Photo: Michael Nigro/Sipa USA / AP Photo
Anyone who has watched Republicans closely during the entirety of this century would be justified in expecting great joy in GOP circles at the prospect of smashing Medicaid this year. This program, which provides health care for poor people, has always been unpopular among Republicans, dating all the way back to Ronald Reagan’s attacks on the original legislation that created both Medicaid and Medicare. Precisely because Medicare, the classic “middle-class entitlement” to which old folks at any income level automatically qualify, has been a bit of a third rail for Republicans, Medicaid, with its constituency of poor people assumed to lean Democratic and its associations with “welfare,” has always been a tempting target.
In the long Paul Ryan era of Republican budget-cutting efforts (when Ryan was House Budget Committee chairman and then House Speaker), Medicaid was always on the chopping block. And when the program became a key element of Democratic efforts to expand health-care coverage in the Affordable Care Act sponsored by Republicans’ top enemy, Barack Obama, Medicaid’s status as the program tea-party Republicans wanted to kill most rose into the stratosphere. No wonder that the last time the GOP had a governing trifecta, in 2017, there was no single “big beautiful bill” to implement Trump’s entire agenda, but instead an initial drive to “repeal and replace Obamacare” along with measures to deeply and permanently cut Medicaid. Rolling back health coverage for those people was Job One.
So now that Trump has returned to office with another trifecta in Congress, an alleged mandate, and a big head of steam that has overcome every inhibition based on politics, the law, or the Constitution, you’d figure that among the massive federal cuts being pursued through every avenue imaginable, deep Medicaid cuts would be the ultimate no-brainer for Republicans. Indeed, the budgetary arithmetic of Trump’s agenda all but demands big Medicaid “savings,” which is why the House budget resolution being implemented right now calls for cuts in the neighborhood of $600–$800 billion. And it’s clear that the very powerful House Freedom Caucus, thought to be especially near and dear to the president’s heart, is rabid for big Medicaid cuts.
To be sure, the extremely narrow GOP margin in the House means that so-called “moderate” Republicans (really just Republicans in marginal districts) who are chary of big Medicaid cuts are one source of intraparty pushback on this subject. But the shocking and arguably more important dynamic is that some of Trump’s most intense MAGA backers are pushing back too. OG Trump adviser Stephen Bannon issued a warning in February, as The New Republic’s Edith Olmsted reported:
Steve Bannon, former architect of the MAGA movement turned podcaster, warned that Republicans making cuts to Medicaid would affect members of Donald Trump’s fan club.
On the Thursday episode of War Room, while gushing over massive government spending cuts, Bannon warned that cutting Medicaid specifically would prove unpopular among the working-class members of Trump’s base, who make up some of the 80 million people who get their health care through that program.
“Medicaid, you got to be careful, because a lot of MAGA’s on Medicaid. I’m telling you, if you don’t think so, you are deeeeeead wrong,” Bannon said. “Medicaid is going to be a complicated one. Just can’t take a meat ax to it, although I would love to.”
Bannon didn’t comment on the irony that it was the hated Obamacare that extended Medicaid eligibility deep into the MAGA ranks (with voters in deep-red Idaho, Missouri, Nebraska, Oklahoma, and Utah insisting on taking advantage of it), making it a dangerous target for GOP cuts. But in any event, particularly given Trump’s occasional promises that he’d leave Medicaid alone (which didn’t keep him from supporting the deep 2017 cuts), there existed some MAGA sentiment for finding “savings” elsewhere.
The volume of this sentiment went up sharply when one of the flavor-of-the-year right-wing “influencers,” Trump buddy Laura Loomer (reportedly fresh from laying waste to the National Security Council staff) went after a conservative think-tanker who was advising HFC types on how to savage Medicaid, per Politico:
In a social media post Monday, Loomer called Brian Blase, the president of Paragon Health Institute, a “RINO Saboteur” for helping draft a letter circulated by 20 House conservatives that advocated for deep cuts to Medicaid in the GOP’s domestic policy megabill.
“In a shocking betrayal of President Donald Trump’s unwavering commitment to America’s working-class families, and his promise to protect Medicaid, [Brian Blase] … is spearheading a dangerous campaign to undermine the Republican Party’s midterm prospects,” Loomer said on X.
Loomer’s blast at Blase was clearly a shot across the bow of the House Freedom Caucus and other Republicans who are lusting for Medicaid cuts and/or are focused on deficit reduction as a major goal. She called Medicaid “a program critical to the heartland voters who propelled Donald Trump to his election victories” and warned that Medicaid cuts could badly damage Republicans in the 2026 midterms.
The perpetually shrewd health-care analyst Jonathan Cohn thinks MAGA ambivalence about Medicaid cuts could be a game-changer. After citing data from Trump’s own pollster showing support for Medicaid among Trump supporters, Cohn noted this could have an impact in Congress:
Trump himself has said he is going to protect Medicaid — although, as is always the case, it’s hard to know exactly what he means, how seriously he means it, or how much thought he has even given to the matter.
But Trump’s own uncertainty here is telling, just like the pushback to Medicaid cuts from the likes of Loomer. Together they are a sign of just how much the politics around government health care programs has changed in the last few years — and why this piece of Trump’s big, beautiful bill is proving so tough to pass.
It wouldn’t be that surprising if there’s a thunderbolt from the White House on this subject before the House budget reconciliation bill is finalized. If there isn’t, nervous House Republicans may be forced to read his ever-changing mind.
