Episode #37 Deep Dive – Republicans Stare into the Abyss, and Jump
A deep dive into this week's episode of Paging America
››› Veterans Administration to cut tens of thousands of health care jobs
In exclusive reporting, The Washington Post found that the Veterans Administration plans to abruptly eliminate as many as 35,000 health care positions this month. This is in addition to a massive reorganization effort that has already resulted in the loss of almost 30,000 employees in 2025.
[These are] mostly unfilled jobs including doctors, nurses and support staff, according to an internal memo, VA staffers and congressional aides. … Employees warn that the contraction will add pressure to an already stretched system, contributing to longer wait times for care.
The decision comes after Veterans Affairs Secretary Douglas A. Collins, under political pressure from Congress, backed away from a plan to slash 15 percent of the agency’s workforce through mass firings. Instead, VA lost almost 30,000 employees this year from buyout offers and attrition.
The agency hopes that the cuts will reduce the health care workforce to as little as 372,000 employees, a 10 percent reduction from last year, according to a memo shared with regional leaders last month and obtained by The Washington Post. [...]
VA spokesman Pete Kasperowicz … said the health care system is eliminating about 26,400 of its open jobs, which he described as “mostly covid-era roles that are no longer necessary.”
Thomas Dargon Jr., deputy general counsel of the American Federation of Government Employees representing over 320,000 VA employees, said the union was not consulted about the cuts. In August, the Trump administration terminated collective bargaining agreements for most of its employees, ending union membership for some 377,000 VA workers.
The cuts to the VA couldn’t have come at a worse time for veterans. Via The Guardian:
The US Department of Veterans Affairs (VA) is experiencing “severe” staff shortages at all its hospitals, with the number of shortages increasing by 50% this fiscal year, according to a new report from the agency’s independent watchdog.
The report, released on Tuesday, [August 12], came a day after the Guardian revealed the department had lost thousands of healthcare professionals deemed “core” to the system under Donald Trump, without which, the agency said, “mission-critical work cannot be completed”.
The inspector general found 94% of VA facilities faced a “severe” shortage of doctors, while 79% faced a severe shortage of nurses. Psychology was “the most frequently reported clinical occupational staffing shortage”. A majority of VA facilities also reported severe shortages of police officers, who keep veteran patients and staff safe.
››› Republicans fail to pass anything to help Americans with affordable health care
Last week, two separate votes in the Senate to avoid the devastating impact of enhanced ACA health insurance subsidies expiring at the end of the year both failed. Things haven’t improved much since then. Last night, the House voted on their own plan – called the Lower Health Care Premiums for All Americans Act – that did not include extending the subsidies and relied instead on association health plans, cost-sharing subsidies, pharmacy benefit manager reforms, and so-called “choice accounts” that allow employers to provide their workers with tax-free funds to buy coverage on the Obamacare exchange.
The bill was passed in a 216 to 211 vote.
A last ditch effort by Democrats to force a vote on a clean bill extending the subsidies using a discharge petition was joined by four Republicans, Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York. It passed but Speaker Johnson said the vote wouldn’t happen until January, after the subsidies have expired.
A procedural vote to force an immediate vote on the extension failed 204-203. Via Reuters:
Democrats loudly protested, accusing Republican leadership of gaveling an end to the vote prematurely while some members were still trying to vote. [...]
Twenty-six House members had not yet voted - and some were actively trying to do so - when the House Republican leadership gaveled the vote closed on Wednesday. It is rare but not unprecedented for House leadership to cut a contested vote short.
Vulnerable Republicans were livid when Speaker Johnson announced he would not allow even a performative vote on a bill to extend the subsidies:
An infuriated Rep. Mike Lawler left a closed-door House Republican meeting Tuesday and sounded off on GOP leaders who are planning to allow key Obamacare subsidies to expire in two weeks.
“This is absolute bullshit,” the New York Republican said.
“I think it’s idiotic not to have an up-or-down vote on this issue,” he told reporters of leaders’ refusal to hold a vote on a modified version of the expiring subsidies. “It is political malpractice.”
Meanwhile, POLITICO reports that anti-abortion groups flooded Capitol Hill during the debates this week, warning members that there will be political consequences for them in next year’s midterm elections if they pass anything that allows health care coverage for abortions. Abortion rights groups were doing the same, warning lawmakers that they will score the vote and withhold support going forward from members who fold and allow for further restrictions on abortion care.
Through it all Trump remained silent.
With millions of Americans being thrown off their health care, experts warn the Affordable Care Act marketplace will enter a “death spiral” without enough healthy enrollees participating.
Links for a deeper dive on Episode #37
The Washington Post: VA plans to abruptly eliminate tens of thousands of health care jobs
Federal News Network: VA says it’s ended most collective bargaining agreements
The Guardian: ‘Severe’ staff shortages at US veterans’ hospitals, watchdog finds
Reuters: US House passes Republican healthcare bill without ACA subsidy renewal
POLITICO: ‘Absolute bulls--t’: Endangered House Republican blasts leaders over impending Obamacare lapse
POLITICO: Despite a possible agreement on ACA subsidies, abortion lurks as a hurdle
The Guardian: Obamacare expiration will have ‘death spiral’ effect on US healthcare – experts
A Republic, If You Can Keep Itv c podcast with Jeff Timmer and Mark Brewer
Jeff Timmer on X: @jefftimmer
Jeff Timmer on Bluesky: @jefftimmer.bsky.social
The termination of collective barganing agreements for 377,000 VA workers feels like the quiet part being said out loud. Stripping workers of their ability to negotiate while simultaneously cutting 35,000 positions creates a perfect storm where remaining staff have zero leverage to push back on unsustainable workloads. The cynicism of calling these "mostly covid-era roles that are no longer necessary" while the inspector general reports 94% of facilities have severe doctor shortages is staggering.
What's particularly grim is the procedural manipulation around the ACA subsidy vote. Gaveling a vote closed while members were activly trying to vote isn't just parliamentary hardball - it's a transparent attempt to insulate vulnerable members from having to take a position. The fact that antiabortion groups managed to deadlock even a bipartisan healthcare extension shows how completely policy substance has been subordinated to culture war positioning.
The death spiral metaphor for the ACA marketplace without subsidies isn't hyperbole. Once healthy enrollees drop out due to cost, premiums skyrocket for everyone remaining, accelerating the exodus. Veterans lose care access while millions lose insurance coverage entirely, but hey, at least nobody had to compromise on anything.