Republicans once maligned Medicaid. Now some see a program too big to
touch
[March 03, 2025]
By AMANDA SEITZ
WASHINGTON (AP) — Every time a baby is born in Louisiana, where
Republican House Speaker Mike Johnson handily won reelection last year,
there’s more than a 60% chance taxpayers will finance the birth through
Medicaid.
In Republican Rep. David Valadao ’s central California district, 6 out
of 10 people use Medicaid to pay for doctor visits and emergency room
trips.
And one-third of the population is covered by Medicaid in GOP Sen. Lisa
Murkowski's Alaska, one of the nation’s costliest corners for health
care.
Each of these Republicans — and some of their conservative colleagues —
lined up last week to defend Medicaid, in a departure from long-held GOP
policies. Republicans, who already have ruled out massive cuts to Social
Security and Medicare, are turning their attention to siphoning as much
as $880 billion from Medicaid over the next decade to help finance $4.5
trillion in tax cuts.
But as a deadline to avoid a partial government shutdown nears,
hesitation is surfacing among Washington's Republican lawmakers — once
reliable critics of lofty government social welfare programs such as
Medicaid — who say that deep cuts to the health care program could prove
too untenable for people back home.
“I've heard from countless constituents who tell me the only way they
can afford health care is through programs like Medicaid,” Valadao said
on the House floor. “And I will not support a final reconciliation bill
that risks leaving them behind.”
And on Wednesday, President Donald Trump, too, made his position on
Medicaid clear: “We’re not going to touch it.”
States and the federal government jointly pay for Medicaid, which offers
nearly-free health care coverage for roughly 80 million poor and
disabled Americans, including millions of children. It cost $880 billion
to operate in 2023.
Johnson has ruled out two of the biggest potential cuts: paying fixed,
shrunken rates to states for care and changing the calculation for the
share of federal dollars that each state receives for Medicaid. Just a
few years ago, Johnson spearheaded a report that lobbied for some of
those changes during the first Trump administration.
Johnson insisted in a CNN interview that the focus will instead be
ferreting out “fraud, waste and abuse" in Medicaid, although it's
unlikely to deliver the savings Republicans seek.
GOP pressure over Medicaid is mounting, with some state party leaders
joining the calls to preserve the program. States are already struggling
with the growing cost of sicker patients and could be left to cover more
if the federal government pulls back. In some states, the federal
government picks up over 80%.
More than a dozen Minnesota GOP lawmakers wrote the president recently
warning that “too deep of a cut is unmanageable in any instance.” Gov.
Joe Lombardo, R-Nev., told Congress in a letter that “proposed
reductions would put lives at risk." In Alaska, state Senate Majority
Leader Cathy Giessel, a Republican and nurse, cited “huge concerns”
during a floor speech.
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President Donald Trump speaks during a Cabinet meeting at the White
House in Washington, Wednesday, Feb. 26, 2025. (Pool via AP)
 Nationally, 55% of Americans said
the government spends too little on Medicaid, according to a January
poll from The Associated Press-NORC Center for Public Affairs
Research.
“It’s now a very popular program that touches a
very broad cross-section of American society,” said Drew Altman,
president of the health care research firm KFF. “Roughly half of the
American people say that they or a family member have at one time
been served by the program.”
Significant changes to Medicaid are still on the table. They have to
be for Republicans get the savings they need to pay for tax cuts.
Work requirements, which could save as much as $109 billion over the
next decade, seem to have solid support among GOP members, with some
individual Republican-led states already moving to implement them.
Republicans also could consider cuts in benefits or coverage, as
well as eliminating a provider tax that states use to finance
Medicaid, Altman added.
Democrats warn that reductions are inevitable and could be dire.
Starting Monday, TV ads will caution people across 20 congressional
districts that hospitals are at risk of closing and millions of
people could lose coverage if Republicans cut Medicaid "to fund
massive tax cuts for Elon Musk and billionaires.” The Democratic
super political action committee House Majority Forward has launched
the seven-figure campaign.
Trump and Republicans have for years called for lowering government
spending on health care, but they have struggled to formulate a
serious plan that gains traction. Trump, for example, has spent
nearly a decade arguing for an overhaul of the Affordable Care Act.
His efforts to repeal the Obama-era national health care law failed
during his first term, and in his most recent presidential campaign
he offered only “concepts of a plan” to adapt the program.
Michael Cannon, a director of health studies at libertarian Cato
Institute, believes Medicaid needs an overhaul because it is a
significant part of the federal budget and a contributor to the
nation's growing debt.
But Republicans, he said, are not looking at serious ways to drive
down the cost of health care.
“The only reason for the cuts right now is to pay for the tax cuts,”
Cannon said. “None of them are talking about the need to do better
health reform.”
___
Associated Press writer Becky Bohrer in Juneau, Alaska, and AP
Congressional Correspondent Lisa Mascaro contributed to this report.
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