Republicans Have a Blindspot – Healthcare

Congressional Democrats should jump on it.

Republicans have long struggled to present a coherent healthcare policy, relying instead on cuts, misleading rhetoric, and budget gimmicks that ultimately harm their own constituents. Their latest budget proposals expose a fundamental vulnerability: an impossible math problem that inevitably leads to slashing Medicaid, a program millions—including those in Republican districts—depend on.

Rather than merely playing defense, Democrats have an opportunity to go on offense, not just opposing these cuts but championing an abundance agenda that expands access, lowers costs, and delivers real healthcare solutions for all Americans. By highlighting the real-world consequences of GOP policies and offering a compelling alternative, Democrats can turn this Republican blind spot into a platform for healthcare that works for everyone.

The Math Doesn't Add Up—Because It Can't

The recent Republican budget resolution creates an impossible math problem. It directs the Energy and Commerce Committee to cut $880 billion in spending over a decade. Since Republicans have pledged not to touch Medicare, and the committee's jurisdiction outside of Medicare and Medicaid only covers about $480 billion in programs, the unavoidable conclusion is that Medicaid must absorb massive cuts.

As Matthew Yglesias explains: “A more technically accurate way of describing the budget resolution would be to say that it “calls for” large cuts to Medicare or Medicaid, rather than simply asserting that it cuts Medicaid. The committee also oversees about $480 billion in programs that are neither Medicaid nor Medicare, but even if they were all completely eliminated — which would include the Children’s Health Insurance Program, which would have all the same political issues as cutting Medicaid — that’s still hundreds of billions of dollars short.

The TL;DR here, then, is simple: This resolution means cuts to either Medicaid, Medicare or some of both.”

Republicans are unlikely to admit their plans to cut Medicaid, instead relying on deceptive framing and technical maneuvers while claiming they haven’t cut the program. One such tactic is adding work requirements to Medicaid, which House Republicans have suggested would save about $120 billion annually. However, these “savings” primarily come from people losing coverage, not from securing jobs with health insurance.

Recent analysis by the Center on Budget and Policy Priorities finds that 36 million Medicaid enrollees—across all 50 states—could be at risk of losing coverage under various work requirement proposals. While not all of them would ultimately be disenrolled, many would.

The Congressional Budget Office has repeatedly concluded that work requirements on these programs do not increase workforce participation but instead create administrative burdens that disproportionately harm disabled individuals, caregivers, and those in unstable, low-wage jobs.

Democrats Should Embrace an Abundance Healthcare Agenda

Instead of engaging in a shell game of semantic denials and hidden cuts, policymakers should address the real problem: the scarcity of healthcare services that drives up costs for everyone. Cutting benefits without addressing supply constraints simply shifts costs and reduces access, leaving vulnerable populations worse off while failing to lower expenses across the system.

This is why Democrats must go beyond just defending Medicaid, and actively push for policies that remove structural barriers to healthcare access and affordability. The best way to beat Republican austerity politics isn’t just by rejecting cuts—it’s by showing that a better, more expansive vision is possible.

Rural Healthcare Cuts vs. Rural Healthcare Solutions

Many Republicans represent districts where Medicaid plays an outsized role in providing healthcare access, particularly in rural areas. If these cuts move forward, they should have to answer to thousands of constituents who stand to lose coverage.

David Valadao (CA-22, R+7) represents a district where nearly seven in ten residents rely on Medicaid. Nick Begich (Alaska At-Large, R+2) has over a third of his constituents enrolled in Medicaid. Robert Bresnahan (PA-8, R+2) represents a district with 31% Medicaid enrollment. Eli Crane (AZ-2, R+9) has nearly a third of residents in his district depending on Medicaid.

Image Credit: The New York Times (Graphic, adapted)

It is also important to note that Republicans are not unified on healthcare cuts. Research shows that some of the largest intra-party divides exist on policies like Medicaid, with many lower-income Republicans opposing deep cuts even if party leadership supports them.

In places where Medicaid is a lifeline, voters should see who is fighting to protect it and who wants to cut it. In swing and lean-Republican districts, Democrats can sharpen the contrast: Republicans vote to take away your healthcare, while Democrats are fighting to protect it. The stakes are not theoretical—Medicaid cuts lead to hospital closures, higher medical debt, and worse health outcomes. Democrats should make sure voters know that Medicaid’s defenders are on the ballot, too.

Now, here is where the offense comes in; Republicans are the ones who want to cut Medicaid that rural hospitals depend on. Democrats should now take it a step further and advocate for reforms that eliminate barriers to access healthcare in these same communities.

Here are some policies specifically designed to help rural communities:

• Eliminate Certificate of Need laws: These regulations require providers to get permission from competitors to open facilities. States with these laws have 30% fewer rural hospitals and higher mortality rates.

• Expand telemedicine access: More than 30 states restrict out-of-state doctors from providing telehealth services. Removing these barriers would improve rural access to specialists and mental health providers.

• Support rural-focused training programs: Incentivize medical professionals to train and practice in underserved rural communities through targeted loan forgiveness and training initiatives.

Endangering 7.2 Million Children vs. Covering All Kids

Not only would rural communities be disproportionately impacted, but also the millions of children who rely on Medicaid for healthcare. Republican cuts would directly threaten coverage for over 7.2 million children currently enrolled in the program. Democrats should not only continue to raise awareness that Republican "non-cuts" like work requirements ultimately kick people off their healthcare, but also go on offense in this area.

This moment presents an opportunity to introduce Medicare for Kids:

• Universal coverage for all Americans under 18 would guarantee healthcare for every child, regardless of their parents' employment status or income level.

• This approach would consolidate existing children's health programs (including CHIP and Medicaid's child coverage) while filling coverage gaps that leave many children vulnerable.

• Medicare for Kids would eliminate bureaucratic hurdles like income recertification that cause children to lose coverage despite remaining eligible.

• Data for Progress polling shows 54% of Americans already support Medicare for Kids, with net support at +25% among Independents, making it both good policy and good politics.

Image Credit: Data for Progress

Work Requirements vs. Workforce Expansion

Republicans claim Medicaid work requirements will save money and boost employment. In reality, they function as bureaucratic hurdles designed to kick people off healthcare, not help them find jobs.

A 2018 Medicaid work requirement in Arkansas led to 18,000 people losing coverage in just seven months before a federal court struck it down. Many who lost coverage were already working or should have been exempt but got caught up in paperwork and red tape.

Similar failures in New Hampshire and Georgia reinforce this reality: work requirements don't increase workforce participation, but they do disproportionately harm disabled individuals, caregivers, and people in low-wage, unstable jobs.

Democrats should not only oppose these bureaucratic barriers to kick people off healthcare, but they should also focus on real workforce solutions that actually address America's healthcare access problems:

• Lift the residency cap: The 1997 cap on Medicare-funded residency slots artificially restricts the physician pipeline. Removing it would expand primary care access.

• Create pathways for immigrant physicians: 165,000 internationally trained doctors in the U.S. are blocked from practicing due to licensing barriers. Fixing this would immediately increase provider capacity.

• Expand scope of practice: Allowing nurse practitioners and physician assistants to work to the full extent of their training would improve access, especially in restrictive states.

A Better Alternative

Republicans have created a political blindspot with their impossible budget math, deceptive Medicaid cuts, and policies that endanger their own constituents. Democrats must push back against these harmful cuts while offering a stronger alternative. An abundance agenda can ensure better care and economic security for all Americans.