The News
If Republicans stick to their current strategy for funding their tax cut bill, the midterm elections are heading toward a fight over something different altogether: health care.
The House GOP’s move to slash $715 billion in Medicaid and other health care spending is igniting familiar timber in the halls of Congress. Health care activists are protesting Republicans, Democrats are syncing up a unified message, and some in the GOP are pointedly questioning their leaders’ plans.
It’s a dynamic Jon Ossoff knows well. He ran for a House seat in the middle of the GOP’s Obamacare repeal attempts, and though he fell short in that race, he vastly overperformed. Today the Georgia Democrat is defending one of the most vulnerable Senate seats in the US.
“Deep cuts to Medicaid will be a political loser for any member who supports them. But even more worrying: It will hurt a lot of my constituents,” Ossoff told Semafor, citing an Atlanta Journal-Constitution analysis that projected “tens of thousands of Georgians will lose coverage.”
One of Ossoff’s potential opponents next fall, Rep. Buddy Carter, serves on the House GOP’s Energy & Commerce Committee — which just advanced the massive Medicaid spending reductions. Other House Republicans may also jump in the race.
“Jon Ossoff and his liberal friends are all in on saving benefits for illegal aliens over Americans who need the help. I don’t care how many lies they tell, I’ll always stand on the side of hardworking Americans,” Carter told Semafor in response.
Republicans are beginning to write part of Democrats’ platform for the midterms, a potential gift to a party still trying to rebuild from President Donald Trump’s victory and public skepticism about their handling of former President Joe Biden’s mental acuity. Congress’ nonpartisan scorekeeper says 8.6 million Americans could lose health insurance coverage as a result of the legislation; another score pegged the number at 7.6 million.
Those are big numbers — and they are pointing Democrats toward a political strategy to retake at least one chamber of Congress. Senate Minority Leader Chuck Schumer spent the April recess in six New York GOP congressional districts raising alarm about the cuts, a sign of how they may play in next year’s fights for House and Senate control.
“This is personal to people. This is not Washington bullshit. This is real,” Schumer told Semafor.
“From a political point of view, the best issues are the ones that generate from the people, not where the politician tells the person they should care about it.”
Democrats are simultaneously targeting Trump’s tariffs, but it’s not clear how long he will keep them in place. Trump’s ethical fouls, for much of the electorate, appear to be baked in.
Another reason that health care promises to resonate: While Democrats are criticizing the GOP tax cuts as overly focused on the wealthy, Republicans also stuffed their bill with other tax breaks on tips, overtime and for parents.
Schumer said the health care portion of the legislation is “absolutely” more politically salient than the tax cuts. Reversing Medicaid reductions “would be priority of business No. 1” when Democrats are back in power, said Sen. Ron Wyden, D-Ore.
Senate Majority Leader John Thune told Semafor that Democrats would argue Republicans want to deny people health coverage “no matter what” his party did on Medicaid. He said the bill’s changes “are designed not to impact beneficiaries,” adding that “there’s support for” work requirements and stopping health benefits for noncitizens.
Polls show voters dislike Medicaid cuts, but internal GOP polling shows support for work and proof of citizenship requirements. Republicans have for now backed off some of the bigger changes they were eyeing, like forcing states to pay a greater share for Medicaid expansion recipients.
But Rep. Ryan MacKenzie, R-Pa., who won one of the closest races in the country, told Semafor he relayed concerns over “changing benefit structures” to GOP leaders Thursday and is now awaiting a response.
He added that he’ll need “some more information” before signing off: “Hopefully we’ll see some changes.”
Know More
The nascent Democratic strategy originated during Trump’s first term, when Democrats found that the Affordable Care Act — which initially cost them congressional majorities — had become popular once voters got accustomed to its upsides.
The lesson Democrats learned: Creating new benefits is hard, but taking benefits away motivates many voters like nothing else.
“We paid a price for it at the polls. But in short order, they paid a price for trying to get rid of it,” Rep. Richard Neal, D-Mass., the top Democrat on the House Ways and Means Committee, told Semafor.
Schumer said the energy in his party was similar to 2017 but that the Medicaid changes could affect even more people than ACA repeal: “I think the depth is greater.”
Republicans aren’t done, and it’s unclear whether they’ll need to further weaken or strengthen their cuts to Medicaid. Most of them are comfortable with some coverage losses from work requirements for Medicaid expansion recipients and stripping coverage from undocumented people.
But there’s unease about slashing a provider tax that’s valuable in rural areas and charging co-pays for some Medicaid beneficiaries.
Sen. Josh Hawley, R-Mo., calls the co-pays a “sick tax on poor people” and is worried that the provider tax legislation could shutter rural hospitals. Democrats, he said, are “loving this.”
Conservatives are already upset that the GOP bill’s work requirements won’t kick in until 2029. Democrats perked up at Hawley’s op-ed in the New York Times calling Medicaid cuts “politically suicidal.”
If Republicans “pass it, this will be one thing we talk about more than anything else,” Sen. Mark Kelly, D-Ariz., said of Medicaid.
Republicans from battleground states say the plans are still in flux. Asked how he planned to discuss changes to Medicaid with constituents, battleground-seat Rep. Brian Fitzpatrick, R-Pa., replied that “none of that’s final right now.”
Sen. Thom Tillis, R-N.C., who has one of the toughest GOP seats to defend next year, said that the Medicaid language needs a “lot of work,” citing Hawley’s concerns. Another incumbent in a tough race, Sen. Susan Collins, R-Maine, has raised issues with the provider tax.
Sen. Joni Ernst, R-Iowa, who could also have a tough race next year, said she supported cutting off Medicaid access to people who shouldn’t have it but also wants to “hear from Iowans on this before making any hard and fast decisions.”
Burgess and Eleanor’s View
Republicans want a tax-cut election, not a health care election. Yet they’re unlikely to avoid one, if they can manage to pass their massive party-line bill this year.
That’s in part because the GOP appears to be in broad agreement — for now, at least — on imposing more strict work requirements for Medicaid recipients.
It seems plausible that Republicans jettison the proposed co-payments and provider tax but keep the rest.
And as long as there are Medicaid spending cuts at all, Democrats are going to make sure voters hear about it.
Room for Disagreement
House conservatives are insisting on more aggressive cuts to Medicaid to further offset nearly $4 trillion in tax cuts. Not to mention that party leaders say voters will agree with them about the changes on the table.
“Our message is simple: we’re safeguarding an essential lifeline for vulnerable Americans, while Democrats continue to take the wrong side of yet another 80/20 issue,” said Mike Marinella, a spokesperson for House Republicans’ campaign arm.
Notable
- Some Republicans want faster Medicaid cuts to pay for state and local tax deductions, per NBC.