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The Dictatorship

Trump’s new Obamacare replacement looks awfully familiar

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Trump’s new Obamacare replacement looks awfully familiar

President Donald Trump infamously asserted during the September 2024 presidential debate that he had “concepts of a plan” to replace the Affordable Care Act (ACA). This weekend, almost 10 months into his second term, he offered a glimpse of what that plan might look like.

Posting on his platform Truth Social on Saturday, Trump said that he was recommending to Senate Republicans that they replace the federal subsidies for ACA premiums, which are sent to private health insurers, with money sent directly to the American people. Although Treasury Sec. Scott Bessent said there was no “formal proposal,” Republican lawmakers jumped onboardand Sen. Rick Scott, R-Fla., said he was “writing the bill right now.”

Setting aside the irony that a Democratic politician would surely be pilloried for pursuing the redistribution of payments from private companies to the masses, let’s dig in.

The insufficiency of HSA funds is just the start of the problems with Trump’s proposal.

This is hardly the first time that Trump has proposed repealing the ACA, on which a record-high 24.3 million people now rely for marketplace plans. The most sweeping of these efforts notably fizzled back in 2017, when the late Sen. John McCain voted against it in the middle of the night. Even in the absence of outright repeal efforts, Republicans in Congress reduced the mandate penalty to $0 in the Tax Cuts and Jobs Act of 2017. This summer, the Centers for Medicare & Medicaid Services finalized a rule that will increase out-of-pocket costs and may lead to as many as 1.8 million Americans losing coverage. At the same time, the One Big Beautiful Bill Act advanced several changes that will limit the ACA’s effectiveness.

Amid such vitriol at the ACA, it can be easy to forget that the law brought America’s uninsured rate to a historic lowimproved health outcomes across a range of conditions and reduced health inequities. What’s more — and what’s especially important when evaluating Americans’ health care costs — Medicaid expansion through the ACA is also associated with reductions in medical debt. These gains help explain why 64% of Americans favor the ACAthough it garners considerably less support among Republicans.

Absent the preservation of the ACA’s core provisions, tens of millions of Americans with preexisting medical conditions would be vulnerable to outright denial of coverage by private insurers. In 2017, the health policy research group KFF estimated that 27% of non-elderly American adults had previously declinable preexisting conditions. That share has likely only increased as complications from Covid-19 have become more common and more people have enjoyed the ACA’s protections — whether gaining a primary care doctor or opting for tests that before the ACA might have revealed a preexisting condition.

But perhaps concerns about health care affordability could be offset by the amount of money that would be redirected to the people.

Trump’s first post was characteristically light on details. In a later post, he suggested that consumers bypass health insurers altogether to purchase plans directly, without explaining how or from whom those plans would be purchased. But Sunday morning, he specified that “Republicans should give money DIRECTLY to your personal HEALTH SAVINGS ACCOUNTS.” Through HSAs, people can put money away and withdraw the funds tax-free for qualifying medical expenses if they’re enrolled in a high-deductible health plan.

GOP policymakers have often championed HSAs because, in theory, they reflect Republicans’ preference for individuals’ choices over government intervention. In practice, HSAs tend to benefit people with higher incomes: They’re the ones with the means to contribute to the accounts, and because they’re in higher tax brackets, they benefit more from each dollar saved. Furthermore, researchers at the Center on Budget and Policy Priorities find that HSAs do not significantly benefit those who struggle with health care costs, and relatedly, that they exacerbate the racial disparities the ACA has effectively reduced.

To make matters worse, Trump is proposing these changes amid a shaky economy.

So, how much money are we talking about? The Congressional Budget Office estimated that in 2023, health insurers received approximately $92 billion in ACA subsidies. That would not come close to covering most Americans’ health care expenses — in 2023, Americans shelled out $500 billion just on out-of-pocket costs.

The insufficiency of HSA funds is just the start of the problems with Trump’s proposal. A core concept of health insurance is the spreading of risk across the pool of enrollees, in order to contain the costs of coverage. When the risk pool is diverse, the premiums of younger and healthier patients offset the expenses of covering older and sicker individuals, a principle at the heart of the ACA’s mandate to hold a minimum level of insurance.

With added reliance on HSAs, America would witness what is called “adverse selection” — healthier and wealthier people would more likely switch away from comprehensive health insurance products, leaving the insured population on average sicker and therefore more costly to insure. Thus, insurers would increase the premiums they charge, likely resulting in an increase in the population that only enrolls in insurance when they have more significant health care expenditures.

High health care costs are already a strain on many Americans, leading to delayed or forgone care or — in the case of about 9% of Americans — being uninsured. Trump’s concept of a plan would make this worse: What might appear at first blush to be a welcome move toward more individualized decision-making would ultimately increase costs. The consequences would include higher rates of uninsurance and underinsurance, as well as exacerbated racial and socioeconomic inequities in health care access.

To make matters worse, Trump is proposing these changes amid a shaky economy with considerable strain on Americans’ pocketbooks. In a country whose dominant health insurance model entails tying insurance to employment, when the jobless rate ticks upit is especially important to preserve access to quality, affordable plans through the ACA. That’s especially true given Republicans’ recent historic cuts to Medicaidweakening a key backstop for low-income Americans.

The American people would be forgiven if they looked at Trump’s and Scott’s words with skepticism in light of congressional Republicans’ opposition to extending marketplace subsidies for even one more year. That refusal has led to sticker shock for marketplace consumers during open enrollment and helped spark a weekslong government shutdown.

Politicians are right to want to confront the problem of high health care costs. But the president’s new proposal is the latest example of his administration’s policy preferences working against that important stated objective, sabotaging effective programs (the ACA) in favor of programs that research consistently shows are comparatively ineffective (HSAs).

Trump’s pledge to replace comprehensive health coverage with direct payments toward health care offers only a hollow hope, promising individual freedom while actually leaving Americans to fend for themselves.

Miranda Yaver

Miranda Yaver is an assistant professor of health policy and management at the University of Pittsburgh and a health care fellow at the Roosevelt Institute.

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The Dictatorship

French company Capgemini to sell subsidiary working with ICE

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French company Capgemini to sell subsidiary working with ICE

PARIS (AP) — French company Capgemini announced Sunday it is selling off its subsidiary that provides technology services to U.S. Immigration and Customs Enforcement, during global scrutiny of ICE agents’ tactics in the Trump administration’s immigration crackdown.

France’s government had pressured the company to be more transparent about its dealings with ICE, whose actions in Minneapolis in recent weeks have raised concern in France and other countries. The government’s campaign against immigrants in Minnesota’s capital has led to the fatal shootings of two U.S. citizens at the hands of federal immigration officers.

Capgemini said in a statement Sunday that it will immediately start the process of selling off its subsidiary Capgemini Government Solutions. It said the rules for working with U.S. federal government agencies ″did now allow the group to exercise appropriate control over certain aspects of the operations of this subsidiary to ensure alignment with the group’s objectives.″

It didn’t give further explanation for the decision, but noted that the subsidiary represents only 0.4% of the company’s estimated 2025 revenue.

Capgemini CEO Aiman Ezzat said he was only recently made aware of the subsidiary’s contract with ICE. In a LinkedIn post, he said, “The nature and scope of this work has raised questions compared to what we typically do as a business and technology firm.’’

The company selloff announcement came after French Finance Minister Roland Lescure, speaking to parliament last week, urged Capgemini ″to shed light, in an extremely transparent manner, on its activities … and to question the nature of these activities.″ Lescure’s office did not comment on the company’s decision.

Non-governmental organization Multinationals Observatory reported that Capgemini Government Solutions provided ICE technical tools to locate targets for the immigration crackdown. CapgemiSni did not immediately respond to a query about the tools.

Capgemini is a consulting and technology company that employs more than 340,000 people in more than 50 countries.

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‘Melania’ opens with strong ticket sales for a documentary

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‘Melania’ opens with strong ticket sales for a documentary

NEW YORK (AP) — Promoted by President Donald Trump as “a must watch,” the Melania Trump documentary “Melania” debuted with a better-than-expected $7 million in ticket sales, according to studio estimates Sunday.

The release of “Melania” was unlike any seen before. Amazon MGM Studios paid $40 million for the rights, plus some $35 million to market it, making it the most expensive documentary ever. Directed by Brett Ratner, who had been exiled from Hollywood since 2017, the film about the first lady debuted in 1,778 theaters in the midst of Trump’s turbulent second term.

While the result would be a flop for most films with such high costs, “Melania” was a success by documentary standards. It’s the best opening weekend for a documentary, outside of concert films, in 14 years. Going into the weekend, estimates ranged from $3 million to $5 million.

But there was little to compare “Melania” to, given that presidential families typically eschew in-office memoir or documentary releases to avoid the appearance of capitalizing on the White House. The film chronicles Melania Trump over 20 days last January, leading up to Trump’s second inauguration.

Marc Beckman, left, shake hands with Defense Secretary Pete Hegseth and his wife Jennifer as they arrive for the premiere of first lady Melania Trump's movie

Marc Beckman, left, shake hands with Defense Secretary Pete Hegseth and his wife Jennifer as they arrive for the premiere of first lady Melania Trump’s movie “Melania” at The John F. Kennedy Memorial Center For The Performing Arts, Thursday, Jan. 29, 2026, in Washington. (AP Photo/Jose Luis Magana)

On Thursday, Trump hosted a premiere of the film at the Kennedy Centerwith attendees including Cabinet members and members of Congress. There, Ratner downplayed its box-office potential, noting: “You can’t expect a documentary to play in theaters.”

The No. 1 movie of the weekend was Sam Raimi’s “Send Help,” a critically acclaimed survival thriller starring Rachel McAdams and Dylan O’Brien. The Walt Disney Co. release debuted with $20 million. The film, with a $40 million budget, was an in-between kind of release for Raimi, whose hits have typically ranged from low-budget cult (“Army of Darkness”) to big-budget blockbuster (2002’s “Spider-Man”).

The microbudget sci-fi horror film “Iron Lung,” directed by YouTuber and filmmaker Markiplier, came in second with $17.9 million, far exceeding expectations. The Jason Statham action thriller “Shelter” debuted with $5.5 million.

But most of the curiosity was on how “Melania” would perform. A week earlier, the White House hosted a black-tie preview attended by Amazon chief executive Andy Jassy, Apple chief executive Tim Cook and former boxer Mike Tyson.

The audience waits in a movie theater for the start of the screening of a documentary about Melania Trump in Ljubljana, Slovenia, Friday, Jan. 30, 2026. (AP Photo/Darko Bandic)

The audience waits in a movie theater for the start of the screening of a documentary about Melania Trump in Ljubljana, Slovenia, Friday, Jan. 30, 2026. (AP Photo/Darko Bandic)

The film arrived in a week dominated by coverage of federal immigration tactics in Minnesota after a U.S. Border Patrol agent fatally shot 37-year-old Alex Pretti in Minneapolis.

“Melania” didn’t screen in advance for critics, but reviews that rolled out Friday, once the film was in theaters, weren’t good. Xan Brooks of The Guardian compared the film to a “medieval tribute to placate the greedy king on his throne.” Owen Gleiberman of Variety called it a “cheese ball informercial of staggering inertia.” Frank Scheck of The Hollywood Reporter wrote: “To say that ‘Melania’ is a hagiography would be an insult to hagiographies.”

But among those who bought tickets over the weekend, the response was far more positive. “Melania” landed an “A” CinemaScore. Audiences were overwhelmingly 55 and older (72% of ticket buyers), female (72%) and white (75%). As expected, the movie played best in the South, with top states including Florida and Texas.

David A. Gross, who runs the movie consulting firm FranchiseRe called it “an excellent opening for a political documentary.”

“For any other film, with $75 million in costs and limited foreign potential, it would be a problem,” said Gross. “But this is a political investment, not a for-profit movie venture, and if it helps Amazon with a regulatory, taxation, tariff or other government issue, then it will pay back. $75 million is insignificant to Amazon.”

President Donald Trump and first lady Melania Trump arrive for the premiere of her movie

President Donald Trump and first lady Melania Trump arrive for the premiere of her movie “Melania” at The John F. Kennedy Memorial Center For The Performing Arts, Thursday, Jan. 29, 2026, in Washington. (AP Photo/Jose Luis Magana)

“Melania” is Ratner’s first film since he was accused of sexual misconduct in 2017. Multiple women, including the actor Olivia Munn, accused Ratner of sexual harassment and misconduct. Ratner has denied the allegations. Last fall, after Trump’s reported intervention, Paramount Pictures said it would distribute his “Rush Hour 4.”

“Melania,” which will stream on Prime Video following its theatrical run, was released globally. Shortly before its debut, South African distributor Filmfinity said it would no longer release it. The company said it changed course “based on recent developments.”

International ticket sales for “Melania” were expected to be minuscule.

Top 10 movies by domestic box office

With final domestic figures being released Monday, this list factors in the estimated ticket sales for Friday through Sunday at U.S. and Canadian theaters, according to Comscore:

1. “Send Help,” $20 million.

2. “Iron Lung,” $17.9 million.

3. “Melania,” $7 million.

4. “Zootopia 2,” $5.8 million.

5. “Shelter,” $5.5 million.

6. “Avatar: Fire and Ash,” $5.5 million.

7. “Mercy,” $4.7 million.

8. “The Housemaid,” $3.5 million.

9. “Marty Supreme,” $2.9 million.

10. “28 Years Later: The Bone Temple,” $1.5 million.

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‘ICE out’: Bad Bunny uses Grammy speech to speak out

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‘ICE out’: Bad Bunny uses Grammy speech to speak out

As awards season progresses, celebrities continue to speak out against the Trump administration’s immigration crackdown — especially in Minneapolis. Though some stars have opted for a slight nod of resistance with pins that say “ICE out,” others have been more vocal in their stances.

Upon accepting the Grammy Award for Best Música Urbana Album on Sunday night, Bad Bunny got straight to the point.

“Before I say thanks to God, I’m going to say ICE out,” the Puerto Rican performer said as soon as he approached the podium with award in hand.

After a standing ovation and cheers from the crowd, he continued.

“We’re not savage, we’re not animals, we’re not aliens. We are humans and we are Americans.”⁣

This is not the first time the artist has spoken out against the Trump administration’s rhetoric against immigrants in the United States. Last year, he announced he would no longer tour in the U.S., which drew criticism from some right-wing commentators.

Despite that pushback, Bad Bunny scored the headlining spot at this year’s Super Bowl and said he decided to “do just one date in the United States.”

The album Bad Bunny accepted the award for, “Debí Tirar Más Fotos,” also won Album of the Year, becoming the first primarily Spanish-language album to win the distinction in the ceremony’s 68-year history.

Kathleen Creedon is a platforms editor for MS NOW. She previously worked as a web producer for Vanity Fair.

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