My question for today is --- “How does a Republican Congressman sell a cut in Medicaid as NO CUTS TO MEDICAID?” Answer --- by hiding it in a big number without specification. In a first and very revealing vote, every Republican but one in the House, (including eleven who are the most vulnerable to a Democratic challenge in 2026), voted to move a budget “blueprint” forward.
This is a first step in the process of crafting a budget. It provides broad numbers on spending and taxing. The next phase is to fill them in with what is called a Budget Reconciliation Bill. (This importance of reconciliation is that it is not subject to Senate filibuster and therefore could pass the Senate with only Republican votes.)
It is true that in the blueprint that just passed, there is nothing specific that promises cuts to Medicaid. That is because there is nothing specific that promises cuts to ANYTHING. So, members of Congress especially those who are vulnerable like my Congressman Mike Lawler (NY – 17) are out there making it clear they are “protecting Medicaid”. But they are lying of course.
Here is how US News and World Report described the sleight of hand
“ …. the blueprint’s single biggest line item calls for the Energy and Commerce Committee to find $880 billion or more in cuts over a decade – a reduction virtually impossible without making significant cuts to Medicaid.”
The budget blueprint also seems to be promising cuts to the SNAP (formerly known as Food Stamps) program: “It also calls for the Agriculture Committee to find $230 billion in savings through 2034 – again, nearly unthinkable without targeting SNAP.”
[Details here.]
This is where I get very frustrated with reporters. There have been countless examples of Republicans --- I’ll use my Congressman Mike Lawler of the NY 17th district as an example --- saying with straight faces “there is nothing in this bill that mentions Medicaid.” Why don’t the reporters ask people like Lawler --- WHERE ELSE in the part of the budget controlled by the Energy and Commerce Committee will you find $880 billion in cuts? Where else in the part of the budget controlled by the Agriculture Committee can they find the proscribed cuts than in SNAP?
For one angry response to Lawler’s dissembling on Medicaid see https://michaelianblack.substack.com/p/congressman-mike-lawler-lied-to-my
[For more details on why it is impossible to cut $880 billion without cutting deeply into Medicaid see https://www.factcheck.org/2025/03/the-war-of-words-over-medicaid-cuts/.
After I wrote the sentence above complaining about the reporters, I did find one example where Republican Speaker of the House Mike Johnson was challenged on where in the $880 billion there could be cuts if Medicaid were off the table.]
Interestingly, Trump has shut the door to cuts to the more popular Medicare and Social Security programs --- and this despite the “real” President Elon Musk repeating the old canard the Social Security is a “ponzi scheme.” [It’s not! Even though it was published in 1999, I think the best book to answer right wing attacks on Social Security is SOCIAL SECURITY, THE PHONY CRISIS by Dean Baker and Mark Weisbrot.]
Because right-wingers hate Social Security (because it’s so efficient and popular), I would not be surprised if they tried to sneak some ways to cut Social Security (and Medicare) in the final version of the Reconciliation Bill.
(In the past, those cuts have been so thoroughly unpopular that the Republicans might try to cut spending without touching those two. One possibility that already seems on the table based on the meat-axe approach of Musk and his cohorts is to close a lot of social security offices thereby reducing the ability of the system to SERVICE people on social security. This will, of course, lead to delays in processing applications and payments and undoubtedly some people will get their checks late, or find themselves “off” the program for some reason or other. There will be a lot of ways to interfere with the smooth functioning of a system that actually works very well.)
But let’s assume that the budget cutters stick with Medicaid and SNAP as their targets. On some level, the right wingers might be able to get away with targeting such programs because they are supposed to be restricted to “the poor.” And going all the way back to Ronald Reagan’s story about the “welfare queen” who exploited the safety net program Aid to Families with Dependent Children (AFDC) to cheat the taxpayers out of thousands of dollars, the idea that programs that help the poor are rife with fraud and abuse stuck with too many taxpayers.
[Details of the woman who used many alias’s and scammed the government out of thousands of dollars here. Though dramatic, this person is hardly indicative of the millions of women and children who relied on AFDC in the 1970s and 80s.]
Unfortunately, these stories had their desired impact. The abolition of AFDC was so popular that Bill Clinton went along with it --- a disgusting surrender to the right wing back in 1996. There still are plenty of middle class people who believe the “poor” are exploiting taxpayers.
[A really outstanding book by the sociologist/anthropologist Arlie Russell Hochschild published in 2016 is Strangers in Their Own Land: Anger and Mourning on the American Right. In this book we meet angry white residents of the area around Lake Charles, Louisiana who direct their anger, not at the petrochemical companies who are poisoning the land, water and air where they live but at black people who they believe are “cutting in line” ahead of them. I know it’s crazy but Hochschild lived and interacted with the folks around Lake Charles for five years to develop her understanding. And it’s very revelatory – it explains a lot about the attraction of the right-wing lies about poor people.]
But Medicaid, despite being created to help the poor get medical care actually is not just for “the poor.” Because of a loophole in how one can be accepted for Medicaid eligibility, many formerly middle-class people to on Medicaid when they enter nursing homes. Good planning involves giving away all their assets to their children and thus becoming “poor enough” to qualify.
The result of this is that approximately 60 percent of Nursing Home Residents are reliant upon Medicaid to pay for long term care.
It is also important to note that expanded Medicaid coverage in some states as a result of the Affordable Care Act (a/k/a Obamacare) was very popular. 41 states voluntarily expanded Medicaid because almost all of the spending came out of the federal budget. The economist Paul Krugman devoted some of a recent substack to describing the benefits to a largely white, rural state, West Virginia, of that Medicaid expansion. The percentage of the population covered by Medicaid went up from under 20 percent to almost 30 percent --- and 45 percent of West Virginia children are now covered by Medicaid. The percentage of the population without health insurance plummeted to five percent as a result of the Medicaid expansion. In addition, many rural hospitals would probably have to close if Medicaid reimbursements were cut back. For Krugman’s arguments with a significant amount of data see https://paulkrugman.substack.com/p/cruel-and-usual-republicans-prepare
In the case of SNAP there is one group of Americans who benefit who are not poor and who have some powerful allies in Congress --- that is FARMERS. The SNAP or food stamp program is a giant subsidy to the purchase of food --- and of course the people who profit from selling that food are the agricultural businesses --- from the giant farms like Perdue Chicken to the giant processing firms like Armor and Swift. A very significant amount of the income of these farmers comes from the taxpayer funded SNAP program. (SNAP may be easy to demonize but it doesn’t have the budget impact of any of the “big three”. $230 billion is much less than $880 billion.)
So it is pretty obvious why the budget blueprint is not about to advertise the cuts in Medicaid and Food Stamps that will ultimately find their way into the Reconciliation Act. Nevertheless, unless the writers of the bill are going to practice their own version of fraud by lying about where the cuts are going to come from, sooner or later they are going to have to come clean and admit that the only way to cut significant amounts of federal spending will be to attack at least one of the BIG THREE --- social security, medicare and Medicaid. Medicaid is the first one up and it will be VERY INTERESTING to see how they try to hide those cuts.
Hopefully. Citizens will be watching very carefully.
Michael Meeropol is professor emeritus of Economics at Western New England University. He is the author with Howard and Paul Sherman of the recently published second edition of Principles of Macroeconomics: Activist vs. Austerity Policies.
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