Why the Republican votes to potentially cut Medicaid matter

It put every one of those House GOP members on record: They are for cutting Medicaid.

By Jeff Nesbit

When every Republican House member but one voted to potentially cut $880 billion for Medicaid in the budget resolution—so that it could be used for tax cuts for millionaires and corporations—they immediately went on Fox News, Newsmax and rest of the GOP media ecosystem to complain loudly: Wait, wait, wait! It doesn’t say “Medicaid” in the bill! We didn’t cut Medicaid!

No, not yet. Budget bills are just blueprints. But what every GOP House member who just walked the Medicaid plank for President Donald Trump did, however, was make certain that the 2026 midterm elections will be about this vote.

It is the Democrats who are protecting Medicaid expansion in red, purple and blue states—and the GOP that is trying to destroy it. It is the Democrats who are doing everything in their power to keep tens of millions of Americans in those states on a lifesaving, affordable health insurance plan—and Republicans who want to strip them of that safety net.

Whenever the reconciliation bill Trump is demanding passes in 2025, the GOP will use mealy mouth, squishy words about finding “waste, fraud and abuse” in the Medicaid system to come up with that $880 billion. It’s the same playbook DOGE—Elon Musk’s Department of Government Efficiency— is using to dismantle federal agencies. It says it’s hunting for “waste, fraud and abuse”—when it’s really just destroying.

Because, finding $880 billion in cuts to Medicaid to pay for tax cuts for the rich will mean cutting millions of Americans from Medicaid. But they will do it with budget trickery, mind-twisting regulations, and opaque rules out of the Centers for Medicare and Medicaid Services they now control. And they will pray no one knows how they’re cutting Medicaid by $880 billion.

That’s why the budget bill vote matters. It put every one of those House GOP members who voted for this on record: They are cutting Medicaid. And some of the House GOP members will pay for it in the 2026 midterm elections. Many votes in Congress don’t really matter. This wasn’t one of those. It will matter.

“The House Republican budget resolution will set in motion the largest Medicaid cut in American history,” House Democratic Leader Hakeem Jeffries (D-N.Y.) said immediately after the vote.

“House Republicans have just taken one of the most morally reprehensible actions Congress has seen in a generation,” Sen. Ron Wyden (D-Ore.), the ranking member of the Senate Finance Committee, said when the bill passed. It’s a “devil’s bargain to slash health care for kids, seniors and working Americans to pay for tax cuts for billionaires and big corporations. Republicans clearly understand cuts to Medicaid will have deadly consequences for the families they represent, and yet they have chosen to move ahead anyway. Republicans will rue the day they decided to go after Medicaid,” he said.

So, before Trump and desperate House GOP members try to rewrite history or obscure how Democrats in the Biden administration continued to expand Medicaid to now 41 states—and extended postpartum Medicaid health care coverage for new moms for up to a year in 48 states and the District of Columbia—it is worth understanding where we are with Medicaid right now and how we got here.

More than 79 million low-income people in the United States are covered by Medicaid— including 49% of all children. The federal government covers part of the cost. States are responsible for the rest.

Under President Joe Biden, the Department of Health and Human Services built financial incentives for states so they could expand Medicaid under the Affordable Care Act. Twenty-one of the states that expanded Medicaid voted for Trump in 2024, which is why the Medicaid cut budget bill vote is so perilous for GOP House members.

Medicaid is also the primary payer for long-term care in the United States, and quite often covers nearly all of the costs of prescription drugs. Biden’s HHS also granted a number of Medicaid waivers so that people couldn’t be dropped from the Medicaid rolls. Both of these huge pocketbook issues—health care costs and the potentially crippling cost of prescription drugs— and assurances that you won’t be cut from a social safety net insurance program such as Medicaid matter a lot to Trump voters.

Americans—from both parties—really like Medicaid. In the Kaiser Family Foundation’s most recent tracking poll, 77% of Americans held favorable views of Medicaid, including 63% of Republicans. Medicaid is also viewed favorably by a majority of voters—62%— who say they voted for Trump in the 2024 election.

But those very same Trump voters almost certainly have no idea—because it is never, ever talked about in the media they read and hear and see—that the House GOP probably just voted to cut Medicaid by $880 billion so that the 2017 Trump tax cuts for the wealthy could continue.

It is sad, even tragic, that these same Trump voters seem to have no idea that it is the Democrats who are fighting for them on Medicaid, while Trump and the Republican Party they voted for that are determined to undermine or outright destroy it.

Jeff Nesbit was the assistant secretary of health for public affairs at HHS in the Biden administration.

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