Latest news with #Medicaid-cutting
Vox
03-07-2025
- Politics
- Vox
Does Trump really not understand his huge bill cuts Medicaid?
is a senior politics correspondent at Vox, covering the White House, elections, and political scandals and investigations. He's worked at Vox since the site's launch in 2014, and before that, he worked as a research assistant at the New Yorker's Washington, DC, bureau. President Donald Trump, joined by House Speaker Mike Johnson (R-LA) and other lawmakers, holds up an executive order he signed in June.A strange thing happened on the way to Republicans' passage of their big Medicaid-cutting bill: We learned that President Donald Trump seems unaware the bill will cut Medicaid. Trying to line up support for the bill in a private call Wednesday with House Republicans, Trump offered his advice that, if they want to win elections, they shouldn't touch Medicare or Social Security — or Medicaid. His comments were reported by Riley Rogerson and Reese Gorman of NOTUS. This is a bizarre thing to say, because Medicaid is the single program being cut the most in the bill. Estimates suggest that its spending could end up cut by as much as 18 percent, causing about 8 million people to lose Medicaid coverage. And this isn't a one-off thing. For months, Trump has publicly promised to protect Medicaid, and reports have described him as queasy about Congress's plans to do otherwise. This puts Vice President JD Vance, who has talked a big game about changing the GOP to appeal more to low-income voters, in an awkward place. On X this week, he attempted to change the subject from the bill's Medicaid cuts, arguing they were 'immaterial' and 'minutiae' compared to the immigration enforcement money that really matters. Privately, many Republicans know differently. 'Group texts are blowing up and frantic phone calls are being exchanged among GOP lawmakers alarmed about the Senate Medicaid provisions,' Politico reported this week. It would be no surprise if Trump and Republicans misled about these cuts in public — GOP officials have been claiming that the Medicaid cuts are purely about limiting waste, fraud, and abuse. But the fact that Trump misstated this so blithely in private, to a friendly audience, is more strange. It suggests he truly is unaware what his 'big, beautiful bill' will do. Why the bill ended up cutting Medicaid deeply despite Trump's repeated promises not to To at least try to understand what's going on here, it's worth grappling with why this bill cuts Medicaid in the first place. Trump's priorities for his bill were tax cuts, immigration enforcement money, and raising the debt ceiling. This is all very expensive, and most of it will just add to the debt. But conservatives in the House insisted that at least some spending cuts had to be included, to partially offset the bill's cost. So GOP leaders searched for cuts that would be sizable — in the hundreds of billions of dollars range. Joe Biden's clean energy subsidies were one obvious target. It's hard, though, to come up with big cuts that aren't politically toxic. As budget wonks know, the real money in the federal budget is in Social Security, Medicare, Medicaid, and defense. Trump had no desire to cut defense, and the Trump-era GOP has deemed the senior-focused Social Security and Medicare politically untouchable. Medicaid, aimed at low-income people, is a different story. Conservatives have long viewed it, along with food stamps and welfare, with suspicion, arguing that government benefits like these disincentivize work and get exploited by the lazy and undeserving. Medicaid beneficiaries are also believed to be less likely to turn out at the polls. These longstanding conservative arguments have been slow to adjust to the news that Medicaid recipients have been an increasing share of the Trump coalition, as he's helped the GOP gain among low-income voters. Many low-income whites in rural areas are on Medicaid, as are low-income Latinos in areas where Trump has done well, such as California's Central Valley. That dissuaded congressional Republicans from even more extreme Medicaid cuts some had wanted — but they still hit the program hard. The Medicaid cuts that made it into the bill were, however, crafted in roundabout ways that Republicans argued were just aimed at waste, fraud, and abuse. These included new work reporting requirements. In theory, a requirement to document your working hours in exchange for coverage may not sound like a cut; in practice, the process will likely be arduous and error-filled and result in many working people losing coverage. The bill also limits the 'provider tax' states may change — a key way many states help finance Medicaid, since provider taxes are reimbursed with federal matching funds — among other changes. All that added up to hundreds of billions in savings, on paper. But behind those savings is 8 million people losing their Medicaid coverage, as well as a potentially devastating impact on rural hospitals that rely on Medicaid payments.
Vox
03-07-2025
- Politics
- Vox
Why Trump's big legislative win could be short-lived
is a senior politics reporter at Vox, where he covers the Democratic Party. He joined Vox in 2022 after reporting on national and international politics for the Atlantic's politics, global, and ideas teams, including the role of Latino voters in the 2020 election. President Donald Trump speaks during an address to a joint session of Congress at the US Capitol on March 4, 2025. Allison Robbert/AFP via Getty Images President Donald Trump is about to achieve his biggest legislative victory yet: His 'big, beautiful bill' — the massive tax- and Medicaid-cutting, immigration and border spending bill passed the Senate on Tuesday — is on the verge of passing the House of Representatives. It's a massive piece of legislation, likely to increase the national debt by at least $3 trillion, mostly through tax cuts, and leave 17 million Americans without health coverage — and it's really unpopular. Majorities in nearly every reputable poll taken this month disapprove of the bill, ranging from 42 percent who oppose the bill in an Ipsos poll (compared to 23 percent who support) to 64 percent who oppose it in a KFF poll. Today, Explained Understand the world with a daily explainer, plus the most compelling stories of the day. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. And if history is any indication, it's not going to get any better for Trump and the Republicans from here on out. In modern American politics, few things are more unpopular with the public than big, messy bills forged under a bright spotlight. That's especially true of bills passed through a Senate mechanism called 'budget reconciliation,' a Senate procedure that allows the governing party to bypass filibuster rules with a simple majority vote. They tend to have a negative effect on presidents and their political parties in the following months as policies are implemented and campaign seasons begin. Part of that effect is due to the public's general tendency to dislike any kind of legislation as it gets more publicity and becomes better understood. But reconciliation bills in the modern era seem to create a self-fulfilling prophecy: forcing presidents to be maximally ambitious at the outset, before they lose popular support for the legislation and eventually lose the congressional majorities that delivered passage. Presidents and their parties tend to be punished after passing big spending bills The budget reconciliation process, created in 1974, has gradually been used to accomplish broader and bigger policy goals. Because it offers a workaround for a Senate filibuster, which requires 60 votes to break, it has become the primary way that presidents and their parties implement their economic and social welfare visions. The public, however, doesn't tend to reward the governing party after these bills are passed. As political writer and analyst Ron Brownstein recently pointed out, presidents who successfully pass a major reconciliation bill in the first year of their presidency lose control of Congress, usually the House, the following year. In 1982, Ronald Reagan lost his governing majority in the House after using reconciliation to pass large spending cuts as part of his Reaganomics vision (the original 'big, beautiful' bill). And the pattern would repeat itself for George H.W. Bush (whose reconciliation bill contradicted his campaign promise not to raise taxes), for Bill Clinton in 1994 (deficit reductions and tax reform), for Barack Obama in 2010 (after the passage of the Affordable Care Act), for Trump in 2018 (tax cuts), and for Biden in 2022 (the American Rescue Plan and the Inflation Reduction Act). The exception in this list of modern presidents is George W. Bush, who did pass a set of tax cuts in a reconciliation bill, but whose approval rating rose after the 9/11 terrorist attacks. Increasing polarization, and the general anti-incumbent party energy that tends to run through midterm elections, of course, explains part of this overall popular and electoral backlash. But reconciliation bills themselves seem to intensify this effect. Why reconciliation bills do so much political damage First, there's the actual substance of these bills, which has been growing in scope over time. Because they tend to be the first, and likely only, major piece of domestic legislation that can execute a president's agenda, they are often highly ideological, partisan projects that try to implement as much of a governing party's vision as possible. These highly ideological pieces of legislation, Matt Grossman, the director of Michigan State University's Institute for Public Policy and Social Research, and his partners have found, tend to kick into gear a 'thermostatic' response from the public — that is, that public opinion moves in the opposite direction of policymaking when the public perceives one side is going too far to the right or left. Because these bills have actually been growing in reach, from mere tax code adjustments to massive tax-and-spend, program-creating bills, and becoming more ideological projects, the public, in turn, seems to be reacting more harshly. These big reconciliation bills also run into an issue that afflicts all kinds of legislation: It has a PR problem. Media coverage of proposed legislation tends to emphasize its partisanship, portraying the party in power as pursuing its domestic agenda at all costs and emphasizing that parties are fighting against each other. This elevates process over policy substance. Political scientist Mary Layton Atkinson has found that just like campaign reporting is inclined to focus on the horse race, coverage of legislation in Congress and policy debates often focuses on conflict and procedure, adding to a sense in the public mind that Congress is extreme, dysfunctional, and hyperpartisan. Adding to this dynamic is a quirk of public opinion toward legislation and referenda: Proposals tend to get less popular, and lose public support, between proposal and passage, as the public learns more about the actual content of initiatives and as they hear more about the political negotiations and struggles taking place behind the scenes as these bills are ironed out. Lawmakers and key political figures also 'tend to highlight the benefits less than the things that they are upset about in the course of negotiations,' Grossman told me. 'That [also] occurs when a bill passes: You have the people who are against it saying all the terrible things about it, and actually the people who are for it are often saying, 'I didn't get all that I wanted, I would have liked it to be slightly different.' So the message that comes out of it is actually pretty negative on the whole, because no one is out there saying this is the greatest thing and exactly what they wanted.' Even with the current One Big Beautiful Bill, polling analysis shows that the public tends not to be very knowledgeable about what is in the legislative package, but gets even more hostile to it once they learn or are provided more information about specific policy details. Big reconciliation bills exist at the intersection of all three of these public image problems: They tend to be the first major legislative challenge a new president and Congress take on, they suck up all the media's attention, they direct the public's attention to one major piece of legislation, and they take a pretty long time to iron out — further extending the timeline in which the bill can get more unpopular.
Vox
03-07-2025
- Business
- Vox
Trump's legislative win could make him a political loser
is a senior politics reporter at Vox, where he covers the Democratic Party. He joined Vox in 2022 after reporting on national and international politics for the Atlantic's politics, global, and ideas teams, including the role of Latino voters in the 2020 election. President Donald Trump speaks during an address to a joint session of Congress at the US Capitol on March 4, 2025. Allison Robbert/AFP via Getty Images President Donald Trump is about to achieve his biggest legislative victory yet: his 'one big, beautiful bill' — the massive tax- and Medicaid-cutting, immigration and border spending bill passed the Senate on Tuesday — is on the verge of passing the House of Representatives. It's a massive piece of legislation, likely to increase the national debt by at least $3 trillion, mostly through tax cuts, and leave 17 million Americans without health coverage — and it's really unpopular. Majorities in nearly every reputable poll taken this month disapprove of the bill, ranging from 42 percent who oppose the bill in an Ipsos poll (compared to 23 percent who support) to 64 percent who oppose it in a KFF poll. And if history is any indication, it's not going to get any better for Trump and the Republicans from here on out. In modern American politics, few things are more unpopular with the public than big, messy bills forged under a bright spotlight. That's especially true of bills passed through a Senate mechanism called 'budget reconciliation,' a Senate procedure that allows the governing party to bypass filibuster rules with a simple majority vote. They tend to have a negative effect on presidents and their political parties in the following months as policies are implemented and campaign seasons begin. Part of that effect is due to the public's general tendency to dislike any kind of legislation as it gets more publicity and becomes better understood. But reconciliation bills in the modern era seem to create a self-fulfilling prophecy: forcing presidents to be maximally ambitious at the outset, before they lose popular support for the legislation and eventually lose the congressional majorities that delivered passage. Presidents and their parties tend to be punished after passing big spending bills The budget reconciliation process, created in 1974, has gradually been used to accomplish broader and bigger policy goals. Because it offers a workaround for a Senate filibuster, which requires 60 votes to break, it has become the primary way that presidents and their parties implement their economic and social welfare visions. The public, however, doesn't tend to reward the governing party after these bills are passed. As political writer and analyst Ron Brownstein recently pointed out, presidents who successfully pass a major reconciliation bill in the first year of their presidency lose control of Congress, usually the House, the following year. In 1982, Ronald Reagan lost his governing majority in the House after using reconciliation to pass large spending cuts as part of his Reaganomics vision (the original 'big, beautiful' bill). And the pattern would repeat itself for George H.W. Bush (whose reconciliation bill contradicted his campaign promise not to raise taxes), for Bill Clinton in 1994 (deficit reductions and tax reform), for Barack Obama in 2010 (after the passage of the Affordable Care Act), for Trump in 2018 (tax cuts), and for Biden in 2022 (the American Rescue Plan and the Inflation Reduction Act). The exception in this list of modern presidents is George W. Bush, who did pass a set of tax cuts in a reconciliation bill, but whose approval rating rose after the 9/11 terrorist attacks. Increasing polarization, and the general anti-incumbent party energy that tends to run through midterm elections, of course, explains part of this overall popular and electoral backlash. But reconciliation bills themselves seem to intensify this effect. Why reconciliation bills do so much political damage First, there's the actual substance of these bills, which has been growing in scope over time. Because they tend to be the first, and likely only, major piece of domestic legislation that can execute a president's agenda, they are often highly ideological, partisan projects that try to implement as much of a governing party's vision as possible. These highly ideological pieces of legislation, Matt Grossman, the director of Michigan State University's Institute for Public Policy and Social Research, and his partners have found, tend to kick into gear a 'thermostatic' response from the public — that is, that public opinion moves in the opposite direction of policymaking when the public perceives one side is going too far to the right or left. Because these bills have actually been growing in reach, from mere tax code adjustments to massive tax-and-spend, program-creating bills, and becoming more ideological projects, the public, in turn, seems to be reacting more harshly. These big reconciliation bills also run into an issue that afflicts all kinds of legislation: It has a PR problem. Media coverage of proposed legislation tends to emphasize its partisanship, portraying the party in power as pursuing its domestic agenda at all costs and emphasizing that parties are fighting against each other. This elevates process over policy substance. Political scientist Mary Layton Atkinson has found that just like campaign reporting is inclined to focus on the horse race, coverage of legislation in Congress and policy debates often focuses on conflict and procedure, adding to a sense in the public mind that Congress is extreme, dysfunctional, and hyperpartisan. Adding to this dynamic is a quirk of public opinion toward legislation and referenda: Proposals tend to get less popular, and lose public support, between proposal and passage, as the public learns more about the actual content of initiatives and as they hear more about the political negotiations and struggles taking place behind the scenes as these bills are ironed out. Lawmakers and key political figures also 'tend to highlight the benefits less than the things that they are upset about in the course of negotiations,' Grossman told me. 'That [also] occurs when a bill passes: You have the people who are against it saying all the terrible things about it, and actually the people who are for it are often saying, 'I didn't get all that I wanted, I would have liked it to be slightly different.' So the message that comes out of it is actually pretty negative on the whole, because no one is out there saying this is the greatest thing and exactly what they wanted.' Even with the current One Big Beautiful Bill, polling analysis shows that the public tends not to be very knowledgeable about what is in the legislative package, but gets even more hostile to it once they learn or are provided more information about specific policy details. Big reconciliation bills exist at the intersection of all three of these public image problems: They tend to be the first major legislative challenge a new president and Congress take on, they suck up all the media's attention, they direct the public's attention to one major piece of legislation, and they take a pretty long time to iron out — further extending the timeline in which the bill can get more unpopular.
