Here's how Republicans are planning to throw millions off Medicaid and lie about it

Trump is teaching his minions to say, "We didn't insure anyone"/"They deserved it."

A lot of the horror in Donald Trump’s sequel is new.

Sure, he was terrible the first time James Comey and Vladimir Putin made him president. But his misery couldn’t measured in donated kidneys that had to be junked, cures for diseases that won’t be found, and intentional infant deaths due to HIV.

That’s what Elon Musk has given us by singlehandedly electing Trump a second time.

How Trump wants to decimate some of America’s poorest families to benefit the richest

However, one aspect of this Trump administration is nearly identical to the last. He wants to give rich people sloppy, unnecessary tax cuts and then “pay” for those tax cuts by basically ending Medicaid as we know it.

You’ll remember that he succeeded in the giveaways to the rich, but thanks to millions of activated Americans and John McCain’s thumb, he failed to gut Medicaid. Thankfully, because you may also remember that Trump bungled us into the worst response to COVID-19 in the rich world with a yearlong supercut of unforced errors that would have been infinitely worse if he’d succeeded in his dream of swiping insurance from masses of struggling workers and their families.

This time around, Trump, MAGA, and the Nerd Reich are determined to punish us for the few weeks rich people had to take out Olive Garden rather than enjoying the lush dining room by destroying the best medical research system ever created and simultaneously gutting the worst health insurance system in the rich world.

Why they need to lie

To be clear, we’re not sure how the details of this will look.

Republicans only need 50 votes in the Senate, which they have for pretty much anything Trump wants. The House is a mess. Speaker Mike Johnson only has a few votes to lose. While there are no true moderate Republicans in Congress, there are Republicans in losable districts—more than enough of them to lose the House in 2026 if democracy continues somewhat usually. If things go wrong enough, the GOP could even conceivably lose the House in special elections before November 2026.

One way they could go wrong is if Republicans touch a third rail and gut the largest provider of insurance in America. And that’s Trump’s plan. He has endorsed $880 billion in cuts for Medicaid, which is actually $44 billion MORE than House Republicans under his and Paul Ryan’s direction tried to cut Medicaid last time.

Because they tried this before, we have a decent idea of what the result would be, according to the Congressional Budget Office:

In calendar year 2026, Medicaid enrollment is estimated to be 8 million lower under the AHCA than under current law due to the combination of two factors: (i) a decline of 6 million in enrollment for newly eligible adults under current law and (ii) a decline of 2 million in enrollment for all other Medicaid enrollees attributable to more frequent — 2 — eligibility redeterminations, the repeal of retroactive eligibility, and optional State work requirements for adults.

That’s at least 8 million who’d be thrown off the program due to paperwork and ridiculous requirements that undermine the very nature of Medicaid, which exists to supplement Americans who can’t get insurance because they’re aged and not rich or taking care of a family member or trying to find a job or a kid.

A model for Medicaid lies

We know that number of uninsured would swell under these new cuts for two reasons:

1. They’re bigger cuts, and they could be larger than $880 billion, as Republicans have a strong incentive to make the Medicaid cuts and the tax cuts even larger.
2. The GOP now has its ideal model for denying Americans the Medicaid they deserve from Georgia, which, under Republican leadership, expanded Medicaid in the worst possible way with all the paperwork “requirements” that were embedded in the 2017 proposed cuts and will be in the 2025 bill.

ProPublica reports on the results:

• Price of Independence: Georgia’s experimental alternative to Medicaid expansion has cost taxpayers more than $86 million.

• Enrollment Shortfall: Only 6,500 participants have enrolled in the first 18 months of the program — roughly 75% fewer than the state had estimated for year one.

Georgia governor Brian Kemp calls this experiment with “work requirements” a success, which makes sense if your goal is to keep poor people from getting health insurance. At every level, this system cruelly makes it almost impossible to get the basic health coverage that every other citizen of every other wealthy nation takes for granted.

“Thousands of others never finished applying, according to the state’s data, as reports of technical glitches mounted,” ProPublica reported. “The state also never hired enough people to help residents sign up or to verify that participants are actually working, as Georgia required, federal officials and state workers said.”

This program and lies that couch it will now be a model for uninsuring millions of Americans.

Here’s how the lie works

Now, you may have heard Trump say Medicaid won’t be “touched,” and you should expect to listen to that lie again and again—even after, Universe forbid, millions lose their Medicaid.

Huffington Post’s Jonathan Cohn—maybe the best reporter about healthcare politics in the nation—attempted to explicate how Trump is reconciling that promise, which Trump followed up by endorsing almost a trillion in Medicaid cuts despite the program's enormous popularity.

It’s simple. Trump’s going to lie about it and use the same lies he’s letting Elon Musk use to gut everything good our federal government does, claiming he’s targeting “waste, fraud, and abuse.” Notably, he’s lining up a similar attack on Social Security.

You can see why he thinks that lie may work, as he’s lost zero Republican support as he’s gone about lawlessly hollowing out the government in the name of this lazy dog whistle that has been regurgitated in right-wing media for generations.

So, just as in 2017, they’re going to gut Medicaid by making it almost impossible to navigate: see the section on “eligibility redeterminations, the repeal of retroactive eligibility, and optional State work requirements for adults.” AND they will take the “optional” out of those State work requirements.

Listen to Jim Jordan if you can stand it:

They’re going to lean into the idea of these “work requirements” while making these completely unnecessary, counterproductive roadblocks a parody of the ridiculous government regulations that they pretend to despise.

Tell the people, Center for Budget and Policy Priorities:

Work requirements have no upside. Medicaid work requirements do not increase employment, research shows,^[1] and the Congressional Budget Office concluded that the 2023 House bill would lead to coverage loss with “no change in employment or hours worked.”^[2] Instead, work requirements strip health coverage from people with low incomes — most of whom are already meeting or exempt from the requirements — leading to gaps in care that damage their health and financial security and make it harder for them to find or keep a job.^[3]

It’s like voter ID and all forms of voter suppression. The idea sounds reasonable until you realize they only exist to solve good things that are happening that Republicans hate—like Black people voting or poor people getting health insurance.

It’s bullshit

It’s critical to remember that this is all bullshit.

“There’s not a pile of Medicaid dollars sitting in a corner labeled ‘waste, fraud, and abuse,’ “ Adrianna McIntyre, a professor at the Harvard School of Public Health, told the HuffPost’s Cohn. “Steep cuts to the program will ultimately mean some combination of fewer people insured, fewer benefits covered, and lower payments to doctors and hospitals.”

But it’s bullshit that has been embedded into Republican brains for decades. And the motivation for going along with this BS is the reason the GOP exists: tax cuts for some of the richest people on earth.

And that’s why Cohn thinks it could work. And if Cohn believes that, we better worry.

Only the truth can save us

The response is simple for Democrats. Don’t engage the lie.

Speak the truth:

Donald, Elon, and Republicans in Congress want to abuse their power by taking health care from millions of struggling Americans to fund massive tax cuts for billionaires like Donald and Elon. It’s immoral, and it must be stopped.

For much of the Trump era, getting Democrats on the same page and repeating a simple moral message has proven impossible. Our Enlightenment brains can’t stand it. However, the party has held firm in defending people’s health care. The message matters. Avoiding spreading the lie matters. Don’t engage in Republican-owned frames like “waste, fraud, and abuse,” thereby increasing their power.

Instead, let us repeat:

Donald, Elon, and Republicans in Congress want to abuse their power by taking health care from millions of struggling Americans to fund massive tax cuts for billionaires like Donald and Elon. It’s immoral, and it must be stopped.