Medicaid is the hill Democrats must die on
Last week, I asked, “Why is no one talking about the millions of Americans the House GOP wants to uninsure?” and answered my own question:
Punchbowl.
This DC-insider newsletter, which makes a killing softening and amplifying House Republican whispers, stuffed wool in our eyes. It decided to cover a statement from vulnerable House Republicans as a refusal to endorse massive Medicaid cuts. Instead, the letter was a go-ahead for Speaker Johnson to uninsure millions of Americans—something only a healthcare-wonk-and-a-half like Andrew Sprung had noticed.
Since then, the reporting has gotten better.
The Bulwark’s Jonathan Cohn, the dean of America’s health care scribes, offered a comprehensive state of the GOP’s war on Medicaid with the appropriate headline, “Health Insurance for Millions Is Now on the Chopping Block.”
The great Charles Gaba followed up with “Republicans have decided which 21 million Americans should lose their healthcare.”
Charles explained how these cuts would shift the burden of coverage of Medicaid expansion to the states and likely uninsure a group of Americans bigger than populations of New Mexico, Nebraska, Idaho, West Virginia, Hawaii, New Hampshire, Maine, Montana, Rhode Island, Delaware, South Dakota, North Dakota, Alaska, the District of Columbia, Vermont, and Wyoming COMBINED.
He also noted:
The imminent threat to healthcare coverage for literally tens of millions of Americans being posed by the budget resolution recently passed by House Republicans, which (fortunately) still has a number of points where it can potentially be stopped.
This got me thinking.
Sympathy for the Senators
As I stood at a Hands Off protest early this month, I marveled at the startling variety of signs. There were so many issues, so much hurt, and so much to fight.
It gave me some sympathy for Democratic Senators who want to fight—something we’ve seen much more this month than in the past two.
We’ve been saying, “We want you to fight.”
They seem to be saying, “But for what? Everything? Then what stands out?”
It’s a reasonable point.
I agree with those who believe that Democrats will eventually have to slow down or shut down Congress in any way they can. The illegality and harm of the Trump/Musk regime have already warranted extreme measures in defense of liberty.
However, the opposition has to make sense to the people doing it and those who need to be informed. That’s the only way an act of mass resistance can inspire the nation. Perhaps the bigger challenge is that the issue must first unite the Democrats in Congress and give them the courage to fight in a way that will make everyone uncomfortable. That issue is Medicaid.
And we can win.
How the GOP's plan can backfire
Republicans think they’re being sly by targeting Medicaid expansion.
It’s a part of Obamacare—probably the best part of Obamacare—and it goes to “able-bodied” Americans. Also, ten red states have not expanded it, so Republicans think GOP elected officials in those states will likely pay less of a political cost from cutting this funding.
Ironically, those are reasons why I believe this is an excellent issue for Democrats, starting with expansion.
Republicans aren’t just vowing to uninsure the 21 million Americans with Medicaid coverage through expansion; they’re denying insurance to another 2.7 million who could get coverage if the Republicans in their states take it.
That allows Democrats to go on the offense in states like Texas, Florida, and Georgia and demand Republicans increase coverage, not shrink it to pay for wildly unpopular tax cuts (and no-bid contracts and the gutting of the IRS so they can’t track rich people’s unpaid taxes) for guys like Elon Musk.
Even if they don’t take the chance to go on offense, this should put Republicans on defense in the states they need to do well in to have any hope of winning the House—including California, New York, and Pennsylvania.
Charles has broken down how many people would lose expansion coverage in every Congressional district in America.
While Republicans love spitting on workers on expansion, saying they’re “able-bodied,” thus don’t deserve the health insurance that might keep them that way, this makes the people who will lose their coverage even more sympathetic.
Democratic Congressmen can find plenty of admirable families who will lose their coverage to highlight in speeches, ads, and town halls. And since this is about health care and the GOP Congress and not a direct fixation of Trump, getting those people to speak out will be a lot easier.
Telling their stories will be essential, as many Americans don’t know they’re on Medicaid due to the variety of names the program goes by in different states.
Plus, Medicaid expansion is really, really great, and cutting it is really, really bad
The benefits of Medicaid expansion are almost surreal.
- It cuts crime, especially drug arrests.
- It increases families’ entire financial well-being.
- It creates jobs.
- It helps hospitals.
(Imagine if everyone had Medicaid as baseline coverage. Sounds like something someone could run on in 2028.)
And the harms of not expanding or taking it away include massive self-inflicted wounds:
- Horrendous damage to rural hospitals, including reducing or eliminating essential services, delaying much-needed equipment upgrades, or closing their doors entirely.
- Increasing insurance costs for the rest of the insurance marketplace.
- DEATH.
And fighting for Medicaid expansion also gives Democrats everywhere a chance to rail against the damage that Bloodthirsty Bobby Jr. has in mind for all Americans.
Politics as usual but also not
Saving the ACA and Medicaid was one of the great victories of the first Trump regime. And if we hadn’t done it, the horrific effects of Trump’s bungling of the pandemic and turn against public health in general would have been far worse.
This is a winnable political fight, but it’s also a unifying platform for the most important effort of this moment: building a mass movement to save our Constitution.
This issue unites Democrats around what has been their best issue on the ballot. It does so in direct opposition to billionaires, and it rallies us around working-class Americans who largely abandoned the party at the polls in 2024.
And it also takes on the biggest problem for the party: the fight deficit.
As messaging maestro Anat Shenker-Osorio noted:
2 years, 2-4 focus groups a week with surge and swing and the answers to "what most bothers you about Dems" have never - and I mean zero times - been pronouns, trans rights or even defund. It is ALWAYS they don't get anything done, they don't fight.
They want us to fight.
To get this party to fight, we need a winnable demand (that polls well) that will benefit all Americans, especially those who work hardest for the lowest wages.
This is it.
And we should be preparing Democrats in Congress with our demand for them: DO ANYTHING YOU CAN TO STOP THIS.
Trump and Musk have tossed the Constitution and are forcing the courts to stop them if they can. We need to escalate to show we’re willing to fight just as hard as they cheat. This will require creativity, courage, and a willingness to get called by the press that sees Democrats as the only humans with any agency.
This is the hill to die on because if we don’t, our neighbors will die—for nothing.
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