Bulwark Takes: Trump Country Is About to Get Hosed By GOP Lawmakers Release Date: May 7, 2025

Summary

In this episode of Bulwark Takes, host Sam Stein engages in a comprehensive discussion with senior correspondent Jonathan Cohn, delving into the intricate dynamics of the Republican Party's proposed Medicaid cuts and their implications for Trump-supporting constituencies. The conversation unpacks the legislative strategies, potential impacts on various demographics, and the political tensions arising within the GOP as they navigate these significant policy changes.

1. Introduction to Medicaid Cuts and GOP Strategy

[00:46] Jonathan Cohn:
Jonathan begins by outlining the overarching Republican agenda: implementing significant tax cuts and offsetting the costs through substantial Medicaid reductions. He emphasizes the scale of the proposed cuts, projecting a staggering $800 to $900 billion over the next decade.

[01:36] Sam Stein:
Sam underscores the magnitude by reiterating, "Billion B with a B," highlighting the financial scale of the GOP's plans.

2. The Impact on Republican Base and Medicaid Beneficiaries

[02:10] Sam Stein:
Sam brings attention to the political conundrum Republicans face: targeting Medicaid, a program now expanded and utilized by many rural white Trump voters, a key component of the GOP's coalition.

[02:33] Jonathan Cohn:
Jonathan provides concrete examples of Medicaid's critical roles, such as substance abuse treatment in opioid-stricken regions like Appalachia and maternity care in the South. He explains that cutting Medicaid doesn't just reduce healthcare access but also jeopardizes jobs and hospital operations in these areas.

3. Detailed Examination of Proposed Medicaid Reforms

[03:42] Sam Stein:
Sam introduces Dave Dayan's report on current Medicaid reform proposals, seeking a breakdown of the specific changes under consideration.

[04:31] Jonathan Cohn:
Jonathan details key proposals, including:

• More Frequent Eligibility Checks: Requiring beneficiaries to re-establish eligibility every few months, which could lead to increased paperwork and unintended loss of coverage.

  [04:42] Sam Stein:
  "People don't do the paperwork in time. They lose it, they file it improperly and then yeah, you'll catch some people who may not be eligible. More likely than not, you'll see reduction in forces through attrition."

• Introduction of Cost-Sharing or Premiums: Imposing premiums on Medicaid recipients above the poverty line, effectively reducing coverage for low-income individuals who cannot afford additional costs.

• Work Requirements: Mandating proof of job search or employment, with exceptions typically for students, disabled individuals, and caregivers. Jonathan warns that such requirements often result in millions losing coverage due to administrative hurdles.

[06:12] Jonathan Cohn:
He elaborates on the complications of implementing work requirements, noting, "You will get millions of people lose health insurance as a result. Most of them are people who, when you dig into it, actually, they were still qualified for the program."

4. Complexities of Medicaid Funding and Provider Taxes

[07:14] Jonathan Cohn:
Jonathan discusses a convoluted aspect of Medicaid funding involving provider taxes. He references a New York Times story by Margo Sanger Katz and Sarah Cliff, explaining how states manipulate tax structures to increase federal Medicaid funding, likening it to a "legal kickback scheme."

[07:57] Sam Stein:
Sam humorously remarks, "Alaska, get on it. What are you doing?" highlighting that almost all states except Alaska exploit this funding mechanism.

5. Congressional Budget Office (CBO) Analysis on Coverage Losses

[08:32] Sam Stein:
Sam shifts focus to recent CBO findings released in response to Democratic requests, revealing stark projections of millions losing Medicaid coverage due to proposed reforms.

[09:20] Jonathan Cohn:
He summarizes the CBO report:

• Cost Savings: Potential savings of over $400 billion.
• Coverage Losses: Up to 9 million people could lose Medicaid, with nearly 4 million becoming uninsured.

[10:46] Sam Stein:
Sam acknowledges the perennial trade-off in policy-making: "more money, less insured. Like that is the trade-off here."

6. Political Challenges and Legislative Dynamics within the GOP

[11:30] Jonathan Cohn:
Jonathan assesses the Republican leadership's precarious position, caught between:

• Conservative Fiscal Austerity: Aiming to reduce government spending to fund tax cuts.
• Electoral Realities: Representing districts with significant Medicaid-dependent populations who may oppose cuts.

[12:04] Sam Stein:
Sam clarifies the nature of the GOP's proposed tax cuts, explaining, "they want to extend expiring tax cuts. People will not feel it as a tax cut. They'll feel it as an extension of the rates."

[13:58] Jonathan Cohn:
He draws parallels to past legislative struggles, comparing the current Medicaid debate to the Affordable Care Act (ACA) repeal efforts. Jonathan quotes Don Bacon, a moderate Republican from Omaha, who expressed frustration over the GOP's handling of Medicaid cuts:

[13:58] Don Bacon: "Don't worry about the Senate, they'll fix it. And now we're getting ready to take our third vote on this. We feel like we're being pushed up to the edge of the cliff here."

Jonathan suggests that Bacon's sentiments reflect a broader GOP disenchantment, reminiscent of the ACA repeal challenges where initial House support faltered in the Senate, leaving moderate Republicans vulnerable.

[14:23] Sam Stein:
Sam recalls historical legislative strategies, mentioning the BTU tax during Bill Clinton's presidency as a cautionary tale of ambitious House-passed policies being derailed in the Senate, leading to political fallout for House members involved.

[15:27] Jonathan Cohn:
Jonathan emphasizes the importance of inter-chamber trust and collaboration, noting that the failure to maintain strong working relationships between House and Senate leaders hinders effective policy negotiation, as seen with the ACA's passage.

7. Conclusion and Future Outlook

[16:11] Sam Stein:
Sam wraps up by acknowledging the ongoing nature of the Medicaid cuts debate, highlighting Jonathan's dual focus on policy analysis and political maneuvering. He indicates that Bulwark Takes will continue to monitor and report on this pivotal policy issue, ensuring listeners remain informed on its developments.

Notable Quotes:

• Jonathan Cohn [01:12]:
  "They want to pass a tax cut. They, they're trying to pay for part of the cost by cutting Medicaid."

• Sam Stein [02:10]:
  "These are the Trump voters who are on Medicaid and Republicans are like, wait a second, we just recruited these people into our political coalition and now we're going to rip apart their health care."

• Don Bacon [13:58]:
  "We feel like we're being pushed up to the edge of the cliff here."

This episode delivers an in-depth exploration of the Republican Party's Medicaid reform proposals, dissecting their potential socioeconomic impacts and the internal political strife they engender. Through insightful analysis and real-world examples, Sam Stein and Jonathan Cohn illuminate the complexities of healthcare policy reform amidst shifting political landscapes.