I mean, Republicans like to campaign on fighting fraud and on the failures of Obamacare, so this hits on both of those priorities. But health insurance also taps into the affordability issues that voters have been talking about a lot lately, and that cuts against Republicans. Millions of people really did lose their health insurance this year. I've spoken to many of them. Some couldn't afford their premiums anymore. Some have lost their Medicaid coverage, and this problem is only going to get worse in the coming year. Premiums are rising again. There are new work requirements in Medicaid that are projected to mean millions more people becoming uninsured, and that's because of the One Big Beautiful Bill Act that Republicans passed last year."

The Gilded Bunker and the Stolen Lifeline

Tina Agetsinger, The Disability Perspective - September 27, 2026

"Last Tuesday, the White House staged a masterclass in the art of distraction. As reported by The New York Times, Vice President JD Vance and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz stood before the briefing room lecterns to declare a major victory for fiscal discipline ... The administration announced it had summarily struck 750,000 Americans from the Affordable Care Act marketplaces, claiming to save the government $2.2 billion by rooting out “fraud” and purging people who supposedly didn’t even exist."

A secretive computer algorithm is taking caregiving money away from disabled people

Mike Hixenbaugh, NBC News - September 8, 2026

"After Nebraska used a new interRAI tool to slash Medicaid funding for nearly 900 people, NBC News uncovered the hidden logic behind some of the cuts."

Each of these three stories is about a different set of cuts, with it's own set of claims, counter-arguments, methods, and scary implications. But they all reinforce for me a memory, and a much broader idea that I think disability communities and activists should be thinking about.

As far back as the early '80s, my father, a pediatrician who worked in public health, told me that it was a bad idea to argue for a preferred program – like health care or home care – by claiming that it was cheaper than the alternative, or that fully funding it it would, "actually save the taxpayers' money." He argued that first of all, you couldn't always count on this being true. Sometimes a program or public service will be more expensive, but still worth doing. Then my father would point out that it was a bad idea in general to defend a project meant to serve human needs based on financial efficiency. If a thing is worth doing, then within reason, it's worth spending money on – maybe even a lot of it.

I think it's probably true that widespread, fully-funded home and community-based services are usually, in aggregate and over the long term, less expensive than a long term care system that depends mostly on nursing homes and other brick and mortar institutions. The problem in U.S. states and at the federal level at the moment seems to be that as more people have the opportunity to choose home instead of care instead of care facilities, the separate budget line items for home care keep getting higher. It startles and terrifies budget analysts and elected officials who are desperate to "control" spending, for a combination of practical, political, and ideological reasons. That's why so many U.S. states and now the Trump administration are cracking down in various ways specifically on home care programs. They are good programs, so they are popular. And being more popular and needed, they are costing more. And to people who either can't or won't understand why, it looks like something is obviously wrong.

But based partly on my father's advice long ago, and partly on watching the ebb and flow of home and community based services over the last 30 or so years, I think we are missing a more fundamental question. It isn't whether or not there's "fraud and abuse" in home care programs, or some other reason why home care spending keeps going up. It's whether we maybe should be spending more – maybe a lot more – on home care and similar services. Maybe instead of relying solely on the efficiency argument, (thought it's still pretty valid), disability activist communities should get braver about suggesting to politicians and the public that really, we should be spending more on home care, not less. Maybe the "right" figure for home care budgets should actually be a lot higher than anyone previously thought. At a time when nothing else we're doing seems to be working, maybe it's an argument worth trying.

IDisability Thinking Weekday is a Monday-Friday newsletter with links and commentary on disability-related articles and other content. You can help promote Disability Thinking Weekday by forwarding it by email or posting on your social media. You can also comment by sending me an email at: apulrang@icloud.com. Collected comments are shared on the first of each month. A free subscription sends a newsletter to your email each weekday. Benefits of paid subscription include:

• A monthly recap with links to all of the previous month's shared articles, organized by topic.
• Listing as a supporter, and a link to your website if you have one.
• You can recommend one disability-related article for me to share per month in a weekday post.

Use the buttons below to start a paid subscription or make a one-time donation.

I am so grateful for your help and engagement, in whichever forms you choose!

Free subscribers: 1,290
Paid subscribers: 5