A showdown is brewing in Congress over looming cuts to Medicaid needed to pay for President Donald Trump’s tax cuts and anti-immigrant agenda, with hardliners pushing to slash the health care safety net while Republicans from swing districts worry about cutting programs their voters rely on.
Republicans who wooed working-class voters in the last election have every reason to be concerned. Medicaid and related programs provide health insurance for nearly 80 million adults and children, but potential cuts outlined in the budget resolution passed by House Republicans this week would leave millions with less money to pay for food and housing while boosting incomes for the extremely wealthy by 3.9 percent, according to an analysis by the Economic Policy Institute.
While Republicans are considering cuts to multiple safety net programs to pay for Trump’s priorities, including the extension of his signature 2017 tax cuts, the cuts to Medicaid alone would reduce incomes for the bottom 40 percent of households far more than the tax cuts would boost them.
Due to increased health care expenses, the average household among the bottom 20 percent of earners would see a 6.8 percent dent in their budget on average. The decrease in income among the lowest-paid workers would be even higher in states that rely heavily on Medicaid; for example, in West Virginia and New Mexico, lower-income Medicaid recipients would lose an average 13 and 16 percent of their income under the proposed cuts.
Wealthy people, on the other hand, don’t need Medicaid but enjoy much larger tax breaks under the Trump plan. While the lowest 40 percent of earners would save between 0.6 and 1 percent of their income on taxes, the wealthiest 1 percent would save 3.9 percent on taxes, which is a significant amount of money considering their level of income.
Working families are visibly frustrated with the private health insurance system, and polls show that voters want the government to spend more on health care spending, not less. Facing protests from members representing blue-collar districts, Republicans can’t get their story straight.
President Trump said on Fox News last week that Republicans are not going to “touch” funding for Social Security, Medicare and Medicaid, popular programs that, along with Pentagon spending, make up a large share of the discretionary budget. However, the next day, Trump threw his support behind the House budget resolution, which calls for $2 trillion in spending cuts while boosting military and immigration enforcement spending by an additional $1 billion.
Republicans attempted to dodge backlash by arguing the budget resolution does not specifically mention cuts to Medicaid or SNAP, the food assistance program for low-income families. However, that portion of the legislation has not been written yet.
In a press conference on Tuesday, House Speaker Mike Johnson refused to rule out cuts to Medicaid but said Republicans are only interested in rooting out unspecified “waste, fraud, and abuse” in the program, a worn-out talking point the GOP has used multiple times in the past when pursuing unpopular Medicaid cuts.
The House budget resolution directs the Energy and Commerce Committee to make $880 billion in cuts that mathematically must come from Medicare, Medicaid or both. The EPI analysis is based on this figure. Medicare is popular and provides health coverage for seniors, including many Trump voters, and Medicaid is widely seen as the most likely target.
Health care advocates say Republicans are “gaslighting” voters, and Democrats are expected to highlight Medicaid cuts in the media over the coming weeks. Congress faces a March 14 deadline to pass legislation funding the government, which will likely require bipartisan support.
“The House Republican budget resolution will set in motion the largest Medicaid cut in American history,” House Minority Leader Hakeem Jeffries told reporters after the vote on Tuesday.
Trump’s demand for a “big, beautiful bill” that includes tax cuts and more border spending without totally exploding the federal deficit has put Johnson in a political pickle. Republicans have a slim majority in the House and can’t afford to lose members on big votes. After watching their colleagues struggle to pass even basic legislation in the last session, Senate Republicans have prepared a competing budget plan for Trump’s agenda that does not include the tax cut extension.
Last week, eight GOP members of the Congressional Hispanic Caucus warned in a letter to Johnson that the coming cuts to Medicaid would have “serious consequences” on families and clinics across the country that depend on the program for funding.
Rep. Rob Bresnahan, a freshman Republican from a blue-collar district in Pennsylvania, where Medicaid recipients could lose up to 8 percent of their incomes under the proposed cuts, voted for the resolution but issued a statement warning against cuts to Medicaid. Bresnahan unseated a long-time Democratic incumbent, and Trump also won his district in November.
“If a bill is put in front of me that guts the benefits my neighbors rely on, I will not vote for it,” Bresnahan said.
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