Medicaid cuts

White House vows no Medicaid cuts — except to those who don’t deserve it

Trump aides say those cut from Medicaid as a result of the GOP megabill shouldn’t have had it in the first place.

By Adam Cancryn and Jake Traylor

The White House plans to confront resistance to Medicaid cuts from Senate Republicans by arguing that any reductions in coverage would only affect people who didn’t deserve it in the first place.

A strong bloc of Republicans in the Senate has signaled that they are uncomfortable with Medicaid reductions in the sweeping tax-and-spending bill enacted last month by the House. President Donald Trump’s advisers are determined to confront those concerns by claiming that cuts would chiefly target undocumented immigrants and able-bodied people who should not be on Medicaid, according to four administration officials and outside allies granted anonymity to discuss strategy.

“This bill will preserve and protect the programs, the social safety net, but it will make it much more common sense,” Office of Management and Budget Director Russ Vought said Sunday. “That’s what this bill does. No one will lose coverage as a result.”

The megabill would add work requirements to the program and bar undocumented immigrants from getting coverage, among other attempts to tighten eligibility. Those provisions are projected to leave roughly 7.6 million low-income people without health care over the next decade — losses that would amount to hundreds of billions of dollars in cost savings for the program.

Contrary to Trump officials’ claims, such cuts are widely anticipated to go beyond immigrants and the narrow slice of able-bodied unemployed, according to health experts. The provisions would likely add new layers of paperwork for low-income enrollees, making it more difficult for qualified recipients to stay on the program and pushing otherwise-eligible Americans suddenly out of health coverage.

In a POLITICO interview published Sunday, Trump Medicaid chief Mehmet Oz argued the changes would “future proof” the program, also insisting that “we’re not cutting Medicaid.”

“There’s a lot of sensitivity about being accused, accused of not taking care of people who have disabilities or seniors without money or children,” Oz said.

Trump officials have aggressively pushed that stance in public and private in recent days, insisting that the administration’s plan will shield “deserving” Medicaid recipients like the elderly and disabled, while targeting those who officials have cast as a drain on the nation’s safety net. Many of those people gained coverage over the last decade through Obamacare’s expansion of Medicaid.

Republicans have been stung before by their efforts to enact health care cuts, most notably facing massive voter blowback in 2017 that cratered Trump’s bid to repeal Obamacare and contributed to widespread losses in the following midterms.

But Trump officials and allies argue that voters will support these changes to Medicaid, seeing them less as cuts than tweaks meant to ensure resources go to those who truly need it.

“Medicaid does not belong to people who are here illegally, and it does not belong to capable and able-bodied men who refuse to work,” said one of the White House officials. “So no one is getting cut.”

In a statement, White House spokesman Kush Desai said Trump would “protect and preserve Medicaid” by “kicking illegal immigrants off of the program and implementing commonsense work requirements,” adding that Americans voted for such policies.

The strategy represents a stark messaging shift for a GOP that has long found itself on the defensive in debates over health coverage. And it’s an attempt by the White House to mirror the approach Trump has taken on other issues like immigration and trade, casting aside political complexities in favor of portraying them as a simple choice between “us” and “them.”

Trump has framed his mass deportation campaign as an effort to rid the country of millions of immigrants deemed undeserving of staying in the U.S. He’s justified his tariffs as a counter to other countries “ripping us off” on trade.

“Before, they were taking things away from people,” Thomas Miller, a senior fellow at the right-leaning American Enterprise Institute, said of the health messaging shift. “Now, they’re saying they’re not deserving.”

In the Senate, Vought and White House legislative affairs chief James Braid have taken the lead in talks with Republican lawmakers, the White House official said. Trump has also dialed up a handful of senators over the last week, said another White House official granted anonymity to discuss internal strategy, ahead of a sprint in the Senate to pass its version of the megabill in a matter of weeks.

The success of that effort could hinge on a handful of GOP senators who are skeptical of any Medicaid policies that could be interpreted as cuts, especially after the House added last-minute health care provisions into its bill that ballooned the predicted coverage losses.

Sens. Lisa Murkowski of Alaska and Susan Collins of Maine have expressed reservations about Medicaid work requirements, while some others have warned more generally about the prospect of cutting the program. Sen. Josh Hawley (R-Mo.), perhaps the most outspoken Republican on the issue, said Monday in a post on X that Trump had assured him “NO MEDICAID BENEFIT CUTS” will be in the bill.

But rather than change course on policy, Trump officials and other Hill Republicans have instead signaled a preference for winning votes by redefining what qualifies as a cut. In a midday missive on Monday, the White House touted its push to remove roughly 1.4 million undocumented immigrants as key to strengthening Medicaid benefits “for whom the program was designed — pregnant women, children, people with disabilities, low-income seniors, and other vulnerable low-income families.”

That strident approach has prompted blowback from patient advocates and health industry groups across the spectrum, and even bewildered some Republicans who questioned the wisdom of making any changes to a program as politically delicate as Medicaid, especially in the red states of Trump’s base.

“The fact remains that a great many Trump voters are on Medicaid, particularly in rural areas,” said GOP pollster Whit Ayres, adding it’s unclear whether voters will buy Republicans’ assertion that some cuts shouldn’t qualify as actual cuts.“If no one loses coverage, how are you going to cut $500 billion?”

Still, Trump aides remain confident they can bring both the Senate and the broader public around to their view. Much of the Medicaid-cautious contingent in the Senate — including Hawley — have already said they’re okay with work requirements, drawing the line instead at broader funding cuts that might directly impact health providers and state budgets.

The White House in the meantime has salivated over a fight with Democrats over coverage for undocumented immigrants, viewing it as another politically advantageous front in its immigration offensive. As for work requirements, Republicans pointed to polling that has consistently shown most Americans support them in theory — even despite the warnings about how it’s likely to play out.

“It’s a simple, clear message to say we’re only taking away coverage from people who are not working,” said Miller. “You don’t get down to the granular details of, what does that actually mean in practice?”