Republicans pushed through deep cuts to Medicaid in President Donald Trump’s sweeping “One Big Beautiful Bill,” even as more Medicaid enrollees than ever are now voting Republican. So, why would the GOP target a program increasingly used by its own base?
Here are the three key reasons behind the move:
1. Paying for Tax Cuts
The GOP needed to find budget savings to extend the Trump-era tax cuts passed in 2017, which were set to expire at the end of the year. Slashing Medicaid — the federal-state health program covering over 70 million low-income Americans — offered a way to offset the cost of trillions in tax cuts without touching politically sensitive programs like Medicare or Social Security.
“Medicaid became the obvious target,” said Republican strategist Joel White. “The money lined up.”
While President Trump initially pledged to “love and cherish” Medicaid, he ultimately backed the cuts to ensure passage of the bill and personally lobbied hesitant GOP lawmakers to support it.
2. Rolling Back Biden-Era Policies
Republicans have long argued that President Biden’s administration allowed Medicaid spending to spiral out of control. They point to relaxed eligibility rules during the pandemic that allowed more people to enroll and claims of widespread waste and abuse.
“There was massive enrollment of people who weren’t eligible,” said Brian Blase, president of the conservative Paragon Health Institute. “It became a backdoor for corporate welfare too, with payments exceeding Medicare rates in some cases.”
The new bill introduces work requirements for certain adult beneficiaries and limits how states can secure extra federal funds — changes Republicans say will eliminate fraud without hurting the most vulnerable.
3. Undoing the Obamacare Expansion
The GOP has long opposed the Medicaid expansion implemented under President Barack Obama’s Affordable Care Act, which allowed more working-age adults to qualify. While Republicans didn’t repeal the expansion outright, the new bill makes it harder for states to extend coverage and reduces federal support.
“The expansion exploded the welfare state,” argued one Republican lawmaker during debate. Others described beneficiaries as “able-bodied adults playing video games” rather than working — rhetoric that echoes decades of GOP messaging on government assistance.
Still, Republicans emphasized the bill preserves Medicaid for key groups like “mothers, children, seniors, and the disabled,” said Rep. Brett Guthrie (R-KY), who wrote the Medicaid provisions.
Internal Tensions and Political Risks
Despite Trump’s efforts to reshape the GOP as a party for the working class, the traditional Republican skepticism of welfare programs hasn’t disappeared. Experts say this ideological conflict — between populist messaging and libertarian-style budget cuts — is on full display in the Medicaid fight.
“The economic populism hasn’t been fully embraced,” said Jake Haselswerdt, a political scientist at the University of Missouri. “They’re still defaulting to the old Reagan-Paul Ryan playbook.”
Whether this decision backfires with Medicaid-dependent voters remains to be seen. Some Republicans argue the changes target only “waste and abuse,” not real benefits, and point out that many dropped from Medicaid could get insurance through an employer or Obamacare exchange.
Still, Democrats have seized on the cuts. Polls show the public is largely opposed to the bill:
- A Quinnipiac poll from June 26 found 55% of voters opposed the legislation, compared to just 29% in favor.
- A KFF survey reported 64% of U.S. adults oppose the Medicaid cuts.
Critics accuse the GOP of sacrificing health care for the poor to fund tax breaks for the wealthy. “It’s going to be easy for Democrats to paint Republicans as heartless and out of touch,” said Chris Howard, a policy expert at William & Mary.
GOP Messaging Challenges
Republicans now face the task of selling the cuts to a skeptical public. White said the party needs to focus on explaining the reforms as necessary to preserve Medicaid long-term.
“Say it clearly: ‘If you are able-bodied, you should work, volunteer, or get educated,’” he said. “And we are protecting the people who truly need help.”
With Social Security and Medicare off-limits, Medicaid may remain Republicans’ only viable source of budget savings — but the political cost of those savings could be steep, especially in an election year.
