In the heart of Louisiana, where Republican House Speaker Mike Johnson secured an impressive reelection victory, a significant number of newborns—more than 60%—enter the world with Medicaid footing the bill. Meanwhile, in central California’s Republican Rep. David Valadao’s district, Medicaid covers medical expenses for six out of every ten individuals, whether it’s a visit to the doctor or a trip to the emergency room. Up North, in Alaska, one of the nation’s priciest health care landscapes, Medicaid extends its coverage to a third of the population, under the watch of GOP Sen. Lisa Murkowski.
Recently, a noticeable shift emerged among certain Republican lawmakers, as they began to publicly defend Medicaid, diverging from traditional GOP stances. Historically, Republicans have been stern critics of Medicaid, alongside other substantial government social welfare programs. Nonetheless, in a bid to outline a financial framework to usher in $4.5 trillion in tax cuts, the GOP has ruled out large-scale reductions to Social Security and Medicare but continues to cast an eye over Medicaid.
As efforts to prevent a partial government shutdown loom closer, some Republicans in Washington express growing reticence about imposing severe cuts on Medicaid. This program, which provides near-free health care services to roughly 80 million low-income and disabled Americans, including millions of children, is jointly funded by both state and federal governments, having cost $880 billion in 2023. Lawmakers like Valadao openly state they cannot endorse any reconciliation bill that threatens constituents’ access to Medicaid, pointing out it’s often the bedrock of their health care affordability.
President Donald Trump has voiced his stance, declaring, “We’re not going to touch it,” regarding potential Medicaid cuts. Meanwhile, Speaker Johnson has publicly stated opposition against two substantial cut proposals: setting fixed reduced rates for states or altering the federal contribution calculation each state receives. Johnson did highlight a focus on “rooting out fraud, waste, and abuse” within Medicaid, though experts warn these measures are inadequate for generating the desired savings.
The pressure to safeguard Medicaid is climbing as state leaders join the chorus urging caution. Some states already shoulder heightened costs due to a growing number of sicker patients and could face increased burdens if federal contributions diminish. States like Minnesota, where several GOP lawmakers appealed to the president, highlight the dire impacts of excessive cuts, calling them “unmanageable.” In letters to Congress, figures such as Nevada’s Governor Joe Lombardo mention the potential risk to citizens’ lives.
Amid growing concern, approximately 55% of Americans believe the government underfunds Medicaid, as per a January poll from the Associated Press-NORC Center for Public Affairs Research. KFF President Drew Altman notes the widespread impact Medicaid has, touching a broad segment of American society, with around half of Americans either directly benefiting or knowing someone who has.
Talks of changing Medicaid linger, considered essential by Republicans to meet savings targets for tax reform. Proposals include implementing work requirements, projected to save up to $109 billion over a decade. These reforms enjoy considerable support within the GOP, with some Republican-led states already adopting such measures. Discussions also entertain the possibility of reducing benefits or cutting a specific provider tax aiding Medicaid financing.
Democrats counter that proposed reductions spell trouble, arguing unavoidable consequences could be severe. Starting next week, a new advertising campaign aims to alert constituents in 20 congressional districts about potential hospital closures and loss of coverage if Republicans pursue Medicaid cuts to finance significant tax breaks for billionaires.
Despite recurrent calls from Trump and Republican allies for reduced government spending on health care, a robust plan remains elusive. This stems from past unsuccessful attempts, such as the bid to dismantle the Affordable Care Act. Michael Cannon from the Cato Institute contends Medicaid reform is necessary due to its considerable federal budget portion and impact on national debt. Nonetheless, he criticizes current GOP efforts as more focused on tax cuts than substantive health care reform.
