Congress
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 Blue Light News 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 Blue Light News 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.
Senate Republicans are hopeful they will be able to confirm Todd Blanche as attorney general by the end of the week. But he’s not in the clear yet, as several undecided GOP senators continue to mull it over.
Blanche’s prospects were nonetheless much improved Monday — less than 24 hours after some GOP senators were predicting he was unlikely to get confirmed as a war of words escalated between President Donald Trump and holdout Republicans.
But then Blanche cut a deal with Sens. John Cornyn (R-Texas) and Thom Tillis (R-N.C.) late Sunday night to clarify a controversial settlement between Trump and the IRS, giving Blanche the votes he needed to get through the Judiciary Committee Tuesday.
He still needs to get through the full Senate, where he can only lose two Republican votes given likely unified opposition from Senate Democrats and Kentucky Sen. Mitch McConnell’s absence.
Several GOP senators who raised alarms last week about Trump’s public threats to rekindle the “Anti-Weaponization Fund” Cornyn and Tillis worked to kill declined to say Monday how they’d vote on Blanche.But in a positive sign for the acting attorney general, several are looking to Tillis and Cornyn, who are now supporting him, as a lodestar for their own deliberations ahead of likely floor votes later this week.
“I think certainly the fact that he has signed this order, basically disbanding [the fund] — that’s a pretty good step,” said Sen. Lisa Murkowski (R-Alaska), before adding that she would “like to find out a little bit more about the negotiations.”
Murkowski said she plans to speak with Tillis and Cornyn.
“I’m curious about what went on over the weekend,” she said.
Blanche has made efforts to ingratiate himself with Murkowski. In July, he trekked to Alaska, in part at Murkowski’s urging, to better understand public safety and tribal jurisdiction matters. He recently announced a nine-figure settlement benefiting Alaska natives’ health care that Murkowski was pleased with.
“I just appreciated the fact that he went to the state,” Murkowski said. “He was only there for two days, but I had asked him in my initial meeting to go up to the state.”
Sen. Bill Cassidy (R-La.), who like Cornyn lost his primary earlier this year to a Trump-backed challenger, declined to discuss Blanche Monday. Sen. Susan Collins (R-Maine) added that she also wanted to talk to Tillis and Cornyn and read the agreement they struck with Blanche.
“Until I do that, I am not going to make a judgement,” Collins said.
Another Republican who hasn’t yet committed to supporting Blanche is Sen. John Curtis (R-Utah). He met with Blanche last week but hasn’t yet weighed in since Sunday night’s agreement. He had indicated before Sunday’s deal that he would be closely tracking Tillis and Cornyn during Tuesday’s Judiciary Committee meeting.
Getting Blanche’s nomination on a trajectory to pass the Senate this week would relieve some of the pressure on Senate Republicans, who are juggling a long to-do list and a shrinking runway to get it done. Trump, amid last week’s standoff, demanded that Senate Republicans confirm Blanche, including warning during a Cabinet meeting that they “will never get anybody like him.”
Tillis told reporters Monday that “the back-and-forth over the weekend was not helpful” but that the talks “ended up at an acceptable place.”
If Blanche gets out of the Judiciary Committee Tuesday as expected, the soonest the Senate could confirm him as attorney general is Saturday unless Democrats unanimously agree to help speed up a final vote.
Senate Majority Leader John Thune said Monday that he’s hopeful the Senate will be able to confirm Blanche but didn’t give an ironclad guarantee as the remaining undecided members review the agreement and talk to Tillis and Cornyn.
“I’d like to figure out a way, a path forward to get him done,” Thune said.
Democrats are likely to use Tuesday’s Judiciary Committee meeting, and the days leading up to a full Senate vote, to hammer Republicans over the deal Cornyn and Tillis struck. Many predicted Monday that Trump wouldn’t stick by the agreement that limits the scope of the IRS settlement and nullifies the $1.8 billion payout fund.
“There are so many loopholes. I wouldn’t be surprised if the president went ahead with the program,” said Sen. Dick Durbin (D-Ill.), the top Democrat on the Judiciary Committee.
Sen. Tammy Baldwin (D-Wis.) warned the remaining undecided Republicans about the deal: “I don’t think that that commitment is worth what it’s written on.”
While Democrats can drag Blanche’s confirmation into the weekend, they aren’t able to prevent him from being confirmed if at least 50 GOP senators support him. But they are determined to use the debate to hit at one of their central midterm campaign messages — corruption — with Senate Minority Leader Chuck Schumer calling Blanche the “architect of Trump’s grifts.”
Tillis suggested Monday he still has questions about who in Trump’s orbit played a role in the roller coaster negotiations over the past week. While the retiring senator is prepared to support Blanche, he said that he’s “not done analyzing the anatomy of this deal and who played a role in there.”
“I’m not going to speak for other members, but I think that it’ll be a solid vote,” he added about Blanche’s chances of being confirmed.
Sen. John Kennedy (R-La.), who appeared skeptical during a Sunday morning talk show interview that Blanche would get through the Senate, did a 180 Monday when asked whether he would get confirmed: “Yes, I do.”
Jennifer Scholtes contributed to this report.
Multiple Senate Republicans joined Sen. Bernie Moreno in calling for Rep. Max Miller to step down from office Monday amid domestic abuse allegations from the Ohio senator’s daughter.
Bernie Moreno — father of Miller’s ex-wife, Emily Moreno — said in a statement Sunday that Miller should not serve in the House soon after the House Republican did a livestream video attempting to defend himself from abuse accusations.
Many of Bernie Moreno’s GOP colleagues were quick to back him following the statement.
“I don’t know [Miller]. I haven’t read a whole lot about him, but if [Moreno] thinks he ought to resign, I’m supportive of that,” Sen. Shelley Moore Capito of West Virginia said in an interview.
Miller has denied the allegations, which include pouring hot water on his ex-wife and holding a gun to her head. He has also denied accusations from his ex-wife that he broke his daughter’s collarbone.
Sen. Roger Marshall of Kansas condemned Miller, adding, “He should resign. He should quit.”
“I don’t know Mr. Miller’s story, but I trust Bernie so much as a good friend, and his family has such high values,” Marshall said in an interview. “I couldn’t imagine them wanting this out in public. So to go through with this, it makes me think that they’re telling the whole truth and nothing but the truth.”
The surge of support from Bernie Moreno’s Senate colleagues marks the first significant crack in a wall of GOP silence regarding the allegations against Miller. The skepticism from Miller’s own party will almost certainly weigh down the congressman’s already floundering campaign as he battles Democratic candidate Brian Poindexter to keep his Cleveland-area House seat.
Miller has until Wednesday to withdraw from the ballot and allow a crash primary to select a replacement.
Some Republican lawmakers stopped short of calling on Miller to withdraw or resign while expressing grave concern about the allegations.
“The accusations are very serious, and if there is truth to them, I am one who says that our elected officials need to be held to high standards,” Sen. Lisa Murkowski of Alaska said. “And certainly, when it comes to allegations of domestic abuse, child abuse, that’s not what we want in our lawmakers.”
A spokesperson for Miller did not immediately respond to a request for comment. In response to Moreno’s statement, Miller said on Sunday, “If my daughter said the same thing to me, I personally wouldn’t wait two years before holding him accountable.”
“You know this isn’t true and the only reason you are speaking out now is to hide from your own media circus,” he added in the post on X.
Notably still silent was GOP Sen. Jon Husted, Ohio’s other senator, who while leaving the Capitol Monday did not respond to reporters’ questions about whether Miller should resign.
Other Republicans in the Ohio House delegation are also staying quiet for now. Almost every House Republican from the state either declined to comment or did not respond to requests for comment on Moreno’s statement.
The exception was Rep. Jim Jordan, who brushed off questions in a Thursday CNN interview about Miller but noted he was “a good man” and was recently campaigning for him.
Asked Monday if Miller should still serve in Congress following Bernie Moreno’s statement, spokesperson for Jordan Stefanie Farrell said, “As Mr. Jordan has said, it’s up to the voters of Ohio’s 7th District.”
Back in the Senate, other Republicans who were unaware of the situation declined to weigh in on the incident.
“I am not aware of the situation, so I don’t have a comment right now,” said Sen. Joni Ernst (R-Iowa), who has been a leading GOP voice on domestic violence issues within the military.
But a steady drip of Republican senators said Monday evening they trusted Bernie Moreno.“It would surprise me if Bernie were being untruthful,” Sen. Cynthia Lummis of Wyoming said. “I guess I was surprised that it bubbled up to the public sphere, but I suspect that Bernie has got a beat on the situation.”
Sen. Jim Justice of West Virginia said he was unaware of the details of the allegations but that “Bernie’s a pretty level-headed guy.”
“I don’t know enough about the allegations, but like Bernie said, it sounds like he thinks he needs psychological help,” Sen. Rick Scott of Florida said, adding, “I trust Bernie.”
Chris Marquette contributed to this report.
Senate Budget Committee Republicans will meet Tuesday morning to talk about advancing a fiscal blueprint for a new party-line spending bill.
Chair Ron Johnson (R-Wis.) declined to say , in an interview Monday if he plans to introduce a resolution this week, noting that he was “working with leadership” and that the “first priority” is to pass a stopgap spending bill. Sen. John Kennedy (R-La.), a panel member, said he didn’t expect the Senate to take up a budget resolution this week because “I don’t think my leadership wants to do it.”
Senate Majority Leader John Thune hasn’t ruled out taking up a budget resolution but has been frank about the challenges it faces among GOP senators.
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