Here’s How to Lose Midterms
Considering Medicaid cuts is a sign of advanced political derangement.
Medicaid cuts are political suicide.
Medicaid, like every massive program undertaken by human beings, has good points and bad points, and I’m not terribly interested in trying to tally them up here. I’m not an economist or an accountant; nor am I a healthcare expert. I can use my eyes, read, and do basic arithmetic, though, and there is very little ambiguity: If the Republicans want to go for a paddle in their own blood at midterms, monkeying with Medicaid funding is a terrific start.
The calculus here is very simple: If you want a multiethnic, working-class coalition of voters—and the going theory is that this is the coalition that put Donald Trump in the White House a second time—Medicaid cuts are a terrific way to blow that up. Look at the numbers! Seventy-seven percent of Americans view Medicaid favorably or very favorably. Sixty-four percent of Republicans view it favorably or very favorably. Around 18.9 percent of Americans are on Medicaid. In the swing states: Pennsylvania, 21.5 percent; Wisconsin, 18.6 percent; Michigan, 21.7 percent; Nevada, 21.7 percent; Arizona, 24.2 percent; North Carolina, 22 percent; Georgia, 15.5 percent. In other states the Republicans are eyeing, the percentage is even higher: New Mexico’s enrollment is over 33 percent.
The Congressional Budget Office found that Medicaid (and Medicare and CHIP) cuts are going to have to figure in a solution to hit the GOP’s ambitious budgeting goals. If the Republicans wish to stay in power, well, maybe those goals have to change. Here’s another calculus for you: Is it worth sacrificing your political power to reduce spending that the Democrats will immediately reinstate after your inevitable ignominious election loss? I am but a humble journalist, yet, to me, this is a no-brainer. Sometimes you have to take a stand for principle and take the political hit, but ideally you won’t do it for mere ephemera.
There is little question that the American healthcare system is enormously dysfunctional. It is not, in itself, a terribly good sign that such a large portion of the American population is enrolled in Medicaid; in fact, the consistent rise in enrollments are in part a legacy of that old bogeyman, the Affordable Care Act or “Obamacare,” which directly led to massive premium distortions. The healthcare market itself is an impossibly creaky Rube Goldberg machine of subsidized demand and perverse incentives. Yet the political reality remains that a large number of voters—including lower-middle class voters who are gainfully employed—rely on Medicaid to cover their families’ legitimate insurance needs. (Even more rely on CHIP, the ACA’s insurance subsidies.) They are going to feel screwed if you cut the program, and they are not going to want to vote for you.
This isn’t a far-out, John-the-Baptist-style prophecy of political doom. Steve Bannon, the MAGA movement bellwether (and, perhaps, 2028 presidential contender), observed, “A lot of MAGA’s on Medicaid. If you don’t think so, you’re dead wrong. Medicaid’s gonna be a complicated one. You just can’t take a meat axe to it.”
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This all is not to say that there aren’t plenty of ways you can improve the program. It is estimated that, in 2023, there was something in the ballpark of $50 billion worth of improper Medicaid payments—that is to say, fraud—but only about $1.25 billion was recovered. Directing the Department of Justice to put more resources toward welfare fraud is a political winner and will save a buck or two. House Speaker Mike Johnson’s proposed work requirements, depending on how they’re implemented, aren’t necessarily political poison either. But these measures won’t get the budget over the proposed line.
So the proposed line needs to change. In a democracy (roughly speaking), sometimes you are faced with two bad choices. The state of the American fisc is appalling, as even mainstream sources have started to concede. But reforming it can occur only within the bounds of the politically possible. Cuts that will bring back the Democrats’ spending disco—not to mention the rest of their policy suite—are not in the long run helpful. Nor even in the short term: Midterms are not so very far in the future.
The Republicans weren’t catapulted into government on a program of revolutionary fiscal austerity. Their mandate is to bring back normality, or rather the fading memory of “normal America” that persists in the hearts and minds of the majority of American voters. (The actually existing normality of the past 20 years has not been to their liking.) While the first weeks of the Trump administration have been chock-full of ’90s-style attacks of fraud, waste, and abuse, they are only one part of a program to reorient America’s economy, culture, and place in the world—a program that aims to reduce mass reliance on entitlements like Medicaid. Is a premature suicide attack on a massively popular welfare program worth the candle?
