There’s a new and important problem facing Republicans as they seek to hammer Medicaid yet again, as I explained at New York:
In the long Paul Ryan era of Republican budget-cutting efforts (when Ryan was House Budget Committee chairman and then House Speaker), Medicaid was always on the chopping block. And when the program became a key element of Democratic efforts to expand health-care coverage in the Affordable Care Act sponsored by Republicans’ top enemy, Barack Obama, Medicaid’s status as the program tea-party Republicans wanted to kill most rose into the stratosphere. No wonder that the last time the GOP had a governing trifecta, in 2017, there was no single “big beautiful bill” to implement Trump’s entire agenda, but instead an initial drive to “repeal and replace Obamacare” along with measures to deeply and permanently cut Medicaid. Rolling back health coverage for those people was Job One.
So now that Trump has returned to office with another trifecta in Congress, an alleged mandate, and a big head of steam that has overcome every inhibition based on politics, the law, or the Constitution, you’d figure that among the massive federal cuts being pursued through every avenue imaginable, deep Medicaid cuts would be the ultimate no-brainer for Republicans. Indeed, the budgetary arithmetic of Trump’s agenda all but demands big Medicaid “savings,” which is why the House budget resolution being implemented right now calls for cuts in the neighborhood of $600–$800 billion. And it’s clear that the very powerful House Freedom Caucus, thought to be especially near and dear to the president’s heart, is rabid for big Medicaid cuts.
To be sure, the extremely narrow GOP margin in the House means that so-called “moderate” Republicans (really just Republicans in marginal districts) who are chary of big Medicaid cuts are one source of intraparty pushback on this subject. But the shocking and arguably more important dynamic is that some of Trump’s most intense MAGA backers are pushing back too. OG Trump adviser Stephen Bannon issued a warning in February, as The New Republic’s Edith Olmsted reported:
“Steve Bannon, former architect of the MAGA movement turned podcaster, warned that Republicans making cuts to Medicaid would affect members of Donald Trump’s fan club.
“On the Thursday episode of War Room, while gushing over massive government spending cuts, Bannon warned that cutting Medicaid specifically would prove unpopular among the working-class members of Trump’s base, who make up some of the 80 million people who get their health care through that program.
“’Medicaid, you got to be careful, because a lot of MAGA’s on Medicaid. I’m telling you, if you don’t think so, you are deeeeeead wrong,’ Bannon said. ‘Medicaid is going to be a complicated one. Just can’t take a meat ax to it, although I would love to.’”
Bannon didn’t comment on the irony that it was the hated Obamacare that extended Medicaid eligibility deep into the MAGA ranks (with voters in deep-red Idaho, Missouri, Nebraska, Oklahoma, and Utah insisting on taking advantage of it), making it a dangerous target for GOP cuts. But in any event, particularly given Trump’s occasional promises that he’d leave Medicaid alone (which didn’t keep him from supporting the deep 2017 cuts), there existed some MAGA sentiment for finding “savings” elsewhere.
The volume of this sentiment went up sharply when one of the flavor-of-the-year right-wing “influencers,” Trump buddy Laura Loomer (reportedly fresh from laying waste to the National Security Council staff) went after a conservative think-tanker who was advising HFC types on how to savage Medicaid, per Politico:
“In a social media post Monday, Loomer called Brian Blase, the president of Paragon Health Institute, a ‘RINO Saboteur’ for helping draft a letter circulated by 20 House conservatives that advocated for deep cuts to Medicaid in the GOP’s domestic policy megabill.
“’In a shocking betrayal of President Donald Trump’s unwavering commitment to America’s working-class families, and his promise to protect Medicaid, [Brian Blase] … is spearheading a dangerous campaign to undermine the Republican Party’s midterm prospects,’ Loomer said on X.”
Loomer’s blast at Blase was clearly a shot across the bow of the House Freedom Caucus and other Republicans who are lusting for Medicaid cuts and/or are focused on deficit reduction as a major goal. She called Medicaid “a program critical to the heartland voters who propelled Donald Trump to his election victories” and warned that Medicaid cuts could badly damage Republicans in the 2026 midterms.
The perpetually shrewd health-care analyst Jonathan Cohn thinks MAGA ambivalence about Medicaid cuts could be a game-changer. After citing data from Trump’s own pollster showing support for Medicaid among Trump supporters, Cohn noted this could have an impact in Congress:
“Trump himself has said he is going to protect Medicaid — although, as is always the case, it’s hard to know exactly what he means, how seriously he means it, or how much thought he has even given to the matter.
“But Trump’s own uncertainty here is telling, just like the pushback to Medicaid cuts from the likes of Loomer. Together they are a sign of just how much the politics around government health care programs has changed in the last few years — and why this piece of Trump’s big, beautiful bill is proving so tough to pass.”
It wouldn’t be that surprising if there’s a thunderbolt from the White House on this subject before the House budget reconciliation bill is finalized. If there isn’t, nervous House Republicans may be forced to read his ever-changing mind.
Given the wide variety of methods used to choose delegate in the Democratic primary (open primary election, closed primary election, caucuses, and even a mixture of these methods within the same state), how can we determine an accurate popular vote total? If the Democratic party had a national primary election in all states on the same day, with the same rules regarding party registration for participation in each state, then the popular vote total would be meaningful.
Changing from a primary open to all registered voters to a closed primary where only voters registered as Democrats can participate, for example, has a significant impact on the total number of votes cast for each candidate. Likewise, changing from a primary election where voters have 12 hours to cast their ballots to a caucus where voters must arrive at a specific time would change the total number of votes cast. And Mr. Kilgore states that vote totals are not even available for several caucus states. Voter participation levels would also be different for an election held on a Tuesday in January in New Hampshire compared to an election held on a Saturday in May in Guam due to such factors as weather and work schedules.
The presidential nominee will be chosed by delegates at the national convention in Denver. When Sen. Clinton or Sen. Obama can win the support of a sufficient number of delegates, then she or he will be the nominee.
I understand that focusing attention on the “popular vote total” is an attempt by Sen. Clinton’s campaign to persuade undeclared superdelegates that she deserves the nomination. Because of the diversity of election and caucus rules and primary election dates, I would argue that the “popular vote total” is an arbitrary, and therefore meaningless, number.