Republican plans to overhaul Medicaid are already shaking up the 2026 midterms

CNN

2 days ago

Senate Republicans have yet to finalize their version of President Donald Trump's sweeping domestic policy proposal, but GOP lawmakers up for reelection in 2026 are bracing for the political impact of the bill's Medicaid cuts.
Sen. Susan Collins of Maine is pushing for a provider relief fund. Sen. Thom Tillis of North Carolina has warned GOP leaders about how many in his state could lose care. And Sen. Joni Ernst of Iowa has picked up a crop of Democratic challengers campaigning off her 'Well, we all are going to die' response to a town hall protester.
Tens of thousands of people could lose coverage in each of those three senators' states, according to a KFF analysis on the version of the bill passed by the Republican-led House last month. Beleaguered Democrats, meanwhile, hope that laser-focusing on health care will help them chip away at the Republicans' 53-seat Senate majority and take back the House.
A key part of Democratic messaging has been to tie the Medicaid cuts, which would largely affect low-income Americans, to tax breaks for the wealthy. The Congressional Budget Office estimates the changes would reduce federal Medicaid spending by roughly $800 billion over 10 years, largely by instituting work requirements for certain adults eligible for Medicaid and postponing a Biden administration rule intended to simplify enrolling and renewing coverage.
'It is crazy politics for them to do this,' said Brad Woodhouse, a longtime Democratic operative and executive director of Protect Our Care, a health care advocacy group that launched a $10 million campaign this year to oppose Medicaid cuts. 'Everyone is going to be unhappy with this bill, unless you're a very high net worth individual: a millionaire, a multi-millionaire, a billionaire, or a large corporation.'
Many Republicans have argued that the cuts to Medicaid are meant to sustain the program for those who need it most. They're also betting that the rest of the bill will be more popular.
Paul Shumaker, a longtime North Carolina GOP strategist who advises Tillis and other Republican leaders in the state, said he was 'bullish' on the midterm elections because he believes voters will support Republican arguments about rooting waste, fraud and abuse out of Medicaid. He also thinks voters will back other policies in the legislative package like cutting taxes on tips and overtime pay and raising the child tax credit.
'Democrats are basically staking themselves out on issues that resonate with one-third of the voters, whereas Republicans have staked themselves out on issues that resonate with two-thirds of the voters,' Shumaker said. 'They have put themselves into a box.'
Democrats are betting that a narrow focus on the bill's health care provisions will have the most impact, even in states like Iowa, where Democrats are hoping to oust Ernst, contest an open governor's seat and two US House seats.
Ernst, who is seeking a third term next year, picked up a Democratic challenger earlier this month after she told a town hall protester 'well, we all are going to die' in response to comments about cuts to Medicaid. Ernst doubled down on the remarks in a video filmed in a cemetery.
An Ernst spokesperson pointed to Ernst's full comments, in which she said she wants to leave Medicaid funding for the 'most vulnerable' and 'those that are eligible.'
'While Democrats fearmonger against strengthening the integrity of Medicaid, Senator Ernst is focused on protecting Medicaid for the most vulnerable,' reads a statement from the senator's office. 'She will continue to stand up for Iowa's rural hospitals, clinics, and community health centers that serve our state.'
Iowa state Rep. J.D. Scholten announced his campaign soon after Ernst's town hall, becoming the second candidate in the race after Democrat Nathan Sage, who announced in April. Some election forecasters shifted the race slightly – from solid to likely Republican — after he launched his campaign.
'We're seeing people, just everyday people calling Ernst 'Joni Hearse,'' Scholten told CNN. 'You just get that sense, politically, that if we can tap into that … this is where our foot's in the door to a lot of voters who have not been voting Democrat.'
It's also motivating Democratic voters in the state. Melinda Magdalene Wings, a 65-year-old retired hospice nurse from Iowa City, Iowa, told CNN she's worried cuts to Medicaid funding would impact the assisted living home where her 86-year-old parents, including her mother who has advanced dementia, reside. In February, she started writing her representatives about the bill.
'As Iowa's elected officials, I expect them to vote for what's best for Iowa — for the people of Iowa — and not for this administration,' she said. 'Money going to millionaires doesn't make any sense.'
A handful of Senate Republicans, including Tillis and Collins, have raised concerns about the impact the reconciliation bill could have on their states, particularly a Senate proposal that would limit how much states can raise provider taxes, a key source of revenue. The provider tax provision is among a handful that Senate Republicans are revising after the chamber's parliamentarian ruled they didn't meet the strict budget rules that allow the legislation to pass with a simple 51-vote majority.
'I've been very concerned about the cuts in Medicaid and the impact on my state, but other states as well,' Collins told CNN's Manu Raju on Tuesday. 'I've also been concerned about the health of rural hospitals, nursing homes, health centers and have been working on a provider relief fund. But that doesn't offset the problem with the Medicaid cuts.'
Tillis said Tuesday that while the bill's Medicaid cuts are 'directionally right,' Republicans 'have to do it at a pace that states can absorb, or we're gonna have bad outcomes, political and policy.'
Tensions within the Senate GOP caucus have also spilled out into the open. Kentucky Sen. Mitch McConnell told colleagues with concerns about the bill during a private GOP conference meeting that 'failure is not an option' and people in their states raising concerns about the bill's Medicaid provisions would 'get over it,' according to a report from Punchbowl News.
Democrats quickly latched onto the comments. 'I hope Republicans can 'get over it' when they lose their seats in the midterms,' DNC communications director Rosemary Boeglin said in a statement.
A spokesperson for McConnell said the senator was referring to people who are 'abusing' Medicaid and 'should be working,' and the need to 'withstand Democrats' scare tactics' on the issue.
'Senator McConnell was urging his fellow members to highlight that message to our constituents and remind them that we should all be against waste, fraud, and abuse while working to protect our rural hospitals and have safety nets in place for people that need it,' the statement read.
Nearly 8 million more people would be uninsured in 2034 because of the Medicaid provisions in a version of the bill passed by the House last month, according to an analysis from the Congressional Budget Office. Most of those cuts come from the legislation's work requirement, which calls for able-bodied adults without dependent children to work or volunteer at least 80 hours a month.
A proposal unveiled by the Senate this month would expand that requirement to adults with children over the age of 14, which would likely result in even more people losing coverage.
Republicans have argued they are reforming Medicaid to sustain the program for people who need it the most. They've focused their messaging on work requirements, which are popular with voters, and policies that would penalize states for covering undocumented immigrants with their own funds.
'President Trump and Senate Republicans are working to protect Medicaid for Americans who truly need it,' Nick Puglia, a National Republican Senatorial Committee spokesperson, said in a statement to CNN. 'Voters will reject Democrats' lies, fearmongering, and attempts to use taxpayer benefits to subsidize illegal aliens and their open border policies.'
Republicans are also framing a vote against the reconciliation bill, which extends the individual income tax cuts in the 2017 GOP tax policy overhaul that are set to expire at the end of the year, as a vote for tax increases.
'I think in the end, this bill will play out on the Republicans saying, 'We got it done. We passed it, the economy's good. We spared you from having to pay more taxes,'' David McIntosh, the president of Club for Growth, told reporters recently. 'And then pivot to say, 'but if my Democrat opponent gets elected, they want to undo it … vote for us so that we can stop them from raising your taxes.''
A Washington Post-Ipsos poll released June 17, before the Senate released its framework, found overwhelming support for some provisions in the bill. Seventy-two percent of Americans support raising the child tax credit, 71% support extending tax cuts for individuals making less than $100,000 and 65% support eliminating taxes on tips. But, as whole, 42% of Americans oppose the bill, while 23% support it and 34% said they had no opinion.
A KFF poll released the same day found that 64% of adults had an unfavorable view of the House's version of the bill. The poll found that 68% of adults – including 51% of Democrats, 66% of independents and 88% of Republicans – support work requirements, but that support for work requirements dropped to 35% when adults heard the argument that 'most people on Medicaid are already working' or unable to work.
Democrats have described the work requirements as an intentional bureaucratic hurdle. Health policy experts and Democratic campaigns have also focused on the ripple effects cuts to Medicaid funding could have on the system as a whole, including rural hospitals and nursing home care.
'A lot of Medicaid patients seek care from the same providers or same types of providers,' said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard University. 'So when you're pulling dollars out of the system and away from those providers, it doesn't just hurt the patients who no longer have insurance through Medicaid.'
CNN's Manu Raju, Alison Main and Fredreka Schouten contributed to this report.