Republicans are going through a nationwide backlash over the destiny of Medicaid — however the potential program cuts are most threatening in seven conservative-leaning states the place voters have forged ballots to develop the entitlement lately.
It’s a rising drawback as Republicans hunt for sufficient financial savings to pay for the White Home’s proposed tax cuts.
Republican Sen. Mike Rounds of South Dakota, which has enrolled greater than 24,000 individuals in Medicaid since voters expanded the insurance coverage program for low-income individuals in 2022, informed POLITICO he’s been arguing towards a few of his personal occasion’s proposals. One would cut back considerably how a lot funding for this system comes from the federal authorities.
“That is not a price reducing measure — that is a price switch,” he stated. “And if you’ve obtained partnerships with the states, you should not be doing that with out having them concerned within the dialogue.”
Republicans face comparable skepticism throughout pink and purple swaths of the nation the place voters have used poll initiatives to develop Medicaid since Congress final focused the protection internet medical insurance program in 2017 – not solely in South Dakota, but additionally in Idaho, Nebraska, Maine, Oklahoma, Missouri and Utah. President Donald Trump gained all of these states besides Maine. And even there, he gained an electoral vote by defeating Kamala Harris within the state’s 2nd Congressional District, the place nearly a third of people are enrolled in Medicaid.
The president’s conflicting steerage to Congress about whether or not and the way a lot to chop from this system suggests he’s conscious of the political peril.
Further states might develop Medicaid within the coming years, making future rollbacks much more difficult. There’s at present a marketing campaign underway in Florida to place growth on the poll in 2026, underscoring the recognition of Medicaid even in probably the most MAGA-friendly states.
“Chopping Medicaid appears to be widespread with some Republican elites and a few proper wing suppose tanks which can be getting funded by some proper wing billionaires, however they’re unquestionably not widespread with the Republican voters,” Joan Alker, the chief director of the Middle for Kids and Households at Georgetown College’s McCourt Faculty of Public Coverage, informed reporters at a briefing on Medicaid this week. “We have seen many polls not too long ago asking voters to rank what they wished … and reducing Medicaid was actually the final on the record for voters of all stripes.”
Coalitions on the bottom within the seven states that handed Medicaid growth initiatives — made up of highly effective hospital associations, grassroots advocacy teams and different unusual bedfellows — at the moment are re-mobilizing to defend them. They’re sending individuals to city halls. They’re publishing op-eds in native newspapers. They’re flooding the cellphone traces of their members of Congress. They usually’re mulling a revival of among the extra aggressive ways activists used to protest makes an attempt to repeal the Inexpensive Care Act in 2017.
“We’re going again to the outdated playbook,” stated Matt Slonaker, the chief director of the Utah Well being Coverage Mission who spearheaded the state’s poll initiative marketing campaign in 2018. “It is at all times onerous to get of us to behave, however they appear to be actually, actually prepared to do that proper now.”
With stress mounting to search out tons of of billions in financial savings, lawmakers who’re often on board with slashing authorities spending stay on excessive alert concerning the blowback they might face of their states over Medicaid. And as they wrestle to maintain their members united behind Trump’s price range plan, GOP management is taking discover.
Home Speaker Mike Johnson on Wednesday evening backed away from among the most sweeping adjustments the GOP had been debating, together with capping the funds states get for every Medicaid enrollee and rolling again federal help for growth states, at the same time as he dismissed outrage his members have not too long ago confronted over threatened cuts at fiery city halls throughout the nation because the work of “paid protesters.”
“All this consideration is being paid to Medicaid as a result of that’s the Democrats’ speaking level,” Johnson stated. “We’re speaking about discovering efficiencies in each program, however not reducing advantages for individuals who rightly deserve them.”
Professional-expansion well being care teams in these seven pink and purple states mounted costly and time-consuming poll initiative campaigns to avoid conservative state legislatures and governors who refused to develop Medicaid, and a few of those self same state officers are at present working to roll again the expanded protection their constituents enacted.
That’s left Republicans on Capitol Hill from Medicaid-expansion states because the loudest — and in some circumstances the one — efficient voices of opposition to the proposed cuts now that Democrats are locked out of energy. And whereas some Home Republicans who characterize pink districts are feeling the warmth, senators must reply to their whole state.
“I do not fairly suppose Republicans know the backlash they’re in for,” stated Brad Woodhouse, a former Democratic Nationwide Committee official who now runs the progressive well being care advocacy group Shield Our Care. “And it is going to be a very bitter capsule in these states which have used poll initiatives as a result of in these circumstances, the voters have actually spoken about their desire.”
Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — each of whom hail from states that expanded Medicaid by poll measure — crossed the aisle earlier this week to help a Democratic modification to the Senate budget resolution that might have blocked tax cuts for the rich if any Medicaid funding is reduce.
Hawley, who represents about 326,000 individuals who turned eligible for Medicaid underneath the state’s 2021 growth, has stated he wouldn’t help “extreme” cuts to Medicaid — particularly cuts that might result in lowered advantages — calling it a “red line” for securing his vote.
The politics are particularly difficult for representatives of extra rural states the place Medicaid has been a lifeline for hospitals struggling to maintain the lights on — hospitals that in some situations are among the many state’s greatest employers.
In Idaho, for instance, voters permitted increasing Medicaid in 2018 with 61 p.c help, extending protection to about 90,000 extra residents. But when federal funding for Medicaid decreases on account of the present negotiations in Washington, the state legislature has the facility to intervene and doubtlessly repeal the growth. Idaho Home Minority Chief Ilana Rubel, a Democrat, is amongst these warning that such an consequence would threaten the state’s remaining rural hospitals.
“That is a catastrophe, not just for the individuals on Medicaid, however for the individuals on non-public insurance coverage,” Rubel stated. “As a result of if you dwell in these rural areas, you understand you may have one of the best insurance coverage on the earth, but when the hospital in your space has gone out of enterprise and also you fall off a ladder or have a coronary heart assault, there will likely be no one that will help you.”
But not each Republican from an growth state is nervous concerning the sweeping reforms hardliners of their caucus are pushing for.
Sen. James Lankford of Oklahoma, the place greater than 245,000 individuals turned eligible for protection after the state voted to develop Medicaid in 2020, echoed Speaker Johnson’s argument that the ultimate price range wouldn’t affect people’ well being care advantages and stated he hadn’t heard from involved residents about it.
“I’ve not heard anybody speaking about reducing off Medicaid to individuals,” he stated. “It has been coping with formulation. It has been coping with fraud.”
Utah Sen. John Curtis informed POLITICO this week that after discussing the matter with Republican Gov. Spencer Cox, he’s not sweating the political implications.
He stated he is “not close to as involved” about cuts to the protection internet program as he’s “concerning the fiscal irresponsibility that we’re going through,” including that he’s “in whole concord with our state leaders on this.”
Medicaid enrollment in Utah grew practically 60 p.c after a poll measure increasing this system handed in 2018. However Utah is among the many 9 states that has a “set off” legislation in place to routinely finish Medicaid growth or require main adjustments to this system if federal funds decline, threatening protection for hundreds of thousands of individuals.
For Curtis, that’s a characteristic relatively than a bug.
“Our state is one in every of extra fiscally accountable states, in my view, they usually noticed this coming,” he stated.
