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David Machledt

@machledtdc

Give me a bike, time to adventure, and family and friends to share it with. Also, a lot of health policy, but the views here are my own.

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07.02.2025
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Latest posts by David Machledt @machledtdc

Disability accommodations are a rare thing that actually trickles down. You like curb cutouts? Auto-opening doors? Jar openers? Ramps? Hand rails? YOU’RE WELCOME

Even as an abled person you use disability accommodations every single day.

Supporting accommodations actually helps everyone.

07.03.2026 00:13 πŸ‘ 1426 πŸ” 450 πŸ’¬ 21 πŸ“Œ 14

Over and over, the patterns repeat

07.03.2026 02:11 πŸ‘ 318 πŸ” 130 πŸ’¬ 3 πŸ“Œ 6

BREAKING:

The Justice Department just posted online three FBI interviews that had been missing from the massive trove of Epstein files initially released.

They're related to unsubstantiated sexual assault allegations against Donald Trump.

DOC 1: www.justice.gov/epstein/file...

06.03.2026 00:05 πŸ‘ 5452 πŸ” 2447 πŸ’¬ 198 πŸ“Œ 217

Horrifying. Jesus Lord in heaven.

04.03.2026 21:08 πŸ‘ 7628 πŸ” 2691 πŸ’¬ 367 πŸ“Œ 125

And ICYMI here is the latest blog by my veteran Medicaid expert colleague Andy Schneider on what is happening with the actions against Minnesota.
Hint: They are unprecedented.
ccf.georgetown.edu/2026/03/02/c...

03.03.2026 19:26 πŸ‘ 10 πŸ” 9 πŸ’¬ 0 πŸ“Œ 1
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One year later, seven fired federal workers share where they are now The Trump administration fundamentally altered the trajectories of hundreds of thousands of lives.

β€œThey unleashed an army of highly talented, skilled, and competent public servants that now have the motivation and the time to fight back. They've tried to break our souls. They tried to break us down, but they're not going to take that fighting servant spirit. They're really not.”

02.03.2026 23:30 πŸ‘ 89 πŸ” 31 πŸ’¬ 1 πŸ“Œ 2
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70% of voters say the Dem Party is too weak
40% say it is too progressive

So why is the money & energy in Dem spaces so tilted 2 moderation? Why is every "smart" analysis about how the party has been taken over by "groups"?

How does that win over the 70%?

www.gelliottmorris.com/p/new-poll-d...

27.02.2026 15:23 πŸ‘ 212 πŸ” 46 πŸ’¬ 18 πŸ“Œ 10
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New poll: Democrats' real problem isn't being too liberal β€” it's being seen as too weak Americans, including swing voters, see the Republican Party as 20 points more extreme than Democrats β€” and the Democrats as weak and ineffective. So why would the *Democrats* moderate?

Today's @gelliottmorris.com post is really eye-opening with respect to Dems' optimal midterm strategy ... www.gelliottmorris.com/p/new-poll-d...

27.02.2026 12:59 πŸ‘ 287 πŸ” 73 πŸ’¬ 12 πŸ“Œ 12

As my colleague Andy Schneider explained there is a complex administrative process CMS has to follow to preemptively withhold or retrospectively disallow federal #Medicaid funding for a state like MN. It would be unlawful to just unilaterally halt federal funding: ccf.georgetown.edu/2026/01/16/c...

25.02.2026 21:57 πŸ‘ 124 πŸ” 55 πŸ’¬ 5 πŸ“Œ 6

This story put my over the edge today. We will not forget thIs inhumanity and there will be accountability.

25.02.2026 21:01 πŸ‘ 2 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

When Bezos fires, @51st.news hires.

We're up to $3171 ($2537 donations, 634 follows), which means it's time for me to cut another check. Keep it up and make me send a third.

The overall fundraiser is at $215,736‼️

24.02.2026 22:44 πŸ‘ 72 πŸ” 28 πŸ’¬ 0 πŸ“Œ 1
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How We Can Eliminate the Need for Mined Minerals by 2050 - RMI Battery circularity strengthens the EV battery supply chain, improves its efficiency, bolsters the economy, and increases energy independence.

Recycling of EV materials is required in the world's biggest EV markets in China and the EU.

Recycling of EV materials boosts further the public health and environmental benefits of EVs.

Recycling debunks EV haters claims about EV materials scarcity.

RMI Report is here:
rmi.org/how-we-can-e...

24.02.2026 12:44 πŸ‘ 11 πŸ” 2 πŸ’¬ 0 πŸ“Œ 0
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State Implementation of Medicaid Work Requirements | Guidelines for Public Records Requests The template provides guidelines and suggested language advocates can use to submit public records requests to their states to obtain information relevant to implementation of β€œcommunity engagement” o...

The template provides guidelines and suggested language advocates can use to submit public records requests to their states. healthlaw.org/resource/sta...

23.02.2026 23:31 πŸ‘ 2 πŸ” 1 πŸ’¬ 0 πŸ“Œ 0
TIP #6 EXEMPTIONS FOR MEDICALLY FRAIL AND SPECIAL MEDICAL NEEDS PEOPLE. OBBBA exempts people who are β€œmedically frail” or who have β€œspecial medical needs” from Medicaid work requirements, and states can still work now to maximize the utility of this exemption. Learn more about what states can do to identify and protect exempt individuals with our latest Timely Tip to Safeguard Medicaid. By Shandra Hartly https://healthlaw.org/timely-tips-to-safeguard-medicaid/

TIP #6 EXEMPTIONS FOR MEDICALLY FRAIL AND SPECIAL MEDICAL NEEDS PEOPLE. OBBBA exempts people who are β€œmedically frail” or who have β€œspecial medical needs” from Medicaid work requirements, and states can still work now to maximize the utility of this exemption. Learn more about what states can do to identify and protect exempt individuals with our latest Timely Tip to Safeguard Medicaid. By Shandra Hartly https://healthlaw.org/timely-tips-to-safeguard-medicaid/

TIP #6 EXEMPTIONS FOR MEDICALLY FRAIL AND SPECIAL MEDICAL NEEDS PEOPLE. OBBBA exempts people who are β€œmedically frail” or who have β€œspecial medical needs” from Medicaid work requirements, and states can still work now to maximize the utility of this exemption. healthlaw.org/timely-tips-...

19.02.2026 18:14 πŸ‘ 1 πŸ” 1 πŸ’¬ 0 πŸ“Œ 0
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NHeLP Condemns Weaponization of Medicaid Data to Justify $1 Trillion in Cuts - National Health Law Program Washington, DC β€” The National Health Law Program (NHeLP) strongly condemns the administration’s release of Medicaid claims data under the guise of fraud prevention. It is a bad-faith effort to manufac...

This is exactly what concerned me with this data release: healthlaw.org/news/nhelp-c...

17.02.2026 21:23 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
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Feel like it's telling that you *don't* see people who have a lot of experience with T-MSIS data rushing to put out quick-and-dirty analyses (they know how quirky T-MSIS data can be)

Sloppy efforts to "expose" Medicaid "fraud" like this are going to expand the large target already on HCBS services

17.02.2026 19:32 πŸ‘ 18 πŸ” 5 πŸ’¬ 2 πŸ“Œ 1

Striking from new Quinnipiac poll:

*Voters prefer path to legalization over deportations for most undocs by 59-34. Among independents it's 61-33

*Majority says Trump on immigration is making America less safe

Again, there's broad rejection of the whole project, not just ICE tactics (see below)

04.02.2026 19:11 πŸ‘ 2400 πŸ” 834 πŸ’¬ 46 πŸ“Œ 68
Bar chart titled "Nebraska Renewal Outcomes and Application Processing Times, September 2025." It shows percentages for Medicaid application outcomes in Nebraska compared to the national average. Data source: KFF Analysis of CMS State Medicaid and CHIP Eligibility Processing Data.

Bar chart titled "Nebraska Renewal Outcomes and Application Processing Times, September 2025." It shows percentages for Medicaid application outcomes in Nebraska compared to the national average. Data source: KFF Analysis of CMS State Medicaid and CHIP Eligibility Processing Data.

Nebraska plans to be the first state to implement Medicaid work requirements on May 1.

Here’s what state data indicate about their potential readiness for eligibility and enrollment system changes: https://on.kff.org/3NO0Pha

03.02.2026 18:54 πŸ‘ 4 πŸ” 5 πŸ’¬ 0 πŸ“Œ 0

What could possibly go wrong?

02.02.2026 21:41 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

but don't call them Nazis

30.01.2026 21:34 πŸ‘ 1560 πŸ” 484 πŸ’¬ 3 πŸ“Œ 1
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House Republican Study Committee Pushes for Second Budget Reconciliation Bill and More Damaging Medicaid Cuts On January 13, the House Republican Study Committee (RSC) unveiled its plan for a second budget reconciliation bill for this Congress, in addition to H.R. 1 (the β€œOne Big Beautiful Bill Act” or P.L. 1...

The Republican Study Committee (RSC) in the House is pushing for a *second* budget reconciliation bill & released a plan with more damaging #Medicaid cuts beyond the draconian cuts enacted last year in H.R. 1. My new blog explains and analyzes these proposed cuts: ccf.georgetown.edu/2026/01/22/h...

22.01.2026 20:07 πŸ‘ 7 πŸ” 10 πŸ’¬ 0 πŸ“Œ 1
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Immigration officers assert sweeping power to enter homes without a judge's warrant, memo says An Immigration and Customs Enforcement memo obtained by The Associated Press reveals that the agency allows immigration officers to forcibly enter homes to make arrests without a judicial warrant.

They just make up bullshit, bad-faith legal theories, do what they want until a court stops them, then lather, rinse, and repeat.

In the meantime, they get to terrorize people. And nothing will happen to any of those responsible.

Our courts are not equipped to deal with this.

21.01.2026 22:14 πŸ‘ 542 πŸ” 161 πŸ’¬ 21 πŸ“Œ 11
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Fraud fight rule #1: Go after the big fish The DOJ crackdown on fraud at Somali-run social service organizations ignores the biggest alleged fraud scheme based in Minnesota.

What @gooznews.bsky.social said

open.substack.com/pub/gooznews...

21.01.2026 10:25 πŸ‘ 13 πŸ” 6 πŸ’¬ 0 πŸ“Œ 0

Insurance companies are not the primary driver of health care costs. It's hospitals.

But, it’s also not clear that we’re getting a lot of value from insurers in driving down health care costs.

21.01.2026 15:14 πŸ‘ 23 πŸ” 9 πŸ’¬ 2 πŸ“Œ 1

Also, their safety is obviously the main point, but Haitian workers are the backbone of the human services industry in Massachusetts. Amid an existing workforce crisis, deporting 45,000 Haitians will devastate care systems for seniors and the disabled. This is policy violence against *many* groups.

21.01.2026 15:08 πŸ‘ 26 πŸ” 6 πŸ’¬ 0 πŸ“Œ 0
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ICE has stopped paying for detainee medical treatment ICE halted payments in October, and the situation will persist for at least several more months

1. ICE has STOPPED PAYING for medical treatment for its 73,000 detainees

ICE has not paid its bills to 3rd party providers since OCTOBER and the situation will likely persist for MONTHS, a Popular Information investigation reveals

Meanwhile, critically ill ICE detainees are not receiving care

🧡

20.01.2026 13:42 πŸ‘ 14152 πŸ” 9039 πŸ’¬ 956 πŸ“Œ 1151
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Hennepin County Attorney Mary Moriarty: "What is this about? It certainly isn't about fraud. This isn't how you investigate fraud. This is about the administration's anger over Minnesota's leaders, our tradition of valuing our neighbors, our immigrant neighbors."

21.01.2026 00:53 πŸ‘ 2774 πŸ” 704 πŸ’¬ 30 πŸ“Œ 24
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CMS Weaponizes Fraud Against Medicaid in Minnesota On January 6, 2026, the Centers for Medicare & Medicaid Services (CMS) Administrator, Dr. Mehmet Oz, sent a letter to the Governor of Minnesota, Tim Walz, notifying him that his state’s Medicaid agenc...

My colleague (and expert on Medicaid law) Andy Schneider’s new blog explores the approach and fact checks the Trump Administration’s threat to withhold a significant chunk of Minnesota’s Medicaid funding.

ccf.georgetown.edu/2026/01/16/c...

16.01.2026 19:21 πŸ‘ 3 πŸ” 3 πŸ’¬ 0 πŸ“Œ 0
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"California’s utility solar and battery generation has risen by 58%, yet generation at the sunniest hour of the day has risen by just 8%."

Batteries are delivering solar after dark!

Batteries make it possible to deliver solar in all hours of the day!

Batteries change the game.
#energysky

16.01.2026 13:16 πŸ‘ 37 πŸ” 11 πŸ’¬ 1 πŸ“Œ 1
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Video Analysis of ICE Shooting Sheds Light on Contested Moments

Here is a gift link to the Times’ new analysis of the Good shooting. www.nytimes.com/2026/01/15/v...

16.01.2026 13:46 πŸ‘ 558 πŸ” 224 πŸ’¬ 33 πŸ“Œ 17