The U.S. and Mexico are the only countries out of 19 other OECD countries where a substantial portion of the population lacks any form of health insurance. In the U.S., about 8 percent of the population, or 27 million people, are uninsured. That number is about to grow larger.

 

That data is part of an independent research study conducted by The Commonwealth Fund, a private foundation. And that is despite the U.S. has spent more on health care than any other nation. In 2024, we spent 18 percent of gross domestic product on health care. That is nearly two times as much as the average OECD country.

 

Over a year ago, the Republican led U.S. Congress cut healthcare spending by cutting public subsidies for private health care insurance which caused millions to lose healthcare coverage. While on paper the savings seemed justifiable, in reality the cuts have just shifted the burden of paying for the uninsured patient to the hospitals, and ultimately, the taxpayer.

 

Before you ask, the Emergency Medical Treatment and Labor Act mandates that hospitals provide treatment to patients with emergency medical conditions, regardless of their insurance status or ability to pay. This federal law was enacted in 1986 to prevent patient dumping, where hospitals would refuse treatment to individuals based on their inability to pay or lack of insurance. This places hospitals and other health care clinics in harm's way.

 

This is not some dire predicament that may happen in the years to come. Some for-profit hospitals are already reporting a 20 percent increase in uninsured visits, and one company is expecting as much as $1 billion less in profits for this year. And the administration is only getting started.

 

As part of the "Big Beautiful Bill," the administration and Congress are cutting an additional $625 billion in Medicaid over 10 years. The CBO estimates another 7.8 million people will become uninsured as a direct result of these changes. That would bring the total number of newly uninsured Americans to almost 17 million.

 

And the trend is not your friend. Baby Boomers of all income levels are retiring and will need increasing healthcare regardless of their ability to pay. If you look at the demographics, those most impacted by these changes are low-income adults in Medicaid expansion states. Young adults (ages 19-34) will be hurt as well. To put that in perspective, that's 3 in 10 Gen Zers who are vulnerable, according to the Urban Institute. People with disabilities who do not qualify for federal disability benefits (2.6 million), and rural residents, where it is estimated that $155 billion in reductions of Medicaid spending will occur.

 

In 2025, the federal, state, and local governments collectively spent $30.6 billion to cover the medical costs of uninsured patients, according to recent government studies. The total cost to taxpayers is higher when you consider uncompensated care costs. Each newly uninsured person can generate as much as $900 in lost revenues for hospitals, two-thirds of which translates into loss profits. Uninsured patients frequently pay 2 to 5 times more for care than insured patients. And that was before the ACA reductions and the expected cuts in Medicaid coverage.

 

In this era of populism, where the GOP majority is already razor-thin, some might think that this kind of legislation is tantamount to political suicide. It would be, but politicians are a crafty lot. Most of the cuts in Medicaid will only become law after the midterm elections this year. In which case some of the base that Republicans depend upon the most to deliver a majority in Congress in November won't realize the devastation to their well-being until it is too late. I won't mention the potential loss of life involved since some might accuse me of valuing human life more than money.

 

Hospitals and emergency rooms will continue to absorb rising uncompensated care from a combination of state-directed payment cuts, much higher charity care, reduced Medicaid/ACA funding, and limited stopgap state programs. Some will attempt to pass on those higher costs to you via increased premiums on your own health care. Others will need to apply to the government to bail them out. In which case, you, the taxpayer, will pay for those bailouts as well.

 

Our healthcare system is a wreck. The U.S. has one of the lowest rates of physician graduates and the lowest rate of primary-care physicians per 1,000 people. Americans also have one of the highest rates of dying prematurely where men are more likely to die from avoidable causes than women.

 

The U.S., on average, has the poorest health outcomes of any high-income country, according to The Commonwealth Fund. The May 28, 2026, paper "U.S. Health Care from a Global Perspective, 2026" argued that a "Lack of universal coverage, weak primary care infrastructure, high out-of-pocket costs, and a complex insurance system contribute to and exacerbate the nation's uniquely poor performance relative to its peers." I couldn't have said it better.

 

In an effort to reduce the growing expense of our nation's healthcare, Congress and the administration have cut or reduced benefits in program after program over the last year. The question they fail to answer is an important one. If health benefits are reduced, who ends up paying for all those who cannot afford it? The short answer is we, the taxpayers, do.

 

The relentless government cuts continue. In the last two weeks alone, the administration ended subsidies for Medicare drug premiums, which could impact millions of older Americans next year. At the same time, the president insisted that RFK Jr. reduce vaccinations, based on an unfounded autism link, even while U.S. cases of measles hit highs not seen since 1991.

 

Those are just two examples of a poorly understood effort to rein in burgeoning healthcare costs while expanding spending in other areas, like the proposed $1.5 trillion defense budget for 2027. Earlier this year, the Congressional Budget Office, which is Congress's official nonpartisan economic and budget agency, is forecasting a dramatic reduction in healthcare coverage not only this year but out into 2030.

 

Readers might recall the change in the Affordable Care Act (ACA) rules passed by the Republican-controlled Congress at the urging of President Trump. As part of the law H.R. 1, enhanced premium tax credits for coverage were reduced substantially. Depending on how much the insured earned, premiums for Obamacare could have doubled. As a result, more than 3 million fewer people (13 percent) signed up for health plans.

 

For those who faced these sudden charges, there was nothing beautiful about the One Big Beautiful Bill Act. Since then, there has been a concerted effort to cut even more government spending, leaving the states to pick up the slack. Between 2025 and the end of the Trump presidency, the number of people with ACA premium tax credits will fall from 20.9 million to 9.7 million (a 54 percent drop). If Congress and the White House continue along this path, the CBO projects that ACA health coverage options will drop by 44 percent between now and 2032.

 

To the uninitiated, this might sound like a great way to reduce government spending, which could be used elsewhere to reduce the deficit, for example. I only wish that were true. A look at what happens to those with no health insurance might change that view.

 

Let's say Joey, with a family of four, caught a steel splinter in his eye because of a part-time work accident. He has no insurance because he can't afford it. Joey uses eyewash, compresses, and whatever else he can muster, but the condition gets worse over the next few weeks. When it goes so bad that he misses work, he goes to the emergency room at the urging of his pregnant wife. By then, what could have been a simple procedure now requires major surgery to save the eye. The hospital bill is more than he makes all year. What happens?

 

A recent New York Times article, "Uninsured Patients Rise Sharply, Hospitals Report, Citing Obamacare Cuts," explains it all. The gist of the article is that more uninsured patients are showing up in hospitals and clinics nationwide. This is costing hospitals hundreds of millions of dollars. Any guess what the hospitals will do in an effort not to go bankrupt — raise prices.

 

I don't have to tell you that companies and individuals who have healthcare insurance are already faced with rising healthcare costs on what seems like a daily basis. What will Joey's dilemma mean to you and/or your company? You will be footing the bill for Joey's eye operation. Now, imagine the cost of another 30 million adults and children in this country who are uninsured. Those who will delay and delay until minor health issues become major and major issues become deadly.

 

Next week, I will tabulate the costs to taxpayers from those who are uninsured as well as who will be most impacted. To make matters worse, there are further reductions right around the corner that will throw even more Americans into the uninsured minefield.

 

As if food prices aren't high enough, climate scientists around the world are concluding that the October-December El Niño period this year could see numerous droughts, floods, and other climate catastrophes. If so, the impact on the supply of agricultural commodities could be serious.

 

There have been 20 El Niños recorded over the past 75 years. For those who don't know, this climate pattern occurs when unusually warm sea surface temperatures spread across the central and eastern Pacific Ocean. This causes a shift in global weather patterns that affects different regions in different ways. Some areas experience heavy rains while others wither under severe droughts.

 

Right now, more than half of England is already in a drought. Overall, as we watch and read about record heat in Europe and forest fires in France and Spain, something even more insidious is occurring in the Pacific Ocean. Scientists are already recording above-average sea surface temperatures for this time of the year (2.0 degrees above average). The tropical Pacific is warmer right now than at any time over the 45 years of satellite record keeping.

 

Consensus forecasts from scientists indicate this year's El Niño will peak at 3.6 degrees Celsius above normal. The record over 149 years of data is at most 2.75 degrees, which was set in 2015-2016. Throughout its history, only six El Niños reached the level of severity expected for this year's event.

 

Some are already calling it the "Super El Niño," which is expected to peak sometime this fall, at the very time of South America's planting season. As you might imagine, the weather could cause severe disruptions to planting cycles and to the harvest of food crops, including sugar, wheat, corn, soybeans, coffee, cocoa, and more.

 

How serious could it become? Back in 1877, the middle of the Pacific Ocean was hotter than anyone could recall. Rain did not come to India, Brazil, or China that year. The soil dried up as crops failed across five continents. Millions died, and it came down to governments deciding who starved and who ate. Fast forward to modern days.

 

You may remember the great run on the world's cocoa crop caused by El Niño a few years ago. The Ivory Coast, where 38% of the crop is grown, was deluged by heavy rains and extreme heat. Insects swarmed destroying the rest. Cocoa prices soared, hitting a record $10.97 a kilo in April 2024. That particular El Niño ranked fifth in modern record keeping. This one forming now is presently ranking number one.

 

In past El Niño events, wheat production in Australia fell dramatically and could again fall by 20-60 percent if drought becomes a factor. The same could be said for corn in Brazil, coffee in Vietnam, sugar in India, Thailand and Brazil, and grain supplies globally.

 

Compounding the weather threat is the impact of climate change, plus two wars at the same time, all of it disrupting the global food production system. The Strait of Hormuz has been shut to commercial traffic for five months. Aside from oil, much of the world's fertilizer production has also been choked off in the Strait, while Europe burns and crops wither. Russia and Ukraine together represent about 27-30 percent of the world's wheat crop. As their war drags on, both countries are aiming their missiles and drones at each other's wheat exports.

 

By this time, I think you are getting the picture. If there is a silver lining to this potential dark cloud, it is that El Niño may help grain production in the U.S. Warmer-than-normal weather conditions are expected across North America, which could benefit the growing cycle. At the same time, El Niño conditions might suppress Atlantic Ocean hurricanes. If farmers do not run out of fertilizer, the country could act as a buffer for grain markets worldwide, especially for corn and soybeans.

 

There is also a chance that between now and September, weather patterns change and the force of El Niño dissipates, along with rising temperatures in the Pacific waters. It is getting late in the day for that to occur, however. There could also be an end to Trump's war, and to the other war he promised to end on day one of his second term. If not, I expect that come winter, and just in time for the midterms, consumers will once again be hit with surging food prices on top of what we are already paying.

 

You may have missed it given all the geopolitical turmoil, wildfires, and so on. Congress passed a bill this month that some call the most significant piece of housing legislation in almost 40 years. It is called the 21st Century Road to Housing Act.

 

It is remarkable for a variety of reasons. It is a bipartisan effort by both houses of Congress, which the president refused to support or sign. It became law anyway (a first). The legislation encompasses 50 measures, a hodgepodge of ideas from both sides of the aisle. The intent is to relieve the scarcity of affordable housing for a generation of low- and middle-income Americans.

 

Homeownership has long been a cornerstone of the American myth. For so many of the younger generations, it has become hopelessly out of reach. In many urban centers, a typical starter home can now command almost $1 million. Home prices have increased by 54 percent nationwide, and even if a young couple could scrape up enough for a down payment, the monthly costs of owning a home have also skyrocketed.

 

A report by the Joint Center for Housing Studies at Harvard reveals that the monthly cost of a median-priced home was $3,120 in the fourth quarter of 2025. Today it has jumped to $3,200, including mortgage payments, thanks to inflation and a variety of other costs. From 2019 to 2025, property taxes gained 31 percent, insurance premiums rose 72  percent, and interest rates on mortgages are above 6 percent and continue to increase. Overall, monthly costs have risen 46 percent since 2019. No wonder the homeownership rate last year fell for the second year in a row! No surprise that the largest decrease was in those under the age of 35.

 

In past columns, I have written at length about the plight of our youngsters. They are strapped with student debt, a weaker job market (thanks to AI and other factors), and are still living with family in basement apartments or their old bedrooms. There is little affordable housing being built to answer the needs of our younger generations. The new bill aims to remedy that problem.

 

It does so mainly by loosening local building regulations while encouraging building. In some cases, it offers areas that build more housing to receive a bigger share of federal funding while cutting money from areas that don't. On the lending front, the act reduces regulations around rural community banks, where most lending occurs in the small mortgage market of less than $100,000.

 

It also discourages the practice of private equity firms that buy up huge swaths of single-family homes. Critics argue that practice reduces the housing stock and forces many would-be buyers to rent instead. It allows investors to hold onto houses they already own but prohibits any future purchases that would bring their holdings above 350 homes.

 

Ask any builder, and they will tell you regulations are the bane of their existence. Red tape, they complain, adds delays, unnecessary costs, and huge headaches for builders and buyers alike. It won't happen overnight, but the act will loosen federal regulations, making it easier and cheaper to build housing at lower prices. It also relaxes lending rules, but probably the most important change is just a tiny tweak to a 50-year-old law.

 

Until now, mobile homes or manufactured homes were required to have a permanent chassis — that's the under-frame that is used to transport the house and must be left attached. It no longer needs to be attached. Those steel chassis can now be reused, saving anywhere from $5,000 to $10,000 toward the price of the house. That may not seem like much, but it is in the world of manufactured housing.

 

Remember, the bill is addressing affordable starter homes for buyers priced out of the market. Manufactured housing can cost anywhere from 27 percent to 65 percent less than houses built on site. When you consider the average manufactured home costs about $135,000 to build, a $10,000 reduction in costs would go a long way if the builder passed that savings on to the first-time home buyer.

 

Now, before you hold up your hands in horror that America will soon become a nation of trailer parks, settle down. Let's take a closer look at manufactured housing. They are built in factories like automobiles, and as such, economies of scale are at work. They use standardized materials and centralized purchasing. Weather isn't an issue, nor is a shrinking labor supply (due to immigration policies).

 

Getting rid of a huge, cumbersome steel frame under the house both saves money and opens a whole new set of possibilities. We could see multi-story versions or houses that are designed to be lower to the ground. Basement installations would be possible and cheaper as well. It could radically change the whole stigmatized trailer park environment we grew up with. The act also provides grants to communities to repair some of those dismal parks that have become eyesores in many neighborhoods.

 

There are too many parts to this legislation to cover thoroughly in the space I have allotted. Is it a panacea for filling the multi-million home building gap we are experiencing today in the U.S.? Not entirely, but it helps. It does set up the conditions to increase the country's housing supply, expand home ownership, and bolster community development programs.

 

It is not an instant cure. Although federal regulations on home construction are being relaxed, there are a myriad of local zoning laws and building regulations that need to be addressed as well, especially in the manufactured-home segment. And the legislation does not address two of the largest issues in the real estate market right now. High mortgage rates and the 54 percent increase in home prices over the past five years.

 

President Trump refused to sign the bill, which automatically became law on July 11. He said he would only sign the bill, which he dismissed as "a big yawn" and "of minor importance," unless Congress passed his pet legislation, a strict voter ID bill, called the SAVE America Act. Even his most partisan allies in Congress could not muster the votes that, if passed, would require proof of citizenship to register to vote and photo ID to cast a ballot. In a mid-term election year where affordability is of critical concern to voters, the president's decision on housing is right up there with his handling of the Iran war.

 

In an era of populism, distrust in government is rampant. That lack of trust has seeped down into just about everything one reads or hears. Government data is no exception.

 

As I wrote in my last column, our own president fired the head of the Bureau of Labor Statistics, claiming the BLS was "broken." He further claimed it would need new leadership "to restore trust and confidence in the BLS's data."

 

Since then, although there has been an acting BLS commissioner, no permanent replacement has made it past the Senate. Six months ago, Trump picked a veteran economist, Brett Matsumoto, as his nominee. This week, a Senate committee voted (12-11) to advance his nomination, but it is unclear whether the full Senate will vote to confirm the nomination. 

 

In his confirmation hearing, Matsumoto recognized the potential for further manipulation and politicization of the BLS. "It is important for the public to be confident that decisions at the BLS are being driven by science rather than politics," he said.

 

If it is science he is after, he may first need to hire qualified subordinates. Fully one-third of the top leadership positions at the BLS are vacant. That may be difficult, since there is a hiring freeze in effect, plus he must deal with a swath of deferred resignations and early retirements. That could be an uphill battle given that the Supreme Court gave the president carte blanche to fire independent government regulators despite federal job protections. As for the money needed to upgrade the governmental data systems, that too will be problematic.

 

In the meantime, meddling with government data, at least on the inflation front, continues. Last month, the Bureau of Economic Analysis, which calculates the Personal Consumption Expenditures Price Index (PCE), announced changes to how they plan to track data. The new method for capturing data and calculating price changes across three subcategories will be revised. In essence, the changes will make the numbers look better (with less inflation) than in the past.

 

Analysts estimate it will reduce core PCE inflation by about 0.2 percentage points. You may remember that Stephen Miran, a Trump advisor and chief architect of "reciprocal tariffs," was appointed to the Fed for a six-month stint and then replaced by the new Fed Chairman Kevin Warsh, another Trump appointee.

 

Miran, along with two Fed staff economists, is behind this effort to alter the PCE, the Fed's main inflation index used to determine the nation's inflation rate. I am sure the Fed will have logical, technical reasons to justify this improvement in their key inflation indicator.

 

At the same time, Fed Chairman Warsh is creating five new policy review task forces to investigate communications, balance sheet policy, productivity and jobs, inflation frameworks, and data. It seems more tinkering is ahead of us.

 

I guess it is pure coincidence that these changes come at a time when mid-term elections are a few months away. We won't know the result or the changes (if any) that may occur until next year. I'm hoping it helps rebuild trust and accuracy rather than the opposite.

 

In my career, I have seen instances of politically motivated meddling in places like Greece, China, and Argentina, to name just a few. In every case, investors lost faith in the data of the country in question, leading to higher borrowing costs.

 

We already have an almost daily problem with nonpublic information that can move markets coming from both within and without the government. Some of it is legal (if questionable); some of it involves leaked advance information from government sources. It doesn't seem that any of the regulatory agencies is willing or capable of stopping it.

 

Taken together, the leaks and inaccuracies among government agencies, both real and intended, are contributing to a deepening sense of distrust and cynicism among voters. Further neglect and delay in regaining that gold standard of government statistics that the country earned over decades should not be taken lightly.