The Focus Group Podcast: "This Country is Effed" (S5 Ep22) with Jonathan Cohn

Release Date: June 14, 2025
Host: Sarah Longwell, Publisher of The Bulwark
Guest: Jonathan Cohn, Healthcare Expert and Author of The Bulwark's "Excellent" Newsletter

Introduction

In Season 5, Episode 22 of The Focus Group Podcast, titled "This Country is Effed," host Sarah Longwell delves deep into the ramifications of the Republican-sponsored "Big Beautiful Bill" (BBB). Joined by healthcare authority Jonathan Cohn, the discussion navigates the intricate intersections of politics, healthcare policy, and public opinion among Biden to Trump voters.

Overview of the Big Beautiful Bill

The episode begins with Sarah setting the stage around the BBB, highlighting its significant healthcare implications. Unlike previous discussions narrowly focused on Republican strategies, this episode broadens the lens to include Biden to Trump voters, uncovering nuanced perspectives that may surprise listeners.

Jonathan Cohn provides a foundational understanding of why healthcare remains a persistently contentious issue in American politics. He emphasizes that the complexity of the U.S. healthcare system—marked by high costs, inconsistent coverage, and a lack of universal insurance—renders policy changes particularly challenging.

Jonathan Cohn (04:34): "Healthcare in America kind of sucks in a lot of ways... it's the only advanced economy where we don't make insurance just a thing you get for being, you know, living here and being a citizen."

Voter Reactions and Personal Narratives

The heart of the episode lies in the authentic voices from focus group participants. These narratives reveal a deep-seated frustration with the current administration's policies, especially regarding Medicaid cuts and their personal financial struggles.

One participant shares her plight vividly:

Participant (00:53): "I'm supposed to live off $900 a month from the government... and with them turning around and cutting Medicaid, I'm already struggling to pay for medications."

Another voice echoes the disappointment and unmet economic promises:

Participant (16:13): "I thought he was going to do something good for everybody, not just billionaires... It's hitting me and my family hard."

These testimonies underscore the tangible human impact of the BBB, moving beyond abstract policy debates to real-life consequences affecting ordinary Americans.

Healthcare's Intractability in Politics

Sarah and Jonathan explore why healthcare remains a difficult policy area to legislate. Cohn highlights two main factors: the entrenched status quo supported by powerful financial interests and a widespread fear of change among the populace.

Jonathan Cohn (04:34): "One of the really powerful forces here is a status quo bias... Fear of change. Everyone doesn't like this way the system is."

He further explains how these elements contributed to the Affordable Care Act's (ACA) tumultuous passage and the subsequent Republican attempts to dismantle it. The discussion reveals that while Republicans aim to cut costs through Medicaid reductions, these moves face staunch opposition due to their direct impact on vulnerable populations.

Economic Concerns and Policy Trade-offs

The conversation shifts to the broader economic implications of the BBB. Participants express skepticism about the administration's ability to deliver on economic promises, such as reducing grocery prices—a key voter concern.

Sarah Longwell (16:13): "I'm kind of aggravated with tariffs impacting my industry directly... We just have to see where that lands."

Jonathan Cohn articulates the potential long-term effects if the economy deteriorates further, questioning how voters might react if essential programs like Medicaid and SNAP are compromised during economic downturns.

Jonathan Cohn (22:42): "Programs like Medicaid and SNAP become really important when the economy goes into the tank... What do the politics look like then?"

Public Perception and Political Strategy

Delving into Republican strategies, Sarah scrutinizes the party's messaging around the BBB, particularly the juxtaposition of Medicaid cuts with tax breaks for the wealthy. Cohn counters the Republican narrative by asserting that cutting Medicaid inevitably reduces coverage for many, despite claims to the contrary.

Jonathan Cohn (33:25): "They know that their strategies are sort of minimize or deny even... they're counting on that money. They're counting on that money to take away health benefits."

The episode also touches upon the use of work requirements in Medicaid policy, a favored Republican tactic aimed at reducing dependency. However, Cohn argues that such measures primarily affect those who are already marginalized and not the able-bodied individuals Republicans claim they target.

Jonathan Cohn (34:37): "Most people on Medicaid work... The system you're setting up is mostly going to get people who actually deserve it."

Legislative Process and Voter Awareness

A significant portion of the discussion revolves around the legislative maneuvering behind the BBB. Jonathan Cohn laments the lack of transparency and the rushed nature of the bill's passage, contrasting it with historical legislative processes like that of the ACA.

Jonathan Cohn (43:30): "We're gonna vote on that for a bill that did not exist in writing two months before, which is nuts."

This opacity breeds skepticism and fuels public distrust, with voters questioning what other agenda items might be hidden within such a massive legislative package.

Concluding Insights and Future Implications

As the episode draws to a close, Sarah and Jonathan reflect on the potential outcomes of the BBB. Cohn speculates that while the bill is likely to pass due to entrenched Republican priorities, its long-term impacts on healthcare and the national debt remain deeply contentious and potentially damaging.

Jonathan Cohn (58:18): "How much do they cut Medicaid, how much do they cut SNAP, how much do they raise the deficit... These are really important questions that are going to reverberate in this country for not just years, but for decades."

Sarah echoes the sentiment of growing voter frustration, particularly as economic relief remains elusive despite promises of substantial policy shifts.

Conclusion

"This Country is Effed" offers a comprehensive exploration of the BBB's multifaceted impact on American voters, especially those navigating the intersection of economic hardship and healthcare dependency. Through poignant personal stories and expert analysis, Sarah Longwell and Jonathan Cohn illuminate the profound political and human stakes embedded in this legislative moment.

Notable Quotes:

• Jonathan Cohn (04:34): "Healthcare in America kind of sucks in a lot of ways... it's the only advanced economy where we don't make insurance just a thing you get for being, you know, living here and being a citizen."

• Participant (00:53): "I'm supposed to live off $900 a month from the government... and with them turning around and cutting Medicaid, I'm already struggling to pay for medications."

• Jonathan Cohn (22:42): "Programs like Medicaid and SNAP become really important when the economy goes into the tank... What do the politics look like then?"

• Jonathan Cohn (33:25): "They know that their strategies are sort of minimize or deny even... they're counting on that money to take away health benefits."

This detailed summary encapsulates the essence of the episode, providing listeners—both regular and new—with a clear understanding of the key discussions, insights, and the overall narrative surrounding the BBB and its implications on American society.