FAFO: MAGA on Medicaid

     “A lot of MAGA is on Medicaid. If you don’t think so, you are dead wrong. Medicaid is going to be a complicated one. You just can’t take a meat ax to it, although I would love to.”
            Steve Bannon, being interviewed on Fox

Bannon

MAGA voters will find out what they voted for.

A political irony of the past decade has been that the people most adamant about repealing the Affordable Care Act -- "Obamacare" -- are the people who most needed and used the program. The working-class exurban and rural poor, who live in bright red districts, which are the places where Medicaid expansion was most beneficial. Small rural hospitals in those areas avoided bankruptcy and closure because the ACA allowed partial reimbursement for services that would otherwise be uncollectible and unpaid. Americans avoided medical bankruptcy.

Oregon contained a particular irony. Rural eastern and southern Oregon was represented by a personable, well-spoken Republican, Greg Walden, who rose by seniority and fundraising prowess to be the powerful chairman of the House Energy and Commerce Committee, which oversees health care legislation. His chairmanship made him part of GOP leadership. The GOP position was simple and clear: Obamacare is bad. The problem for Walden was that his district (which includes my home and farm) had more Medicaid recipients under the ACA than any other congressional district in the country represented by a Republican, and more than all but three congressional districts in the country. 

There is a pattern here in Oregon and nationwide. The reddest areas are the ones with the highest Medicaid enrollment:

Willamette Week

Looking ahead to Medicaid cuts, the most Republican districts are where the highest premium increases will occur:

KFF.org

Everyone wants to cut "waste, fraud, and abuse." There is casual, sloppy talk that works in campaign rallies and press conferences. It claims that surely we can get more work done with far fewer people if we just crack the whip and cut the waste. Let Musk/DOGE go in with a chainsaw. 

The news is starting to drift out that mass cuts in federal budgets and personnel mean elimination of programs that people in red districts and states consider essential. Conservative Republicans complain that the Forest Service is not processing timber sales quickly enough -- but DOGE required mass layoffs of the people who do that work. Oops. The IRS is a favorite villain, but cutting IRS employees mean that wealthy tax cheats have an easier time cheating, putting more burden on the easy-to-collect W-2 income from working-class taxpayers. Republican senators from Louisiana and Alabama are complaining that medical research funding at their flagship universities is frozen. 

But the real crunch will come in health care. The policy choices will be clear. Trump and Musk must cut Medicaid spending substantially to retain the tax cuts in Trump's 2017 tax law, the law that reduced marginal rates on the wealthiest taxpayers. Trump-supporting working people in red America will lose their Medicaid or pay more for it so that Trump's billionaire allies and friends keep more of their income. It is a bad look.

Trump is a gifted salesman, but that is going to be a tough sale. 

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