Thread by @DutchRojas

𝐒𝐇𝐎𝐏𝐏—𝐇𝐨𝐰 𝐒𝐭𝐚𝐭𝐞𝐬 𝐏𝐫𝐢𝐧𝐭 𝐚𝐤𝐚 𝐑𝐈𝐏𝐎𝐅𝐅 𝐓𝐚𝐱 𝐏𝐚𝐲𝐞𝐫𝐬 𝐔𝐧𝐝𝐞𝐫 𝐭𝐡𝐞 𝐆𝐮𝐢𝐬𝐞 𝐨𝐟 𝐌𝐞𝐝𝐢𝐜𝐚𝐢𝐝

The most elegant heist in modern American history—and almost no one in Congress can explain it.

Let’s dissect this scheme the way you’d dissect any imperial fraud:
With facts, flow, and a little fire.

A Thread...🧵

Imagine a 17th-century monarchy so broke it begins taxing its own nobility…
Only to send the money back with royal interest, using a fake charity as cover.

That’s SHOPP. Supplemental Hospital Offset Payment Program

A fake tax, a fake payment, and real federal cash.
1/

Bookmark this.
You won’t hear it in committee hearings.

This isn’t good policy or reform.
It’s racket wrapped in a series of lies.

And the people profiting?
They’re not on your side.

The virtue-signalers.
The academic frauds.
The bipartisan swamp.

They all eat while patients wait.

Follow @DutchRojas if you’re done playing dumb.
This thread is your permission to stop pretending.
2/

𝐇𝐞𝐫𝐞’𝐬 𝐡𝐨𝐰 𝐭𝐡𝐞 𝐬𝐡𝐞𝐥𝐥 𝐠𝐚𝐦𝐞 𝐫𝐮𝐧𝐬:

•Health Systems “donate” money to the state (this is the “tax”)
•The state labels it as a Medicaid provider payment
•That triggers a federal match (up to 2:1 or more)
•The state sends the bloated payment right back to the same hospitals
•The hospitals get more than they gave
•The state keeps the spread

𝐓𝐡𝐢𝐬 𝐢𝐬𝐧’𝐭 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞.
𝐈𝐭’𝐬 𝐡𝐢𝐠𝐡-𝐟𝐫𝐞𝐪𝐮𝐞𝐧𝐜𝐲 𝐌𝐞𝐝𝐢𝐜𝐚𝐢𝐝 𝐚𝐫𝐛𝐢𝐭𝐫𝐚𝐠𝐞.
3/

𝐘𝐨𝐮’𝐝 𝐭𝐡𝐢𝐧𝐤 𝐚 𝐬𝐜𝐚𝐦 𝐭𝐡𝐢𝐬 𝐛𝐨𝐥𝐝 𝐰𝐨𝐮𝐥𝐝 𝐛𝐞 𝐜𝐨𝐧𝐭𝐫𝐨𝐯𝐞𝐫𝐬𝐢𝐚𝐥.

But 49 out of 50 U.S. Senators couldn’t explain what SHOPP even is.
Most don’t know it exists.

The rest are funded by the same health systems that profit from it.

We’re not witnessing ignorance.
We’re witnessing institutional capture.
4/

Let’s talk scale:

•Oklahoma SHOPP = $1.4B

•Texas variant = $5B+

•California’s Medicaid tax loop = $9B+

•Florida, New York, Illinois = similar stories

In total, tens of billions in synthetic Medicaid spending—recycled through state books to unlock a federal ATM.

Yes, Taxpayers are paying 2x for the same.
Once via State income tax and again Federal tax.
5/

And where does it go?

Not to patients.
Not to outcomes.
Not to rural physicians.

It goes to:

•Lobbyists
•Bondholders
•Construction projects
•Executive bonuses
•And “nonprofit” systems that behave like sovereign hedge funds

6/

And who’s left out?

•Independent physicians: no facility, no bonus
•Clinics and ASCs: blocked by policy
•Patients: fewer options, longer waits
•Taxpayers: footing the bill for corporate welfare

This isn’t a public health program.
It’s a capital market subsidized by the federal government, cleverly disguised as Medicaid.
7/

This is not accidental. It’s engineered.

Medicaid is now the largest source of bonus cash for U.S. health systems.
But only if you play the game at scale.

If you’re small, ethical, or independent?
You get scraps.

That’s not a market.
That’s a protection racket.

This is how empires collapse.

Not from war.
From internal theft disguised as benevolence.

RT this thread.
Tag a Senator.
Ask them what SHOPP is.
Watch them fumble.

@DutchRojas