Look, we get it. The budget math is brutal. The political math is brutal. Congress must extend the TCJA, and tack on more tax cuts, while trying to maintain some plausible face of fiscal responsibility. The House has a very narrow margin and some implacable fiscal conservatives to appease.

All of that is true. But if Congressional Republicans are going to go ahead and cut Medicaid, they should go ahead and do it with open eyes.

Many Trump Voters Rely on Medicaid

There are a couple things to keep in mind. First, since the post-ACA expansions, Medicaid is no longer a niche program for the poor. Medicaid covers one in five Americans. Second, the Republican Party is now the party of the working man, which means that cutting programs that working class Americans benefit from will be unpopular with their own voters.

2024 exit polls indicated an approximate 15-point swing toward Trump among voters earning less than $50,000 annually, and for the first time since the 1960s Republicans won a majority of Americans in this income bracket.

43% of Medicaid enrolees are white, 45.9% are male. Most importantly, Donald Trump won Medicaid recipients. 49% of 2024 voters on Medicaid backed Donald Trump, versus 47% for Kamala Harris. According to one survey, nearly one in five Trump voters (18%) report that they themselves use Medicaid; according to surveys, 77% of Americans have a positive view of Medicaid, and 65% of Republicans (of Republicans!) have a favorable view of Medicaid.

If Republicans reduce funding or eligibility for Medicaid, many Americans will end up on the ACA exchanges. While the ACA marketplace offers subsidies, coverage there almost always costs more than Medicaid. In other words, cutting Medicaid would in many cases be hitting our own voters with a tax increase. Is this what they voted for?

Political Impact

Let's crunch some numbers. 49% of Medicaid beneficiaries voted for Trump in 2024, which allows us to estimate the number of Medicaid beneficiaries who voted for Trump in each swing state and compare that to his vote margin.

Here's what that means in the key swing states: in Arizona, which is having Senate races next year, Trump's margin of victory was about 45,000 votes; we estimate there are about 995,000 Trump voters in Medicaid. In Georgia, Trump's margin of victory was 65,000 votes; there are around 980,000 Trump voters on Medicaid in Georgia. In Michigan, where there is an open Senate seat coming up, Trump's margin of victory was 40,000 votes; there are approximately 1,245,000 Trump voters on Medicaid in that state. In Nevada, Trump's margin of victory was just 22,000 votes, versus 441,000 Trump voters on Medicaid. In North Carolina: 70,000 vote margin; 1,300,000 Trump voters on Medicaid. In Pennsylvania, where John Fetterman will be defending his seat, Trump carried the state by just 80,000 while we estimate that 1,560,000 Pennsylvanians on Medicaid voted for Trump. Wisconsin: just a 30,000 vote margin, versus 610,000 Trump voters on Medicaid.

Since the strongest energy for cutting Medicaid is in the House, with its precarious majority and looming election, we thought we'd crunch some numbers on key House districts as well. Keep in mind that every time we kick people off Medicaid, we are hurting Trump voters more than we are hurting Democrat voters. In CA-13, which was won by Democrats by just 0.09%; we estimate that 38,000 individuals would lose Medicaid coverage in case of steep cuts. In IA-1 (R), the margin was 0.19%, and we estimate that Medicaid cuts would hit 35,000 voters. In PA-7 (R), the margin there was 1.01% and we estimate that approximately 40,000 voters would be hit by Medicaid cuts. In CO-8 (R), hitting 37,000 individuals will make it harder to keep a district that was won with just a 0.73% margin. In ME-2, which Democrats won by just 0.69%, kicking 36,000 people off of Medicaid, a relative majority of whom are Trump voters, will not help us.

Conclusion

As we said above, we understand the difficulty of both the budget and the political equations. But if Congressional Republicans decide to go ahead with steep Medicaid cuts, they should do so with open eyes. When your correspondent speaks to elected officials in DC, he too often gets a sense that they don't know who their voters are. Significant Medicaid cuts would hurt our voters, and in a way that they will notice and remember.

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