Trump Voters On Medicaid, On Medicaid Cuts
The noted health policy expert Steve Bannon had a warning for Republicans interested in cutting federal Medicaid spending, saying: “A lot of MAGAs on Medicaid. If you don’t think so you are dead wrong. You can’t just take a meat axe to it.” Bannon was correct, there are more than 20 million Republicans on Medicaid, although I don’t know from our polling how many of them regard themselves as MAGA. We asked Trump voters about Medicaid in focus groups we just conducted in Arizona, Pennsylvania, Kentucky, Arizona, Nevada, North Carolina, Ohio, Missouri and Oklahoma with Democratic and Republican Medicaid beneficiaries. What we heard was that they were not expecting big Medicaid cuts from the Trump administration when they voted for President Trump and worry about what the impact of cuts in federal Medicaid spending will be. One implication: Trump built a populist base of working people formerly in the Democratic party, making it more difficult for him to support traditional conservative Republican efforts to cut federal programs that serve that population. That also makes it more likely for tension—if not a rift—to develop over spending cuts between Trump and Republicans on the Hill who want to cut entitlement programs that now serve a significant part of Trump’s base.
For Republican Trump voters on Medicaid, the election was about immigration and the economy, not Medicaid. As one Republican woman from Arizona who voted for Trump put it: “I didn’t hear a peep about healthcare. Nope. It’s immigration for me.” Another Trump voter in Arizona doubted Trump would go for Medicaid cuts:
“I think Trump knows that people are struggling right now, and I don’t think he’s gonna do, at least not right now, cut anything Medicaid because he just knows people’s financial problems right now.”
Some Trump voters on Medicaid are receptive to efforts to go after fraud and abuse in Medicaid, suggesting that efforts to redefine spending cuts as fraud-hunting might resonate with them. They were, however, uncertain whether fraud was a product of beneficiary or provider misbehavior. They did not believe fraud was especially severe in Medicaid, seeing it instead as prevalent everywhere. Trump voters were more receptive to work requirements than Harris voters, but many were working already or felt they would be exempt, and struggled to figure out how the requirements would affect them.
In an especially relevant finding, Trump voters in the focus groups opposed cutting Medicaid to pay for tax cuts, because they do not see the tax cuts benefiting them. “I don’t make much money to get my taxes affected by that. It would hurt my Medicaid,” said a Trump voter in Nevada.
Overall, there are partisan and ideological differences between low-income Harris and Trump voters—that’s why they voted as they did—but in the end when it comes to health care, lower-income working people share common problems and needs. A Trump voter in Nevada summed it up: “Times are tough right now. You know everything is overpriced and no one is working and can’t afford anything, and my health is terrible, so it’s kind of tough times.” She was not expecting Medicaid to be cut.
Whatever happens in the short term in Congress, voter reaction will be somewhat muted until the congressional committees determine specific cuts that states and voters can react to, and we see how successful Republicans are at recasting spending cuts as eliminating fraud and abuse.