How 7 states could thwart GOP plans to overhaul Medicaid

Republicans are facing a nationwide backlash over the fate of Medicaid — but the potential program cuts are most threatening in seven conservative-leaning states where voters have cast ballots to expand the entitlement in recent years.

It’s a growing problem as Republicans hunt for enough savings to pay for the White House’s proposed tax cuts.

Republican Sen. Mike Rounds of South Dakota, which has enrolled more than 24,000 people in Medicaid since voters expanded the insurance program for low-income people in 2022, told POLITICO he’s been arguing against some of his own party’s proposals. One would reduce significantly how much funding for the program comes from the federal government.

“That's not a cost cutting measure — that's a cost transfer,” he said. “And when you've got partnerships with the states, you shouldn't be doing that without having them involved in the discussion.”

Republicans face similar skepticism across red and purple swaths of the country where voters have used ballot initiatives to expand Medicaid since Congress last targeted the safety net health insurance program in 2017 – not only in South Dakota, but also in Idaho, Nebraska, Maine, Oklahoma, Missouri and Utah. President Donald Trump won all of those states except Maine. And even there, he won an electoral vote by defeating Kamala Harris in the state’s 2nd Congressional District, where nearly a third of people are enrolled in Medicaid.

The president’s conflicting guidance to Congress about whether and how much to cut from the program suggests he is aware of the political peril.

Additional states could expand Medicaid in the coming years, making future rollbacks even more challenging. There’s currently a campaign underway in Florida to put expansion on the ballot in 2026, underscoring the popularity of Medicaid even in the most MAGA-friendly states.

“Cutting Medicaid seems to be popular with some Republican elites and some right wing think tanks that are getting funded by some right wing billionaires, but they're unquestionably not popular with the Republican voters,” Joan Alker, the executive director of the Center for Children and Families at Georgetown University’s McCourt School of Public Policy, told reporters at a briefing on Medicaid this week. “We've seen many polls recently asking voters to rank what they wanted … and cutting Medicaid was literally the last on the list for voters of all stripes.”

Coalitions on the ground in the seven states that passed Medicaid expansion initiatives — made up of powerful hospital associations, grassroots advocacy groups and other strange bedfellows — are now re-mobilizing to defend them. They’re sending people to town halls. They’re publishing op-eds in local newspapers. They’re flooding the phone lines of their members of Congress. And they’re mulling a revival of some of the more aggressive tactics activists used to protest attempts to repeal the Affordable Care Act in 2017.

“We're going back to the old playbook,” said Matt Slonaker, the executive director of the Utah Health Policy Project who spearheaded the state’s ballot initiative campaign in 2018. “It's always hard to get folks to act, but they seem to be really, really ready to do this right now.”

With pressure mounting to find hundreds of billions in savings, lawmakers who are usually on board with slashing government spending remain on high alert about the blowback they could face in their states over Medicaid. And as they struggle to keep their members united behind Trump’s budget plan, GOP leadership is taking notice.

House Speaker Mike Johnson on Wednesday night backed away from some of the most sweeping changes the GOP had been debating, including capping the funds states get for each Medicaid enrollee and rolling back federal support for expansion states, even as he dismissed outrage his members have recently faced over threatened cuts at fiery town halls across the country as the work of “paid protesters.”

“All this attention is being paid to Medicaid because that’s the Democrats’ talking point,” Johnson said. “We’re talking about finding efficiencies in every program, but not cutting benefits for people who rightly deserve them.”

Pro-expansion health care groups in these seven red and purple states mounted expensive and time-consuming ballot initiative campaigns to circumvent conservative state legislatures and governors who refused to expand Medicaid, and some of those same state officials are currently working to roll back the expanded coverage their constituents enacted.

That’s left Republicans on Capitol Hill from Medicaid-expansion states as the loudest — and in some cases the only — effective voices of opposition to the proposed cuts now that Democrats are locked out of power. And while some House Republicans who represent red districts are feeling the heat, senators will have to answer to their entire state.

“I don't quite think Republicans know the backlash they're in for,” said Brad Woodhouse, a former Democratic National Committee official who now runs the progressive health care advocacy group Protect Our Care. “And it's going to be a particularly bitter pill in these states that have used ballot initiatives because in those cases, the voters have really spoken about their preference.”

Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — both of whom hail from states that expanded Medicaid by ballot measure — crossed the aisle earlier this week to support a Democratic amendment to the Senate budget resolution that would have blocked tax cuts for the wealthy if any Medicaid funding is cut.

Hawley, who represents about 326,000 people who became eligible for Medicaid under the state’s 2021 expansion, has said he wouldn’t support “severe” cuts to Medicaid — specifically cuts that would lead to reduced benefits — calling it a “red line” for securing his vote.

The politics are especially tricky for representatives of more rural states where Medicaid has been a lifeline for hospitals struggling to keep the lights on — hospitals that in some instances are among the state’s biggest employers.

In Idaho, for example, voters approved expanding Medicaid in 2018 with 61 percent support, extending coverage to about 90,000 more residents. But if federal funding for Medicaid decreases as a result of the current negotiations in Washington, the state legislature has the power to intervene and potentially repeal the expansion. Idaho House Minority Leader Ilana Rubel, a Democrat, is among those warning that such an outcome would threaten the state’s remaining rural hospitals.

“That's a disaster, not only for the people on Medicaid, but for the people on private insurance,” Rubel said. “Because when you live in these rural areas, you know you can have the best insurance in the world, but if the hospital in your area has gone out of business and you fall off a ladder or have a heart attack, there will be nobody to help you.”

Yet not every Republican from an expansion state is worried about the sweeping reforms hardliners in their caucus are pushing for.

Sen. James Lankford of Oklahoma, where more than 245,000 people became eligible for coverage after the state voted to expand Medicaid in 2020, echoed Speaker Johnson’s argument that the final budget would not impact individuals’ health care benefits and said he hadn't heard from concerned citizens about it.

“I have not heard anyone talking about cutting off Medicaid to people,” he said. “It has been dealing with formulas. It's been dealing with fraud.”

Utah Sen. John Curtis told POLITICO this week that after discussing the matter with Republican Gov. Spencer Cox, he’s not sweating the political implications.

He said he's “not near as concerned” about cuts to the safety net program as he is “about the fiscal irresponsibility that we're facing,” adding that he’s “in total harmony with our state leaders on this.”

Medicaid enrollment in Utah grew nearly 60 percent after a ballot measure expanding the program passed in 2018. But Utah is among the nine states that has a “trigger” law in place to automatically end Medicaid expansion or require major changes to the program if federal funds decline, threatening coverage for millions of people.

For Curtis, that’s a feature rather than a bug.

“Our state is one of more fiscally responsible states, in my opinion, and they saw this coming,” he said.

Topics

GOP is considering cuts to Medicaid funding. Here's who could be impacted

The House GOP is considering significant cuts to Medicaid, potentially slashing billions. Health policy experts say Medicaid provides vital services to many Americans
ABC News - 1d
How Medicaid cuts could improve access to care

Coverage — having health insurance — most certainly does not guarantee timely medical care.
The Hill - 2d
Jeffries says Johnson's budget plan could lead to big Medicaid cuts

House Minority Leader Hakeem Jeffries is warning that House Speaker Mike Johnson's budget proposal would lead to Medicaid cuts. CBS News' Taurean Small reports.
CBS News - 3d
Gov. Lujan Grisham sounds alarm on Medicaid cuts in House GOP budget plan

While President Trump insists he won't touch Medicaid, his agenda in Congress tells a very different story. The House is set to vote on a spending plan that could cut Medicaid funding by hundreds ...
CBS News - 4d
Slashing Medicaid to Pay for Trump’s Tax Cuts Could Lead to Vast State Shortfalls

Republicans have proposed lowering the federal share of costs for Medicaid expansions, which could reshape the program by gutting one of the Affordable Care Act’s major provisions.
The New York Times - 2d
What's in the House GOP budget plan?

The House is expected to vote on a budget plan this week. It will be a key test to see if Republicans can unify around President Trump's agenda. CBS News congressional correspondent Nikole Killion ...
CBS News - 4d
Cuts to Medicaid possible if Johnson's budget plan passes

Lawmakers on Capitol Hill are concerned about potential cuts to Medicaid if House Speaker Mike Johnson's budget proposal is passed. CBS News' Caitlin Huey-Burns reports.
CBS News - 3d
Fantasy Basketball: These stars could get shut down — here's how to prepare and plan ahead

Silly Season is about to kick off in the NBA (if it hasn't already). Fantasy basketball analyst Dan Titus has some advice for how to navigate it.
Yahoo Sports - 1d
Rep. Dusty Johnson defends GOP budget plan

The House GOP budget plan includes trillions of dollars in spending cuts and recommendations for significant cuts to Medicaid. It directs the committee that oversees the program to look for $880 ...
CBS News - 3d
Trump says House budget plan will not cut Medicaid benefits

President Trump said the budget plan he endorsed and that passed in the House will not lead to cuts to Medicaid benefits. CBS News' Caitlin Huey-Burns has more.
CBS News - 2d
Will Johnson's budget plan protect Medicaid like Trump promised?

House Speaker Mike Johnson says his budget plan will protect Medicaid benefits but will still probe for "fraud, waste and abuse." CBS News' Taurean Small reports.
CBS News - 1d
Jeffries warns major Medicaid cuts are coming with budget plan

House Minority Leader Hakeem Jeffries says cuts to Medicaid will emerge from the budget negotiations in Congress. CBS News' Nidia Cavazos reports as President Trump and House Speaker Mike Johnson ...
CBS News - 1d
A Team of Female Founders Is Launching Cloud Security Tech That Could Overhaul AI Protection

Cloud “container” defenses have inconsistencies that can give attackers too much access. A new company, Edera, is taking on that challenge and the problem of the male-dominated startup world.
Wired - 3d
How would Medicaid cuts impact seniors in nursing homes?

The safety net is already precarious, so any shifts could break the system
MarketWatch - 1d
Details on Senate-passed GOP budget plan after "vote-a-rama"

Senate Republicans have passed a budget resolution after pulling an all-nighter through a process known as "vote-a-rama." The passage comes despite President Trump's earlier backing of a competing ...
CBS News - Feb. 21
House GOP plan to pass Trump agenda set to face key test

The House GOP’s plan to pass a large chunk of President Trump’s agenda is set to face a key test this week when the conference looks to adopt a budget resolution, which would set the legislative ...
The Hill - 5d
GOP Gambles on Budget Plan That Helps the Rich and Cuts Aid to the Poor

The House Republican budget plan would pair tax cuts that primarily benefit the rich with cuts to programs that help the poor.
The New York Times - 2d
How Washington plans to defend the dollar

Trade tariffs grab headlines but the less-visible fight around money matters deeply to the president
Financial Times - Feb. 22
A DOGE dividend could be a win-win-win for the GOP and Team Trump

With Democrats screaming that the sky is falling every time the Department of Government Efficiency axes one federal worker, Elon Musk’s team needs some good public relations.
The Hill - Feb. 21
Dem absences could help GOP pass its budget

House Democratic absences on Tuesday could help GOP leaders move their massive budget blueprint through the lower chamber. With just a hairline majority, Speaker Mike Johnson (R-La.) has raced for ...
The Hill - 3d
Senate GOP to vote on its plan for Trump's agenda despite Trump backing House plan

Senate Republicans plowing ahead with their efforts to advance the first stage of their two-part package to pay for Trump's agenda despite Trump backing the House’s plan.
ABC News - Feb. 20
Senate adopts GOP budget plan in "vote-a-rama," despite Trump backing competing House plan

The Senate has adopted a slimmed-down GOP budget proposal focusing on defense, border security, and energy priorities, despite President Trump's earlier backing of a competing plan put forward by ...
CBS News - Feb. 21
Inside Republicans' budget plan that extends Trump tax cuts, potentially threatens Medicaid

After a lot of back-and-forth on Tuesday night, House Republicans were able to narrowly adopt a budget resolution that would advance President Trump's agenda. The proposal passed in a 217-215 vote. ...
CBS News - 2d
How Trump's tariffs on Mexico and Canada will sweep across the U.S., state by state

From Maine to Montana to New Mexico, states across the U.S. will face significant economic issues from President Donald Trump's trade war on Mexico and Canada.
CNBC - 3d
Morocco says it dismantled Islamic State cell that was planning attacks

Moroccan authorities have arrested a dozen people they said were planning attacks on behalf of the Islamic State in the Sahel
ABC News - 4d
EU plans to relax gas storage targets for member states

Brussels hopes a ‘more flexible’ filling trajectory will reduce market disruption
Financial Times - 2d
'We're not prepared': States brace for Trump's plans to dismantle the Education Department

Trump has said he wants school policy to be left to the states, but state officials and lawmakers aren’t clear on what that would look like.
NBC News - 2d
How Trump’s mission to Mars could save the nation

A robotic colony on Mars might seem like far-fetched science fiction, but so was the Moonshot. American Exceptionalism will rise again.
The Hill - 6d
How Trump’s Reverse Robin Hood Could Backfire

Taking from the poor and giving to the rich has not been a historically smart move.
Inc. - 1d
How Trump’s Tariffs Could Affect American Companies

Business owners told The Times that President Trump’s tariffs could lead to higher costs and expressed frustration at the sudden uncertainty about policy.
The New York Times - 4h
Israel’s army admits failures on Oct. 7. Its probe of the attack could put pressure on Netanyahu

TEL AVIV, Israel — An investigation by the Israeli military has determined that Hamas was able to carry out the deadliest attack in Israeli history on Oct.
NBC News - 1d
Israel's army admits failures on Oct. 7. Its probe of the attack could put pressure on Netanyahu

An investigation by Israel's military has determined that Hamas was able to carry out the deadliest attack in Israeli history on Oct. 7, 2023, because the much more powerful Israeli army misjudged ...
ABC News - 1d
Utah Could Become the First State to Ban Fluoride in Public Water

A bill before the governor would prohibit adding fluoride to water systems. The move could affect children’s health, experts warned.
The New York Times - 2d
GOP senator praises Elon Musk as the ‘United States’ consultant’ amid federal cuts

In an exclusive interview with Meet the Press, Sen. Markwayne Mullin (R-Okla.) defends President Trump and Elon Musk's cuts to federal agencies amid backlash from Oklahoma voters.
NBC News - 6d
Trump’s Plan to Repeal Climate Policy Could Upend Shift to Electric Cars

The administration is setting the stage for Congress to repeal a longstanding waiver that allows California to set its own pollution standards. State officials say the effort is illegal.
The New York Times - 2d
YouTube star MrBeast planning investment round that could value company at $5bn

Funds would be used to create holding company for 26-year-old’s growing empire of video and food businesses. The world’s biggest YouTube star, MrBeast, is planning to raise hundreds of millions of ...
The Guardian - 2d
Student loan borrowers face abrupt 180 as GOP budget plans threaten to raise payments

Student loan borrowers could see their payments increase under budget plans currently under discussion by House Republicans, a violent about-face after years of working with the Biden ...
The Hill - 4d
Watch live: Jeffries, Dem leaders make case against GOP budget plan

House Minority Leader Hakeem Jeffries (N.Y.) alongside other Democrats will give remarks Tuesday afternoon as their Republican colleagues press forward with a budget resolution that seeks to push ...
The Hill - 3d