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Early in Donald Trump’s first term, Steve Bannon met with some House Republicans who were wavering on whether to vote for a Trump-backed bill that would have slashed Medicaid, the federal-state program that today pays medical bills for about 72 million low-income Americans.
Bannon, who at the time was a senior White House adviser, read them the riot act: “This is not a debate,” he said, as Axios reported at the time. “You have no choice but to vote for this bill.”
Eight years later, Trump and the Republicans are back in power ― and maybe laying the groundwork for a similar vote. The budget proposal House Republicans voted out of committee on Thursday night envisions massive spending reductions virtually certain to include Medicaid, in part to finance the tax cuts Trump has said are his top legislative priority.
But this time around, Bannon has some different advice for the Republicans ― and the Trump White House, too.
“A lot of MAGA is on Medicaid,” Bannon said on Thursday, during an interview on Fox. “If you don’t think so, you are dead wrong. Medicaid is going to be a complicated one. You just can’t take a meat ax to it, although I would love to.”
Bannon probably understands this better than most high-profile figures in American politics. The proposed Medicaid cuts during Trump’s first term were part of legislation to repeal the Affordable Care Act, aka Obamacare. That bill proved spectacularly unpopular ― and ultimately failed to pass ― in part because even many diehard Trump supporters would’ve stood to lose health coverage had it succeeded. Which is exactly what could happen now, as Bannon knows.
But these days, it’s not just cuts to Medicaid threatening Trump supporters.
Since reassuming the presidency, Trump has issued a torrent of executive orders that seek to limit, downsize or even eliminate key federal programs and agencies. To implement all of this, Trump has deputized adviser and billionaire tech tycoon Elon Musk, whose Department of Government Efficiency has been laying off federal workers by the thousands and blocking federal spending by the billions.
Trump says the purpose of these orders and Musk’s demolition tour of the executive branch is to eliminate wasteful spending ― and, no less important, to clean out the left-wing, “woke” politics that he says have infected these federal initiatives. Which may or may not be worthwhile on the merits, depending on your perspective.
But whatever the rationale, the effect is likely to be especially strong in communities where Trump is popular. Some have already taken a hit. The question now is how quickly that realization sets in, and whether anything changes as a result.
What DOGE Looks Like In Rural America
One Republican who seems to understand is Katie Britt, the senator from Alabama. Last weekend, a reporter from AL.com asked her to react to news that the National Institutes of Health was sharply reducing its research grants. The University of Alabama-Birmingham is a top recipient of NIH grants, and also Alabama’s largest employer.
Britt said she was all for cutting waste, to make sure taxpayer dollars are “spent efficiently, judiciously and accountably.” But she added that she wanted to work with the administration on “a smart, targeted approach … in order to not hinder lifesaving, groundbreaking research at high-achieving institutions like those in Alabama.”
It sounded a lot like a warning, or at least an objection, especially from a staunch Trump supporter. And it wasn’t the only one out there. Bill Cassidy, the Republican senator from Louisiana who also happens to be a physician, told STAT News: “One thing I’ve heard loud and clear from my people in Louisiana is that Louisiana will suffer from these cuts. And research that benefits people in Louisiana may not be done.”
Louisiana, like Alabama, is a strongly pro-Trump state. It also gets about $300 million a year in NIH research funding, according to an analysis of public data by the Louisiana Illuminator. Other solidly red states with big NIH-backed institutions include Texas and Tennessee. The rural sections of these states ― or any state, really ― can be especially dependent on NIH money, because universities, teaching hospitals and affiliated clinics may be the only large employers there, and the sole providers of major medical care, as well.
As of Friday, a judge has temporarily blocked the NIH funding reduction, citing federal law that would seem to prohibit the Trump administration from making those cuts unilaterally. The same goes for orders that have effectively shut down most foreign aid through the U.S. Agency for International Development.
Cuts at USAID might seem less likely to have a perceptible effect stateside, because American jobs don’t generally depend on foreign assistance. But in farm country, they do, because that’s where USAID gets food: Farmers, who voted overwhelmingly for Trump, could lose as much as $2 billion if food aid goes away.
“You’re talking about a direct impact on American products and American jobs,” George Ingram, a senior fellow at the Brookings Institution, told the Washington Post.
Republican lawmakers from Kansas, Arkansas and other rural states are rallying behind legislation to save the primary food aid program by moving it out of the State Department and over to the Department of Agriculture.
And they aren’t the only GOP lawmakers making the case to protect programs on the Trump target list. Nearly two dozen House Republicans have been lobbying their leadership to spare federal subsidies for electric vehicles that Trump has said he is determined to eliminate.
It’s not the potential of backsliding on climate progress that worries these Republicans. It’s the potential of losing jobs in their districts, which are home to new, sprawling EV factories in what’s become known as the “battery belt” stretching across the South. And what’s true for EVs is true for the clean energy push more generally: The money that President Joe Biden and the Democrats invested in projects like solar and wind power has gone disproportionately to Republican districts.
Take the money away, and it’s those districts that could suffer disproportionately.
How Republican Leaders Might React
Just what that suffering would look like in practice is hard to say. Cuts may not turn out to be as devastating as critics fear or say — and, in the case of the executive actions Trump and Musk have been carrying out, it’s always possible the courts will block these cuts, as they have with DOGE’s attempted NIH funding reduction.
But Trump is already well on his way to making some long-term changes — by, among other things, getting his appointees confirmed. That includes Robert F. Kennedy Jr., whose nomination as Secretary of Health and Human Services once seemed to be in doubt because even some Republicans seemed queasy about his repeated, dishonest attacks on vaccines.
Among those voting yes were Sen. Cassidy, a vocal Kennedy critic, which is a reminder that even Republicans raising concerns about elements of the Trump agenda may vote to support them anyway. As for Sen. Britt, 24 hours after expressing concern about those NIH cuts, she was hanging out with Trump at the Super Bowl in New Orleans.
Kennedy’s confirmation wasn’t the only vaccine-related news this week. The other piece was word of a measles outbreak that has already infected two dozen people in Gaines County, Texas, where the vaccination rate is among the lowest in the state — and where more than nine out of ten voters picked Trump in 2024.
That’s not surprising. Republican-leaning voters are less likely to trust or get vaccines, studiesandpolls have shown. And Trump has made plenty of vaccine-skeptical statements of his own.
Installing Kennedy at HHS at the very least reinforces that message. At worst, it turns U.S. vaccination policy over to somebody who has spent a career making false and misleading statements on vaccine safety. In either case, Trump’s own supporters could feel the effects most directly — though perhaps only when it’s too late to stop them.
