Understanding the Coming Premium Apocalypse - American Health Care Becoming Unaffordable!!

                                          Article by Paul Krugman - 29 September - 2025

    Why health insurance is about to become unaffordable

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

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

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

Source: KFF

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

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

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

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

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

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

Source: Charles Gaba

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

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

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

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

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

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

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

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

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

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

Irish Taoiseach Micheál Martin - Says What is Needed to be Said at the United Nations.

 Ireland’s Taoiseach Micheál Martin delivered one of the strongest addresses at the 80th United Nations General Assembly, condemning Israel’s actions in Gaza as genocide and denouncing atrocities in the West Bank. 

He called out starvation used as a weapon of war, vowed accountability for war crimes, and reaffirmed Ireland’s recognition of Palestine.

POWERFUL SPEECH: Finland President Speaks Out on Ukraine, Gaza, & Urgent Need for UN Reform

 Wonderfully stated.

Jimmy Kimmel, Somber but Defiant, Defends Free Speech in Return to ABC

Wonderful! 

Totally Insane UN Address - ‘Your Countries Are Going to Hell’: Trump Airs His Grievances at the U.N.

 

In a meandering address, President Trump rebuked global institutions and complained about immigration, environmentalists, windmills and more.

By Luke Broadwater

Reporting from the United Nations in New York

"He accused environmentalists of wanting to “kill all the cows.” He personally insulted the Muslim mayor of London. He bashed allies and foes across the globe. He questioned whether the United Nations should even exist.

“What is the purpose of the United Nations?” President Trump asked a gathering of the U.N. General Assembly on Tuesday, in a meandering, 56-minute speech that extended nearly four times as long as his allotted time limit.

“I’m really good at this stuff,” Mr. Trump said. “Your countries are going to hell.”

In his remarks, Mr. Trump lectured the United Nations and other countries about how they are failing and aired a list of grievances. Those included but were not limited to: a malfunctioning escalator at the U.N.; his not winning a renovation contract at the United Nations during his time as a real estate developer; windmills; other countries’ immigration policies, which he claimed were leading them to ruin; and the way Brazil is being run.

The White House had billed Mr. Trump’s address to the 80th session of the United Nations General Assembly as a chance for the president to lay out his vision for how America should wield its power abroad.

But Mr. Trump’s teleprompter malfunctioned early on, and while he appeared to be reading the speech, he often broke into ad-libs.

There was some policy discussed. He announced a new effort to enforce the biological weapons convention that would use “A.I. verification,” and said he wanted “a cessation of the development of nuclear weapons.”

Mr. Trump also issued a new warning: that the U.S. military would continue to play the role of judge, jury and executioner in killing suspected drug smugglers operating in international waters. “We will blow you out of existence,” he warned anyone moving drugs out of Venezuela.

But he spent nearly a quarter of his speaking time attacking efforts to address climate change.

Mr. Trump undermined the scientific consensus on climate change, saying it was “made by stupid people.” He celebrated the U.S. withdrawal from the Paris climate accord and “clean, beautiful coal.” He talked about American energy exports and added that “the United States has been taken advantage by much of the world, but not anymore.”

And Mr. Trump called climate change the “greatest con job” ever perpetrated on the world and claimed environmentalists are out to eliminate America’s cows.

“‘No more cows — we don’t want cows anymore.’ I guess they want to kill all the cows,” Mr. Trump said.

He briefly turned to the topic of religion, falsely claiming that Muslim leaders in the West are planning to institute Shariah law, while proclaiming Christianity to be the “most persecuted religion on the planet.”

According to the White House, Mr. Trump had always planned to target “globalist institutions” in his speech. Since taking office, he has made drastic changes to America’s approach to foreign policy.

He has largely eschewed the use of nonmilitary “soft power,” severely cutting foreign aid and dismantling the U.S. Agency for International Development. He has declined to pay for more aid to help Ukraine fight off Russia’s invasion or try to put any limits on Israel’s broadened military campaign in Gaza. And he has told strongmen leaders of other countries that the United States would no longer sit in judgment of them.

Several close U.S. allies issued what amounted to a reprimand this week of his go-it-alone vision, joining most of the U.N. body in recognizing Palestine as a state and risking the ire of the president, who has adamantly opposed such a move.

The president, for his part, has made it clear he wants little to do with much of the U.N. mandate. He has withdrawn the United States from the U.N.’s Human Rights Council, and ordered a review of America’s role in the organization. The Trump administration clawed back $1 billion in funding for the U.N. and informed Congress of its intent to cut another $1 billion, adding to a funding shortfall at the United Nations.

But at the same time, Mr. Trump has inserted America into peace negotiations in conflicts across the globe, including the war in Gaza. The president has also shown a willingness to use a quick show of force, as he did when he ordered airstrikes on Iran’s nuclear facilities.

Mr. Trump, who is in open pursuit of a Nobel Peace Prize, trumpeted his role in bringing about several peace agreements or cease-fires during his speech, including a deal between Armenia and Azerbaijan and Rwanda and the Democratic Republic of Congo.

Then he argued he was doing, as a side job, what the U.N. should. “Sadly, in all cases, the United Nations did not even try to help in any of them,” he said, adding that “all I got from the United Nations was an escalator on the way up that stopped right in the middle.”

He claimed that all the United Nations does is write “strongly worded letters” and speak in “empty words.”

“It’s sad I had to do these things instead of the United Nations doing them,” he said.

Also on his schedule Tuesday were meetings with António Guterres, the U.N. secretary general; President Volodymyr Zelensky of Ukraine; President Javier Milei of Argentina; and President Ursula von der Leyen of the European Commission. He was also meeting with the leaders of Qatar, Saudi Arabia, Indonesia, Turkey, Pakistan, Egypt, the United Arab Emirates and Jordan.

The meeting with the leaders of predominantly Arab or Muslim countries comes at a pivotal time for the war in Gaza, as Israel’s military pushes into Gaza City and the country faces allegations in a U.N. inquiry of carrying out a genocide. And it will come with the stark absence of Palestinian leaders, as the Trump administration has denied visas to Mahmoud Abbas, the president of the Palestinian Authority, and his delegation.

Arab countries have created their own proposal to rebuild Gazaand turn it into part of a future Palestinian state, without Hamas in government. Some of the United States’ longest-standing allies, including Australia, Britain and Canada, now recognize Palestine as a state. Mr. Trump has argued that such a designation rewards Hamas and harms efforts to reach a peace agreement with Israel, and he has cast doubt on any eventual two-state solution.

Mr. Trump has also insisted that he wants humanitarian aid to flow into Gaza and lamented the “real starvation” there. But the president has not publicly sought to stop the military push by Prime Minister Benjamin Netanyahu of Israel or challenge him to restore pathways for aid.

During his speech, Mr. Trump bashed the U.S. allies who were recognizing a Palestinian state. He said those countries should instead unite around a message to Hamas: “Release the hostages now.”

Prime Minister Carney of Canada - Enjoy Clear thinkig Expressed Well.

Everything You've Wanted to Know about Black Holes With Brian Cox.

 Excellent explanation of everything I could ask for if ever given the opportunity.

Cuts to Cancer Research - Rachel Maddow video at bottom.

Blood Cancer Unide, the new name of Leukemia & Lymphoma Society (LLS) has heard great concerns from patients, caregivers, volunteers, healthcare professionals, researchers, community organizations and others who are fearful and confused by NIH spending cuts and other policies being proposed and implemented in Washington. 

LLS’s work is nonpartisan, but we do engage with the government. LLS works to advance public policies that improve patients’ health, collaborating with lawmakers who support that goal, regardless of their party affiliation. And we speak out when policymakers take actions that threaten patients’ health, regardless of their party affiliation. As an independent, nonpartisan voice for patients, LLS vigorously opposes any actions that jeopardize their lives and well-being.  

Our point of view is not driven by politics; it comes from an understanding of and commitment to the needs of patients. LLS has worked across the aisle for more than 70 years to advance its mission and will continue to do so  

Below are answers to some of the most common questions we are hearing. 

Updated: February 18, 2025 

What blood cancer research funding is being cut? 

In February 2025, the current Administration suddenly announced immediate cuts to biomedical research funding administered through the National Institutes of Health (NIH) totaling billions of dollars. This includes across-the-board cuts for all current and future blood cancer research supported by NIH. 

These sudden funding cuts have been put on hold by the courts—for now.  

NIH grants cover “direct” and “indirect” costs. Direct costs are tied to specific projects such as salaries, travel and supplies. Indirect costs cover a portion of grantees’ facilities and administrative costs.  

Though they are described as “indirect,” these funds are essential to lifesaving research. As defined by the NIH, they support critical facilities for scientific research, such as buildings and capital improvements, utilities, lab equipment and its maintenance, and other administration and general expenses such as the director’s office, accounting, personnel and other types of expenditures that support the research. 

In addition to covering the infrastructure that helps makes the U.S. scientific engine run, indirect costs also cover NIH requirements for tracking dangerous chemicals, hazardous waste disposal and radiation safety.  

What would happen if these cuts were to take effect? 

It is reasonable to have a conversation about how biomedical research is funded; but it is dangerous to unilaterally make sudden cuts without consulting with organizations that understand the full effect of sudden cuts. A more measured approach would reduce the disruption to ongoing and future medical research and ensure we continue to see the incredible successes we have come to expect from U.S. medical research. 

While there have been some slowdowns in funding over the years, historically there has been broad bipartisan support in Congress for NIH funding. The majority of senators and congresspeople recognize the vital role federal funding plays in the health of our nation. 

What is NIH’s role in blood cancer research? 

NIH is the premier source of government funding for all biomedical and health services research, including for blood cancer. NIH funding can be tracked back to virtually every new drug and medical advancement in recent history. 

NIH grants also provide the infrastructure for all pediatric cancer research. Due to their smaller patient populations, pediatric cancer and other rare diseases will likely not be studied without support from NIH.   

What part does LLS play in blood cancer research? 

As the largest nonprofit funder of blood cancer research, LLS funding complements funding from NIH and other sources. The pharmaceutical industry also plays a key role in funding new drug studies.  

The U.S. model of public-private-foundation partnership for medical research has led to some of the most important advancements in cancer care worldwide. 

Does LLS get funding from NIH? What exactly is LLS’s role in research funding? 

LLS does not receive any federal funding. Over the last 75 years, LLS has invested $1.8 billion in research resulting in blood cancer patients living longer and better lives. LLS currently has more than $250 million in research funding commitments to propel the next generation of blood cancer care. Like NIH, LLS grants also include funds for direct and indirect research costs. 

LLS makes independent decisions about its research investments. Our work is led by a group of dedicated scientists, with input from independent advisors, who seek out and fund innovative science for every type of blood cancer.  

LLS will keep doing all it can to advance the best research and accelerate better and safer treatments to improve the lives of blood cancer patients and their families, but we cannot do it alone. Ongoing funding from government and other entities is essential to maintaining a steady pace of finding new cures and improving the lives of blood cancer patients and their families.    

How is the NIH research funding pause impacting patients? 

The sudden announcement of these cuts is causing disruptions in cancer research as scientists cannot be certain of their current and future funding streams. Even temporary cuts can take their toll on patients, on their families, and on science, too. 

A permanent reduction in funding could result in less research and fewer new treatments in the future. Some institutions may be able to fill in any gaps left by NIH funding, while others will likely have to scale back or slow their research efforts. 

A longer-term problem is that reduced NIH funding may push researchers out of U.S. academia, where they perform vital foundational scientific work. In times when NIH funding is uncertain, researchers look for other career paths. From 2021-2022, because inflation reduced available funding, there was nearly a 10% drop in the number of young scientists employed in post-doctoral academic research positions.  

Will these cuts at NIH really matter in the long term? Can’t universities and others fill the funding gap? 

Sustained funding from NIH has been the cornerstone of U.S. excellence in biomedical research. Without it, the pace of quality, impactful advances will slow.  

Dramatic advances in research have transformed care for many blood cancer patients, but there is so much more to do. Breakthroughs don’t just happen—they are the result of many years of research.  

Before a powerful new therapy reaches patients, it undergoes intensive scientific inquiry, analysis, testing and validation. The only way to rapidly achieve better cancer treatments is through consistent, robust funding for science – through the public sector, academia, industry, and nonprofits.   

If funding is frozen, why am I still seeing new drugs being approved by the FDA? 

The treatments being approved by the FDA now likely benefited from NIH (and often LLS) research funding years ago. It can take 10 to 15 years or more to bring a new drug to market.  

For example, a new type of drug called a menin inhibitor was approved in late 2024 to treat people with acute myeloid leukemia. LLS funded research in the early 2000s that discovered menin’s role in the devastating behavior of AML. Identifying these new connections allows for new kinds of drugs to be developed that may work for patients who have not responded to existing drugs or that work better for all patients.  

LLS and NIH committed funding over the next two decades to develop the first compound to inhibit menin, and to do the years of scientific work needed to make the inhibitor potent and safe for use in patients.  

Today, thanks to the long-term investments of LLS, NIH and others, one menin inhibitor is available, another is on the way, and work is already underway on next generation menin-based treatments.  

What programs does LLS have to fund research that is improving the lives of blood cancer patients? 

Our comprehensive research strategy is designed to generate near team impact for blood cancer patients by supporting drugs that are close to FDA approval through the LLS Therapy Acceleration Program. LLS also focuses funding on seeding the research pipeline through our Academic Grants to keep innovative therapies coming in the future.  

LLS leads two master clinical trials. The LLS Pediatric Acute Leukemia Master Clinical Trial (PedAL) is helping to speed up the process of finding new treatments for blood cancer in kids. LLS’s Beat AML® Master Clinical Trial is transforming treatment for adults with acute leukemia. Beat AML has already shown improved survival for patients enrolled in Beat AML compared to those receiving standard chemotherapy. 

The LLS Equity in Access research program provides funding to health services researchers who are working to uncover and address the social, economic, and environmental disadvantages that keep blood cancer patients and survivors from accessing the high-quality treatment and care they need throughout their lives. 

What is LLS doing to address potential cuts to NIH funding? 

Through our Office of Public Policy, LLS is encouraging the Administration to partner with patients, clinicians, and researchers to understand and appreciate the full impact that its cuts on funding have on patients and healthcare infrastructure.  

To address the threat of funding cuts, LLS partners closely with partner organizations across the cancer community as a part of the One Voice Against Cancer (OVAC) coalition. Through OVAC, LLS will engage with lawmakers and push back quickly – as we always have – if needed.   

LLS is also empowering those who care about this issue by providing opportunities to make their voices heard. Please see below for more information. 

How can I help/what can I do? 

LLS is vigorously defending against actions that threaten the lives and well-being of cancer patients, like cuts to the National Institutes of Health (NIH) and proposals to cut Medicaid, which provides healthcare to more than 70 million Americans, including more than 37 million children. 

But we are also focused on ensuring lawmakers drive forward our other priorities, like the Accelerating Kids’ Access to Care Act and bills to support the research and development of pediatric cancer treatments and cures. 

As we continue this work, your voices can make an enormous difference.  

Right now, please send a message to your members of Congress calling on them to publicly urge the Administration to rescind these devastating cuts. It only takes two clicks (or two taps on your phone). 

 

Michael Fanone’s Statement to the American People on The Death of Charlie Kirk

Charlie Kirk is dead. Shot in the middle of a speech at Utah Valley University.

I am not going to sugarcoat it: I have nothing but contempt for Charlie Kirk’s politics. He made a career out of poisoning young minds with grievance, conspiracy, and hate. He profited off division. He defended the indefensible. He celebrated cruelty. I don’t grieve for his ideas, and I won’t sanitize what he represented.

But here’s the thing: violence has no place in American politics. None.

I know what it’s like to be on the business end of political violence.

I felt fists, flagpoles, and tasers on January 6th. I heard men scream that they were going to kill me in the name of Donald Trump.

That day taught me something too many of us are still trying to ignore: once political violence becomes acceptable—once you decide that your enemy isn’t just wrong but expendable—you don’t control where it leads.

If you cheered this shooting because you hated Kirk, you’re no better than the mob that chanted for Mike Pence’s hanging. If you shrug it off because it happened to the other side, you’re part of the same sickness that’s rotting this country.

The truth is, we’re running out of safe spaces for disagreement. Universities, statehouses, even the Capitol itself—each one has been marked by the threat of blood.

Democracy doesn’t survive in that environment. Free speech doesn’t survive. We don’t survive.

Charlie Kirk’s death doesn’t make him a martyr. It doesn’t redeem his politics. But it does mark another line we’ve crossed in this country—a line that should never have been crossed in the first place.

I’ll say it again: violence is not politics. And if we don’t reclaim that principle right now, we’re going to lose the very thing that makes this place worth fighting for.