Republicans Might Give Democrats an Opening on Health Care—Again
Amid the busy start to Trump’s second term, something that has received relatively little attention is the Republican Party’s budget bill working its way through Congress. Just hearing the words “budget bill” is enough to make many people’s eyes glaze over. But at the center of the debate around it is a perennially contentious issue that could cause political headaches for Republicans if they proceed on their current path: health care.
Both parties have historically faced voter scrutiny when pushing policies related to health care reform. Efforts to expand health insurance have often been met with charges of socialism and created a public backlash—but so, too, have efforts to restrict it. An important truth about American politics is that once a new benefit is firmly established, taking it away can be even riskier.
We’ve seen this principle at play regarding health care within recent memory. One of the first major actions taken by the Republican-controlled Congress in Donald Trump’s first term was to repeal the Affordable Care Act (ACA, or “Obamacare”). Polling around that time showed that the law’s popularity had risen to net-positive territory, perhaps in response to the imminent threat against it. Moreover, Republican plans to repeal it were extremely unpopular. But for a dramatic “no” vote from Senator John McCain, they would have succeeded anyway.
This attempted repeal was a boon for Democrats, who won a “blue wave” election in the subsequent midterms, netting 40 new House seats and making extensive gains down the ballot. The AP VoteCast survey from that election found that a plurality of voters identified health care as the top issue facing the country, and those who agreed broke overwhelmingly for Democrats over Republicans in House races, 76 percent to 22 percent.
However, even in spite of that recent history, Republicans are giving it another go. Their latest budget is likely to include massive cuts to Medicaid—a program that provides health insurance to low-income Americans, especially in rural areas—and the codification of a proposed rule by the Trump administration that could hamper the ACA insurance exchanges. One estimate from the Kaiser Family Foundation found that these changes and others in the bill could grow the uninsured population in the U.S. by as many as 16 million people.
Unsurprisingly, these moves are unpopular. For starters, Medicaid remains highly favored across the political spectrum. As of this year, fully 83 percent of Americans had a favorable attitude toward the program, including 74 percent of Republicans (whose favorability has grown by 11 points since last year). The public also has strongly favorable views toward the ACA, with fully 66 percent approving of it as of this year, though a majority of Republicans still hold unfavorable views of the law. Both overall figures represent record highs.
Moreover, polling from earlier in the month showed Trump’s approval rating deeply underwater on healthcare, with just 33 percent of voters (including only 24 percent of independents) approving of his performance against 53 percent disapproving.
Democrats looking for an issue on which to gain a leg up ahead of next year’s midterms would be wise to zero in on health care. As I documented last week, post-election research found that despite the party’s low standing after 2024, health care remains one of the few issues on which they have an advantage over Republicans.
At a time when many Americans believe life feels increasingly unstable, the threat of losing their insurance and becoming more exposed to medical bankruptcy is likely to be a real motivator. Democrats’ own strategists seem to be taking note of this, advising their House candidates to make the GOP’s impending cuts “the defining contrast of the 2026 election cycle” and launching an ad campaign on the topic against Republicans in vulnerable districts.
It remains to be seen whether congressional Republicans will follow through with these threatened cuts—and whether Trump, who has explicitly stated he will not touch Medicaid benefits, would sign a budget bill that included them. But as the 2018 midterm showed, it may not matter whether these changes ultimately pass. Just the threat of adopting them could give Democrats a potent weapon heading into next year’s midterms.
Editor’s note: A version of this piece first appeared in UnHerd.
I suspect the reason that Medicaid is so popular is that masses of people conflate it with Medicare. This is really a product of Republicans giving Democrats an opening on health care but of longer standing. If this works for Democrats, they should thank Paul Ryan. At any rate, controlling this issue is a poisoned chalice. Screwing around with payment systems like insurance and welfare won't fix the deeply broken health CARE system. To do that you have to deal with corporate medicine, health deserts and most intractable of all, lifestyle. And do all this into the teeth of demographic decline.
Michael, would you acknowledge there is more complexity in Medicaid payment systems and the ACA generally than is captured in an opinion poll? There are legitimate problems with the Medicaid provider tax, for instance, and enhanced premiums subsidies are unsustainable. And NONE of the proposed Democratic programs actually lower health care costs, they merely have the federal government subsidize premiums, something our country cannot afford. I also think there is a difference between the original Medicaid program and how it was expanded under the ACA, with the feds paying MORE for people who are NOT disabled, pregnant, children, etc.