On Episode 20 of the Progress Pondcast, we interviewed Mark Stier, the executive director of the Pennsylvania Policy Center about the fascist regime’s plans to attack Medicaid. As you’ll see, we were all very prescient, which is one good reason to subscribe to our podcast, because we often see a bit over the horizon. Even better, you can support us on Patreon.

On the 23rd day of the fascist regime, the House Budget Committee released their fiscal plan. In order to pass Donald Trump’s legislative agenda without fear of a Democratic filibuster in the Senate and without any Democratic votes in the House, the GOP needs to use a process called ‘budget reconciliation.’ The first step in that process is for the House and Senate to agree on a budget plan. The House’s version has shockingly huge cuts to Medicaid.

Shocking, that is, if you didn’t listen to our podcast with Mark Stier.

Notably, the reconciliation instructions embedded in the draft blueprint call on the House Energy and Commerce Committee to cut at least $880 billion in spending, meaning lawmakers would likely need to enact deep cuts into Medicaid — going beyond the work requirements that most Republicans support. Those are likely to set off a significant backlash from moderate Republicans and GOP governors, since they would mean states would have to foot more of the bill for the program and could lead to patients losing benefits.

The good news is that the Republicans can’t afford any backlash from within their own ranks because they only have the slimmest majority in the House. But, as we’ve seen with the confirmation of all Trump’s cabinet nominees (save Matt Gaetz), congressional Republicans are terrified of going against the flow. We can’t assume this plan will fail.

The meat of the problem is that Medicaid is low-hanging fruit. The Republicans want to extend Trump’s tax cuts and spend more on defense. They want billions more for immigration enforcement, and have other expensive plans like eliminating the tax on tips. Yet, they also want to reduce deficit spending.

If you’re looking to find spending cuts, most of the money is in Social Security, Medicare, and Medicaid. The reconciliation rules explicitly forbid touching Social Security, and Trump has repeatedly promised not to cut Medicare. That leaves Medicaid as the biggest available piece of pie.

The first line of attack is to impose new work requirements, and that’s a huge problem all on its own. The Center on Budget and Policy Priorities (CBPP) estimates that the work requirement proposals would put at risk the heath coverage of 36 million Americans.

The second, and related, line of attack is to reduce the federal 90% funding match to the states for new Medicaid enrollees. As Stateline reports, many states that expanded Medicaid under the Affordable Care Act have triggers to end the expansion if the 90 percent match is reduced.

Legislators in Idaho have introduced a bill that would repeal voter-approved expansion, while Republicans in Montana are considering allowing their expanded program to expire. Some South Dakota lawmakers want to ask voters to let the state end expansion if federal aid declines. Nine other states already have trigger laws that will end their expansion programs if Congress cuts federal funding.

Meanwhile, discussions have stalled in non-expansion states such as Alabama, as lawmakers wait to see what the Trump administration will do.

So, reducing the federal match will have a domino effect that will help unwind the Affordable Care Act, but it will do so indirectly with the help of conservative state legislatures. To see what this might mean in practice, the Idaho Department of Health and Welfare estimates that more than 89,000 Idahoans could lose their health coverage if the state repeals its Medicaid expansion. This isn’t going to be popular, at all.

“Quite honestly, I have received hundreds of emails from constituents that have said, ‘please do not repeal.’ I have received zero asking me to repeal, which I think is very telling,” said Idaho state Rep. Lori McCann, a Republican who represents a swing district in the northern part of the state.

Medicaid is surprisingly popular even though it redistributes money to the poor, some of whom are not the most sympathetic recipients. The most recent KFF survey finds 77 percent of the public with a positive opinion of Medicaid, including 63 percent of Republicans. While it’s not popular to give money to able-bodied people who don’t work, the CBPP explains this isn’t very common.

Proposals to take Medicaid away from people who don’t meet red tape-laden work requirements are based on the false premise that Medicaid enrollees do not work, when in fact data show that nearly 2 in 3 adult Medicaid enrollees aged 19-64 already work, and most of the rest would likely not be explicitly subject to the requirement based on having a disability, caring for family members, or attending school.

This probably means that the Republicans are overestimating how much money will be saved by imposing stricter work requirements and underestimating how much the public will hate these cuts.

What the House Republicans are proposing to do to Medicaid will be devastating if enacted, but they have little choice but to try. They can’t find the money elsewhere to satisfy their own deficit hawks that Trump’s expensive legislative agenda won’t explode the deficit. I don’t know if they can thread the needle and pass cuts steep enough for the deficit hawks without scaring off the so-called moderates who represent competitive districts and can easily lose their jobs if they cause a massive public backlash.

My suspicion has been that the crazy antics of Elon Musk’s DOGE are at least in part designed to satisfy the deficit hawks that they’re serious about cutting spending even if the actual budget numbers tell a diametrically opposite story of explosive new debt. Maybe this will work, but it doesn’t appear that it has sealed the deal yet. Some House Republicans want to roll DOGE cuts into their budget plan to pad the numbers, but that would require the codification of the haphazard shotgun approach employed by the Muskovites. That will prove difficult to do. If these things could easily pass through Congress, there would be no need for Musk to act on his own.

Make sure your representatives know that you oppose cuts the Medicaid, including the work requirements and the reduction of the federal match. This is one fight we might win.

You can listen to our podcast with Mark Stier on YouTube: