The Importance of Health Care in Policy Decisions
Forget DOGE. Republicans are flirting with political peril as they take steps to dismantle Medicaid.
TroibNews 
As several GOP lawmakers faced criticism at town halls last week, speculation is growing about the implications of Elon Musk's Project Chainsaw — formally known as the Department of Government Efficiency — for the GOP's congressional majorities.
There are clear parallels to the early days of the 2010 Republican surge and the public outcry that preceded the "blue wave" which ended GOP control of the House in 2018.
However, discussions with insightful individuals from both parties suggest that the recent protests sparked by DOGE are not directly comparable at this point.
A more pressing concern for Republicans lies in their legislative priorities. Both the 2010 and 2018 House upheavals were driven by issues surrounding the Affordable Care Act—the most significant overhaul of American health care in recent history.
Now, Republican lawmakers are preparing to vote on a substantial domestic policy agenda, which may include significant cuts to Medicaid, a critical part of the nation's health care safety net, amounting to more than $800 billion over the next decade.
This is the real source of anxiety for the GOP. President Donald Trump has expressed his own reservations regarding Medicaid cuts, creating unease among the party's vulnerable members as Speaker Mike Johnson's budget seeks to appease his most conservative supporters.
Two vulnerable Republicans I spoke with over the weekend were dismissive of the backlash against Musk. “I’m all in on DOGE,” Rep. Tony Gonzales said on Sunday, contending that reducing the federal workforce is “wildly popular” among Republicans in his competitive district and is “weirdly a non-factor” for most others except extreme Democrats. Another vulnerable member, who requested anonymity to speak freely, labeled last week’s protests as “pearl-clutching” by the media and Democrats.
For both of these lawmakers, however, Medicaid represents a different concern.
“That’s where the battle’s coming,” Gonzales asserted. “There’s no doubt that there’s waste, fraud and abuse in every program in the government, including Medicaid — but at what point do you stop cutting into the fat and start cutting into the bone? You can’t pull the rug out from millions of people.”
Gonzales, whose district has a significant number of constituents enrolled in Medicaid, co-authored a letter with seven other House Republicans from districts with large Hispanic populations, urging Johnson to reconsider the GOP's course on Medicaid. He also plans to address the issue with the speaker at a scheduled meeting this evening.
Recent grassroots political movements provide valuable lessons: Americans often react strongly when they fear losing what they have.
In 2010, it was conservatives and moderates concerned that Democrats were attempting to drastically transform the health care system, threatening their own private coverage and increasing government involvement. Then, in 2018, millions of low- and middle-income Americans resisted GOP efforts to roll back federal subsidies and dismantle the ACA's widely supported protections for those with pre-existing conditions.
Currently, the GOP seems to assume that the public views Medicaid as a welfare program benefiting the poor and undeserving. The most favored method for reducing it involves imposing work requirements on “able-bodied adults.”
What they appear to overlook is the program's transformation over the past decade: the ACA expanded Medicaid enrollment beyond the very poor in many states, and countless seniors now depend on it for nursing and other high-level care. The program also supports safety-net hospitals, and cuts here could severely impact private healthcare budgets.
Notably, Trump seems to recognize this distinction. While he has not shown any hesitation regarding DOGE—arguing this weekend that Musk should be “MORE AGGRESSIVE” in cuts—he consistently expresses his disinterest in reducing Medicaid funding.
Nevertheless, the party is moving forward: Johnson wants a vote on a fiscal plan that mandates at least $880 billion in cuts primarily from Medicaid. Without these reductions, not only does Johnson risk alienating the right wing, but it also jeopardizes other GOP agenda items, including the proposed permanent extension of Trump's 2017 tax cuts.
This upcoming vote could mark the start of a real struggle to maintain the slim GOP majority.
“A win for the evening could cost him the majority a year later,” a well-informed Democrat remarked. “It’s the first step toward voting on these Medicaid cuts.”
It's not just Republicans in swing districts who are anxious. Steve Bannon, a key figure in the MAGA movement, argued on his War Room podcast that cuts to Medicaid could negatively impact working-class supporters of Trump. He stated, “Just can’t take a meat ax to it, although I would love to.”
Even some Trump allies, although dismissive of Bannon, concur with his viewpoint. A longtime confidant of Trump mentioned that many seniors who support him depend on Medicaid, not just Medicare, and that these voters are vocal if their benefits are threatened.
“It’s not just working people or the inner-city kids” from blue areas, the source observed, predicting that Trump would not permit the cuts: “This is something that is non-negotiable to [Trump].”
Meanwhile, Democrats are eagerly anticipating another GOP misstep regarding health care. Feeling pressure from their base to fight back, they are concerned that opposing the DOGE cuts might not deliver strong political messaging, unlike health care issues.
They are already investing millions in advertisements related to Medicaid across the nation.
Last month, Protect Our Care, a Democratic organization aimed at defending the ACA during previous Republican control, launched a $10 million campaign titled “Hands Off Medicaid.” This month, they have begun airing ads on Fox News targeting specific House Republicans, while the House Majority PAC, which seeks to regain control of the House, has been sharing statistics regarding Medicaid recipients in GOP districts.
Republicans may believe that the protests against DOGE will have minimal impact — even the most conservative districts include Democrats ready to show up at town halls. The initial backlash lacks the intensity witnessed during the GOP's attempts to repeal the ACA in 2017, which led to widespread outrage across the political spectrum.
However, those closely observing the developing situation understand the potential ramifications: You ain’t seen nothing yet.
Alejandro Jose Martinez for TROIB News
There are clear parallels to the early days of the 2010 Republican surge and the public outcry that preceded the "blue wave" which ended GOP control of the House in 2018.
However, discussions with insightful individuals from both parties suggest that the recent protests sparked by DOGE are not directly comparable at this point.
A more pressing concern for Republicans lies in their legislative priorities. Both the 2010 and 2018 House upheavals were driven by issues surrounding the Affordable Care Act—the most significant overhaul of American health care in recent history.
Now, Republican lawmakers are preparing to vote on a substantial domestic policy agenda, which may include significant cuts to Medicaid, a critical part of the nation's health care safety net, amounting to more than $800 billion over the next decade.
This is the real source of anxiety for the GOP. President Donald Trump has expressed his own reservations regarding Medicaid cuts, creating unease among the party's vulnerable members as Speaker Mike Johnson's budget seeks to appease his most conservative supporters.
Two vulnerable Republicans I spoke with over the weekend were dismissive of the backlash against Musk. “I’m all in on DOGE,” Rep. Tony Gonzales said on Sunday, contending that reducing the federal workforce is “wildly popular” among Republicans in his competitive district and is “weirdly a non-factor” for most others except extreme Democrats. Another vulnerable member, who requested anonymity to speak freely, labeled last week’s protests as “pearl-clutching” by the media and Democrats.
For both of these lawmakers, however, Medicaid represents a different concern.
“That’s where the battle’s coming,” Gonzales asserted. “There’s no doubt that there’s waste, fraud and abuse in every program in the government, including Medicaid — but at what point do you stop cutting into the fat and start cutting into the bone? You can’t pull the rug out from millions of people.”
Gonzales, whose district has a significant number of constituents enrolled in Medicaid, co-authored a letter with seven other House Republicans from districts with large Hispanic populations, urging Johnson to reconsider the GOP's course on Medicaid. He also plans to address the issue with the speaker at a scheduled meeting this evening.
Recent grassroots political movements provide valuable lessons: Americans often react strongly when they fear losing what they have.
In 2010, it was conservatives and moderates concerned that Democrats were attempting to drastically transform the health care system, threatening their own private coverage and increasing government involvement. Then, in 2018, millions of low- and middle-income Americans resisted GOP efforts to roll back federal subsidies and dismantle the ACA's widely supported protections for those with pre-existing conditions.
Currently, the GOP seems to assume that the public views Medicaid as a welfare program benefiting the poor and undeserving. The most favored method for reducing it involves imposing work requirements on “able-bodied adults.”
What they appear to overlook is the program's transformation over the past decade: the ACA expanded Medicaid enrollment beyond the very poor in many states, and countless seniors now depend on it for nursing and other high-level care. The program also supports safety-net hospitals, and cuts here could severely impact private healthcare budgets.
Notably, Trump seems to recognize this distinction. While he has not shown any hesitation regarding DOGE—arguing this weekend that Musk should be “MORE AGGRESSIVE” in cuts—he consistently expresses his disinterest in reducing Medicaid funding.
Nevertheless, the party is moving forward: Johnson wants a vote on a fiscal plan that mandates at least $880 billion in cuts primarily from Medicaid. Without these reductions, not only does Johnson risk alienating the right wing, but it also jeopardizes other GOP agenda items, including the proposed permanent extension of Trump's 2017 tax cuts.
This upcoming vote could mark the start of a real struggle to maintain the slim GOP majority.
“A win for the evening could cost him the majority a year later,” a well-informed Democrat remarked. “It’s the first step toward voting on these Medicaid cuts.”
It's not just Republicans in swing districts who are anxious. Steve Bannon, a key figure in the MAGA movement, argued on his War Room podcast that cuts to Medicaid could negatively impact working-class supporters of Trump. He stated, “Just can’t take a meat ax to it, although I would love to.”
Even some Trump allies, although dismissive of Bannon, concur with his viewpoint. A longtime confidant of Trump mentioned that many seniors who support him depend on Medicaid, not just Medicare, and that these voters are vocal if their benefits are threatened.
“It’s not just working people or the inner-city kids” from blue areas, the source observed, predicting that Trump would not permit the cuts: “This is something that is non-negotiable to [Trump].”
Meanwhile, Democrats are eagerly anticipating another GOP misstep regarding health care. Feeling pressure from their base to fight back, they are concerned that opposing the DOGE cuts might not deliver strong political messaging, unlike health care issues.
They are already investing millions in advertisements related to Medicaid across the nation.
Last month, Protect Our Care, a Democratic organization aimed at defending the ACA during previous Republican control, launched a $10 million campaign titled “Hands Off Medicaid.” This month, they have begun airing ads on Fox News targeting specific House Republicans, while the House Majority PAC, which seeks to regain control of the House, has been sharing statistics regarding Medicaid recipients in GOP districts.
Republicans may believe that the protests against DOGE will have minimal impact — even the most conservative districts include Democrats ready to show up at town halls. The initial backlash lacks the intensity witnessed during the GOP's attempts to repeal the ACA in 2017, which led to widespread outrage across the political spectrum.
However, those closely observing the developing situation understand the potential ramifications: You ain’t seen nothing yet.
Alejandro Jose Martinez for TROIB News
