WASHINGTON — Republicans’ big plan to cut taxes, fund border security and defense spending and fulfill all the key parts of President Donald Trump’s domestic agenda will rely on deep cuts to Medicaid.
But Republicans are risking a massive political backlash by cutting a program many of their constituents rely on.
Medicaid provides health insurance coverage to 72 million Americans, including millions of children, and is a vital safety net in many states full of Trump supporters. Louisiana, Kentucky, Mississippi, West Virginia and Arkansas are all among the 10 states with the largest shares of Medicaid recipients, according to the nonpartisan Henry J. Kaiser Family Foundation.
No Republican lawmaker has outright said they would oppose the GOP budget plan over Medicaid cuts, but several have suggested they’d rather not yank health care away from their less wealthy constituents.
“Large cuts to Medicaid would hurt a lot of people in my state — and we voted overwhelmingly for President Trump,” Sen. Shelley Moore Capito (R-W.Va.) said in an interview with HuffPost this week.
The debate over the future of Medicaid and other safety net programs is already roiling the GOP, as Republicans as hunt for savings to help pay for the $4.5 trillion in tax cuts President Donald Trump has demanded.
In the House, a group of moderate Republicans representing districts with sizable Hispanic populations warned Speaker Mike Johnson (R-La.) this week against imposing severe cuts to programs like Medicaid and federal food assistance. Johnson only has a narrow one-seat majority in the chamber, and a group of deficit hawks have been demanding he push for even sharper spending cuts, complicating efforts to pass Trump’s agenda.
In the Senate, Republicans seem sensitive to coming attacks about cuts to health care programs. During a marathon session of votes on their budget plan Thursday night, GOP senators adopted an amendment aimed at protecting Medicare and Medicaid. It was an effort to preemptively refute Democrats’ midterm election ads: See, we support Medicaid too.
But Democrats opposed the amendment, maintaining that it was written with a loophole that would allow for cuts to millions of beneficiaries. They offered a slew of other amendments to protect the program and prevent tax cuts for the wealthy, but those were voted down by the GOP majority.
West Virginia’s junior senator, Jim Justice, a former Democrat-turned-Republican, said he doubted “those sweeping changes that will really hurt people” would actually happen.
“Do I really believe that President Trump is going to do something that is really detrimental to millions of seniors? I think I don’t believe it. I don’t believe that’ll happen at all,” he said.
Other Republicans have drawn a harder line against cuts to health coverage. Missouri Sen. Josh Hawley told HuffPost: “I don’t like the idea of massive Medicaid cuts. We should have no Medicare cuts of any kind.”
Trump’s first-term attempts to repeal Obamacare — which would have rolled back Medicaid significantly and also stripped away protections for people with preexisting conditions — led to the lowest approval ratings of his tenure, and provided Democrats with the attack ads they needed to win back the House in 2018. The party is more than prepared to run the same playbook ahead of the 2026 midterm elections.
“Republicans have made it crystal-clear that gutting Medicaid is one of their main strategies for paying for their massive tax cuts,” Sen. Chuck Schumer (D-N.Y.) said this week.
The House Republican budget plan, which Trump has endorsed, calls for slashing as much as $880 billion from Medicaid to help finance the tax cuts. Half of Medicaid spending benefits people eligible due to old age or disability.
Lawmakers have not yet detailed how, exactly, they would achieve the savings, but House Speaker Mike Johnson (R-La.) has suggested they would reduce Medicaid spending partly through imposing limits on benefits to people who can’t show they’re working.
“Work is good for you. You find dignity in work. And the people that are not doing that, we’re going to try to get their attention,” Johnson said last week.
Tracy Hartnett is a 47-year-old Medicaid beneficiary in Jane Lew, West Virginia. She said she previously worked part-time as a cook in a public school, but her learning disability makes it difficult to hold a job — especially given that most of her energy goes toward taking care of her 70-year-old mother.
“My job is basically going up and visiting my mom in the nursing home and making sure she’s being taken care of the right way,” Hartnett told HuffPost. “There’s just no way I could go back to work with trying to take care of a family member that needs a lot of help.”
Medicaid pays for both Hartnett’s health expenses and her mother’s nursing home. The program covers a quarter of adults in West Virginia and most of the state’s nursing home residents.
A new work requirement would likely only apply to “able-bodied” adults and not people with disabilities, though it’s possible even disabled Medicaid enrollees would have to prove to the state why they should keep their coverage.
“They would be exempted, but they would have to still do the paperwork and prove they’re unfit to work,” Kim Musheno, a Medicaid expert with The Arc of the United States, a civil rights organization for people with disabilities, told HuffPost. “It’s very difficult for people with intellectual and developmental disabilities to jump through these hoops.”
Musheno pointed to Arkansas, one of several states that was allowed to set up a work requirement for Medicaid during the first Trump administration. About 25% of the population subject to the requirement lost coverage, according to KFF. Studies showed some enrollees were confused by the requirement or weren’t even notified of the change.
“A lot of people in Arkansas didn’t know about the new work requirements and didn’t fill them out, and they were pushed off,” Musheno said.
The Arkansas program came to an end when a federal judge ruled it was incompatible with Medicaid’s mandate to promote better health care for low-income Americans. A work requirement attached to a recent expansion of Georgia’s Medicaid expansion survived a different legal challenge, and is in place today.
The Supreme Court hasn’t ruled on work requirements yet, so their legality remains an unsettled matter — and could also depend on any new legislation Congress passes.
In January, Arkansas Gov. Sarah Huckabee Sanders (R) announced she would ask the Trump administration to let her bring the work requirement back, even if Congress doesn’t change the law.
“All Americans can contribute to that great future, but not if they are watching from the economic sidelines,” Sanders said.
