It’s Only a Subsidy If You’re Poor – The Health Care Blog


By KIM BELLARD

Even though most ACA enrollees/would-be enrollees have made their 2026 enrollment decisions assuming the expanded premium subsidies are not going to be renewed, the renewal of those subsidies is not entirely dead. Last week the House narrowly passed an extensionrelying on a discharge petition and 17 Republican Congressmen willing to go against their leadership. Meanwhile, in the Senate, Senator Bernie Moreno (R-OH), of all people, is leading an effort to come up with a bill to expand them as well.

Whether it will eventually get passed is uncertain, as is how/when it might be reconciled with the House bill, and the President might just veto whatever extension might manage to emerge. The expanded subsidies aren’t dead yet, they’re just “mostly dead,” as Miracle Max would say.

The seeming indifference to the concerns of over twenty million ACA enrollees is appalling, but in character. This is an Administration and a Republican Congress that doesn’t like SNAP, Medicaid, school lunches, or aid to starving people in Third World countries, among other things. If you’re poor, they think, too bad; get a job, or a better job, and pull yourself up yourself. No handouts.

If they were against federal subsidies generally, out of fiscal prudence or other guiding principles, I could respect it. I wouldn’t agree with it, but it’d at least be intellectually honest. The trouble is, they’re not against subsidies per se; they just don’t like them going to poor people. I.e., the ones who need them most.

What set me off on this was a ProPublica/High Country News investigation into grazing on public lands. If you live in the East you probably don’t think much about either grazing or public lands, but if you live in the West you are probably very familiar with both. Almost 50% of land in Western states is federally owned. It ranges from 85% in Nevada to 4% in North Dakota. Almost half of California is federal land. You might be forgiven if you assume federal lands must be national parks, but they are small relative to land managed by the Bureau of Land Management (BLM), the U.S. Fish & Wildlife Service (FWS), and the U.S. Forest Service (USFS).

According to ProPublica: “The federal government allows livestock grazing across an area of publicly owned land more than twice the size of California, making ranching the largest land use in the West.” Well, you might think, that’s not inherently bad; we might as well use the land for something, maybe even make a little money from it. That’s the problem; the federal government is practically giving it away. Its analysis found that the grazing fees charged amount to a 93% discount relative to the market rate. You read that right: ninety three percent. That’s not a discount, that’s a giveaway.

OK, that’s eye-opening, but if it helps a bunch of ranchers who are struggling to survive, maybe that’s not so bad; ranching goes back to frontier days and has a certain cowboy appeal. Unfortunately, that stereotype isn’t quite true.

ProPublica found:

A small number of wealthy individuals and corporations manage most livestock on public lands. Roughly two-thirds of the grazing on BLM acreage is controlled by just 10% of ranchers, our analysis found. And on Forest Service land, the top 10% of permittees control more than 50% of grazing. Among the largest ranchers are billionaires like Stan Kroenke and Rupert Murdoch, as well as mining companies and public utilities.

To be fair, there are a large number of small ranching operators who also take advantage of grazing on federal land; they’re just not the operations who do most of the grazing.

As if the rich ranchers weren’t already benefiting, the Trump Administration wants to increase subsidies and reduce oversight. But of course it does. Instead of being a protector of public lands, BLM has turned into a facilitator of their exploitation.  Current and former BLM employees told ProPublica about the political pressure that was applied whenever they tried to do anything that might be considered “anti-grazing.”

It’s not just ranchers. We like to think of family farmers working their land, and we provide tens of billions in aid to farmers, but, according to the Environmental Working Group:

…the vast majority of farmers do not benefit from federal farm subsidy programs and most of the subsidies go to the largest and most financially secure farm operations. Small commodity farmers qualify for a mere pittance, while producers of meat, f(r)uits, and vegetables are almost completely left out of the subsidy game (i.e. they can sign up for subsidized crop insurance and often receive federal disaster payments).

Meanwhile, the Trump Administration brags about how it “is making major strides in putting America’s public lands to work for the American people,” by which it means if you want to drill for oil or gas, mine for coal, tear down forests, while paying little and not worrying about environmental concerns, you’re in luck. But by “American people” it means “rich American people.”

Similarly, subsidies that go to the U.S. fossil fuel industry are difficult to pin down, but a 2025 analysis by Oil Change International estimated them at $31b annually, double the amount in 2017. And that was before the “Big, Beautiful Bill” added even further to the subsidies.

Don’t even get me started on how corporations and rich individuals manage to evade federal taxes, such as through the carried interest loophole. Not many poor people benefit from that.

Yes, perhaps the expanded ACA credits perhaps were expanded a little too much, and, yes, there may be some fraud in the program. But to throw the baby out with the bathwater by simply allowing them to expire is draconian. The estimated $30b in annual costs for the subsidies is not trivial, but I’d rather spend it ensuring millions of people can get/keep health coverage than giving it to rich ranchers, farmers, or oil companies.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.ioand now regular THCB contributor


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