Photo: Andrew Harnik/Getty Images
From practically the moment the 2024 election returns were complete, it’s been obvious the new Republican regime in Washington would pursue major cuts to Medicaid in order to finance tax cuts for the wealthy. How did we know that? First of all, its Trump 1.0 predecessors did so in 2017 and failed, which had to stick in many craws. Second, the budgetary arithmetic of the agenda Donald Trump campaigned on required major domestic-spending cuts while putting the largest domestic-spending programs, Social Security and Medicare, off-limits. Third, the narrow margin of GOP control over the House added to the already formidable leverage held by the House Freedom Caucus, whose members are all but frothing for the demolition of programs like Medicaid. Fourth of all, the over-the-top triumphalism surrounding the election has encouraged a sense of political invincibility in a party whose leaders believe they are on the brink of a major voter realignment in their favor.
So it’s not surprising Democrats early on were talking about Republicans planning “tax cuts for billionaires paid for by Medicaid cuts,” not just because they knew it was an effective message but because it was a prophecy guaranteed (at least roughly) to come true. It has been fascinating to watch congressional Republicans deny, deny, deny this reality through a variety of means that are becoming less available every day.
During the run-up to the passage of a budget resolution in the House, Speaker Mike Johnson reassured Republicans in marginal districts who were getting hammered over Medicaid that there were no actual Medicaid cuts in that resolution. This was technically true in the sense that the words “Medicaid cuts” did not appear in the legislation. But its whole purpose was to set up a budget reconciliation bill that would in fact all but require Medicaid cuts, thanks to an instruction to the Energy and Commerce Committee to find $898 billion in mandatory spending cuts — there’s no way the committee could find that kind of dough elsewhere. And even as he was disclaiming any bad intent toward Medicaid in public, Johnson was privately guaranteeing at least $1.5 trillion in mandatory spending cuts to the FC zealots.
With the budget resolution now in the bag, House Republicans are moving toward drafting the reconciliation bill and are beginning to break the news that Medicaid is indeed on the butcher’s block. But Johnson and his allies are becoming adept at claiming that while many hundreds of billions of dollars may get whacked, it won’t affect actual Medicaid beneficiaries. Here’s the Speaker at his weaselly best at the beginning of this week:
House Speaker Mike Johnson (R-La.) said Sunday that Republicans would protect entitlement programs as they press ahead with deep cuts to federal spending, but he added the government must “eliminate people on Medicaid” who are not “eligible to be there.”
“The president has made absolutely clear many times, as we have as well, that we’re going to protect Medicare, Social Security, Medicaid, for people who are legally beneficiaries of those programs,” Johnson told Maria Bartiromo on Fox News’s “Sunday Morning Futures.”
“At the same time, we have to root out fraud, waste and abuse, we have to eliminate on, for example, on Medicaid who are not actually eligible to be there. Able-bodied workers, for example, young men, who are — who should never be on the program at all,” he added.
One person’s “waste, fraud, and abuse” is, of course, another’s basic benefits, as we have learned once again from the DOGE crusade to gut federal agencies with disfavored programs and services whether they are run efficiently or not. So that’s just agitprop. Just as importantly, Johnson is playing games with the idea of “eligibility.” Perhaps he believes “able-bodied workers” and “young men” shouldn’t receive Medicaid, but at least in the 41 states that have accepted the Affordable Care Act’s Medicaid expansion, many of them are eligible so long as their incomes are low. Saying you don’t want to cut benefits for anyone who was eligible for Medicaid many years ago is cold comfort to those losing benefits now.
An equally alarming bit of indirection came this week from Commerce Committee chairman Brett Guthrie, who told Politico he might achieve “added savings from lowering the share of federal payments for certain beneficiaries in states that have expanded Medicaid.” In nine of those states, any reduction in the federal match rate would automatically cancel the expansion, with those covered by it losing benefits instantly; in three others, the expansion would be immediately reviewed. But in all 41 expansion states, coverage would be at risk unless states immediately come up with more money to make up for federal cuts. These are “Medicaid cuts” and “benefit cuts” by any reasonable definition, if only via a cost shift.
Beyond such word games, the biggest dodge on Medicaid is being pursued by Senate Republicans, whose own committees have been told they only have to come up with a small fraction of the cuts the House is pursuing under the same budget resolution. That’s because the Senate is pretending that $3.6 trillion in tax cuts are cost-free under an extremely dubious scoring method. Even if the Senate parliamentarian that polices that chamber’s budget rule buys this unprecedented maneuver, the same House fiscal hawks who are lusting for Medicaid cuts are insisting they won’t go along with it. To keep them from rebelling against the budget resolution, Republican leader John Thune publicly said his chamber could if necessary produce the same $1.5 trillion in cuts the House has promised to achieve. Where do you suppose that’s going to come from?
So Medicaid cuts are on the way, even though just today a group of 12 House Republicans warned Johnson not to go there. So it’s more important than ever for GOP leaders to keep their plans closely held even as they profess love for Medicaid beneficiaries. Perhaps the most audacious cover-up effort has involved a pressure campaign against billboard companies selling space to Democrats who want to advertise what’s going to happen to Medicaid, as The Hill reports:
The House GOP’s campaign arm in recent weeks has successfully pressed three advertising companies to pull down Democratic billboard displays bashing vulnerable Republicans over Medicaid — a setback to Democratic campaigners hoping to make health care a liability for battleground Republicans around the country.
In a series of cease and desist letters, the National Republican Campaign Committee (NRCC) said the imposing roadside ads — sponsored by a splinter group of the top Democratic super PAC in six battleground districts — promoted “patently false” claims against the targeted GOP incumbents, warning the companies that they would be complicit in defaming those lawmakers if the billboards were left up for public consumption.
At some point, Republicans are going to have to stop denying they’re doing what they’re doing, unless they are willing to redo their budget plans entirely.
