Republicans just delivered Donald Trump a “big, beautiful” legislative win. Now they’re fretting it will lead to some ugly electoral losses.
GOP lawmakers are warning that slashing spending on Medicaid and food assistance will cost the party seats in the midterms — threatening their razor-thin House majority — by kicking millions of Americans off safety-net programs.
“You would be foolish not to worry about it,” Sen. Jim Justice (R-W.Va.) said in a brief interview. “If you don’t keep the voters right with you, you’re going to awaken to a bad, bad, bad day.”
Justice voted for the megabill last week, despite his concerns over some of its Medicaid provisions — and after warning Republicans “cannot cut into the bone.” Steep cuts, he said, would cost the GOP voters and lead the party to “awaken to [being in the] minority.”
Republicans have already lost one of their most vulnerable senators over the bill: North Carolina’s Thom Tillis, who privately told his colleagues he would lose his seat over Medicaid cuts before announcing his retirement and publicly torching the public-health overhaul on the Senate floor. Another vulnerable GOP senator, Susan Collins of Maine, opposed it over the “harmful impact” Medicaid cuts would have on low-income families and rural health care providers.
“When you don’t get health care right, it tends to have probably an outsized impact on politics,” Tillis said in a brief interview ahead of the Senate’s vote. He warned his party that slashing Medicaid could become a political albatross, like the Affordable Care Act was for Democrats during Barack Obama’s presidency.
The final bill, passed by the House Thursday, delivered a $1 trillion-plus cut to health care programs and could lead to an estimated 11.8 million people losing their insurance.
House Speaker Mike Johnson privately cautioned that the deeper cuts the Senate passed could cost him his slim majority next year, though he ultimately whipped his members to support the changes. Several Republicans said the cuts would make the bill a tougher sell to their voters.
Adding to the GOP angst: Democrats are preparing to weaponize the bill as they did Republicans’ failed efforts to repeal the Affordable Care Act in 2017. That 2018 midterm election led to a GOP wipeout in the House, with the party losing 40 seats, including some districts in Trump-leaning territory. Democrats are planning to again hitch vulnerable Republicans to the cuts to social safety-net programs.
“I could have defended the House bill every day,” said GOP Rep. Don Bacon, who had raised concerns over cuts to food aid and announced he would retire from his Nebraska swing seat as the Senate prepared to deepen the cuts in the House bill.
“The other side is going to use Medicaid as an issue,” he said, even as he voted for the megabill. “And I think the Senate [version of the bill] gives them a little more leverage to do so.”
Republicans are walking a tightrope as they return to their districts to start selling the sweeping policy package. They’re going to lean into the megabill’s popular provisions, like eliminating taxes on tips, while trying to escape unpopular reductions to safety-net programs. The final bill slashes spending by $1.7 trillion.
Voters broadly dislike the megabill; some recent polling shows a 2-to-1 margin of disapproval, according to surveys conducted by Quinnipiac University, The Washington Post, Pew Research and Fox News. Nearly half of voters want more federal funding for Medicaid, while just 10 percent want less, according to Quinnipiac.
“What we know from past elections is that messing with people’s healthcare coverage is very problematic for politicians. And it has, in the past, yielded some very, very negative views about the people who supported it,” said Republican pollster Whit Ayres.
Meanwhile Democrats are rushing to capitalize on the controversy and plan to make it a centerpiece of their midterm messaging.
House Minority Leader Hakeem Jeffries spoke on the floor for eight hours and 45 minutes, reading letters from constituents of vulnerable GOP lawmakers who could lose access to both programs. Democratic candidates followed up with post-vote statements blasting the Republicans they’re looking to unseat for effectively kicking people in their districts off their health care plans.
Their campaign arms and allied super PACs have already released several rounds of ads hammering vulnerable Republicans and say they plan to keep up the pace.
Republicans are trying to figure out how to fight back.
Their early salvos have focused on painting Democrats as supportive of tax hikes since they opposed a bill that would extend Trump’s 2017 tax cuts and eliminate federal taxes on tips and overtime. Republicans also argue they’re protecting the “most vulnerable” Medicaid recipients by removing undocumented immigrants and others they say shouldn’t have access to the program anyway.
But in a tacit acknowledgment of the potential electoral fallout, some Republicans have pledged to try to reverse provisions such as the provider tax drawdown before they take effect in 2028.
“To the extent that there’s reform, and … you can legitimately argue it’s the waste, fraud, abuse, that’s a good position to be in,” said Rep. Russ Fulcher (R-Idaho). “If it’s just strictly a situation where you say, ‘We’re just cutting and spending’ and it’s not cognizant as to how and where, that’s where we get into trouble.”
Another potential security blanket for the GOP: Many Americans at risk of steep Medicaid cuts reside in deep-red swaths of the country that are unlikely to turn blue next year. But there are also high percentages of Medicaid enrollees in some GOP-held swing districts Democrats are itching to flip.
The Senate’s harsher Medicaid language prompted Rep. Brian Fitzpatrick (R-Pa.) to vote against the megabill, putting him in the company of deficit hawk Rep. Thomas Massie (R-Ky.). Fitzpatrick, in a statement, said the Senate’s changes “fell short” of protecting constituents in his suburban Philadelphia district that has more than 100,000 enrollees.
Another top Democratic target, Rep. David Valadao (R-Calif.), voted in favor of the bill despite expressing “several concerns” with the stricter limits on provider taxes and state-directed payments that he unsuccessfully lobbied Senate Majority Leader John Thune not to include.
Valadao lost his seat in Democrats’ health-care-fueled 2018 wave, when liberal groups successfully yoked him to GOP efforts to overturn the Affordable Care Act, and won it back in 2020. Now those groups are running the same playbook in his Central Valley district that enrolls nearly two-thirds of his constituents in Medicaid — the highest percentage in the GOP conference.
Valadao, who fought for months to rein in some of the changes to the program, sought to justify his vote in a statement Thursday by arguing “it does preserve the Medicaid program for its intended recipients” and includes a $50 billion stabilization fund to offset harm to rural hospitals.
New York Rep. Mike Lawler, whose lower-Hudson Valley district has more than 200,000 people enrolled in Medicaid, said in a brief interview that he “fought extensively to make sure that there were not draconian changes to Medicaid” and that lawmakers will have time to address some of the others before they take effect.
“At the end of the day, this is about strengthening the program,” he said. As for electoral consequences: “You just tell people what’s actually in the bill, as opposed to what the Democrats have been trying to fearmonger on.”
But Democrats are confident that “putting shine on a turd” will not work, said Ian Russell, a consultant who served as the political director of Democrats’ House campaign arm in 2014 and 2016.
“Republicans are running back their 2018 playbook,” said CJ Warnke, communications director for House Majority PAC, the Democratic leadership-aligned super PAC. “And it’s once again going to cost them the majority.”
Samuel Benson, Cassandra Dumay, Melanie Mason, Nicholas Wu and Holly Otterbein contributed to this report.
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