Medicaid Cuts Haunt Republicans In Battleground States

Democrats in battleground states seeking to flip control of Congress in November are counting on a potent weapon: the deep cuts to Medicaid that Republicans approved last year in their signature legislation known as the One Big Beautiful Bill Act.

In recent Senate debates in Alaska, Georgia, Iowa, Maine, Michigan and South Carolina, Democratic candidates went after their opponents for supporting the law, which will reduce federal funding to the low-income health insurance program by hundreds of billions of dollars over the coming years. They also vowed to restore the money to the program if elected.

Republican candidates in those states have turned to the same defense: touting the $50 billion fund for rural health that was added last minute to the megabill to shore up support from GOP lawmakers concerned about its deep cuts to other health programs.

Sen. Susan Collins (R-Maine), who voted to advance the bill, but ultimately voted against its final passage, pointed to the rural health fund when defending that decision.

“If I had not allowed the bill to go to the floor, I would never have been able to author the $50 billion fund to help rural health care that is so important to the state of Maine,” she said when debating Democratic challenger Troy Jackson last week.

Jackson had a quick retort.

“What she brought back is a pittance [compared] to what we're losing in this state,” he said. "Senator Collins is like an arsonist who helped set the fire, and then she wants credit for bringing a cup of water to put it out.”

Other Democrats candidates echo his response. They note that the rural health dollars states will receive over the next five years is a fraction of the federal funding deficit they’ll face due to other provisions in the bill. They also argue the program has done little to stem the tide of hospital closures and service reductions in rural America.

In Maine, for instance, one hospital recentlyeliminated its labor and delivery services, while others are struggling to keep their doors open amid a sharp dropoff in federal funding.

Polling and ad spending suggest Democrats’ health message appears to be resonating. A POLITICO poll released last week found that an overwhelming majority of voters are aware of the One Big Beautiful Bill Act and oppose its contents, which include tax cuts for individuals and corporations, restrictions on food stamp eligibility and provisions to encourage fossil fuel extraction.

In addition to imposing mandatory work requirements on millions of low-income adults without children enrolled in Medicaid, the bill’s health care provisions also reduce the health funding states receive by hundreds of billions by changing their ability to tax hospitals and kick the money back to them via higher reimbursements. Beginning in 2027, it also boots millions of legal immigrants from Obamacare’s individual market, a move predicted to raise costs for citizens as immigrants are on average younger and healthier than the general population.

The GOP’s attempts to rebrand the package as the “Working Families Tax Cuts,” POLITICO’s poll additionally found, have done little to win over the electorate. In fact, Americans’ view of the legislation is slightly worse today than upon its enactment last year, when a poll by the health policy think tank KFF found opponents outnumbering supporters two-to-one.

Now, in the final weeks of the campaign, Democrats who have made the bill’s Medicaid cuts a leading message are tied or leading in many battleground races, including in states Trump previously won.

Michigan Gov. Gretchen Whitmer, the vice chair of the Democratic Governor’s Association, said in an interview with POLITICO that as she travels around the country to stump for gubernatorial candidates in red and purple states, she constantly hears how health care costs and the looming Medicaid cuts are “animating a lot of voters.”

She thinks the fallout from the federal health cuts is especially boosting Amy Acton’s chances of becoming Ohio’s first Democratic governor in 15 years, arguing her medical background gives her “credibility on the issue that is hard to match” as she talks about the rising number of uninsured people in the state.

“We've written off Ohio for a long time,” she said. “But because of how bad the lived experience is for Ohio voters right now, and with a really excellent candidate like Amy Acton, there's a real possibility there.”

Another survey by KFF released last week found that voters favor Democrats over Republicans on tackling the rising cost of health by 20 points — a sharp increase over the 11-point margin the same survey found earlier this year. A Quinnipiac poll in late September yielded similar results. And according to a national survey conducted by the left-leaning health advocacy group United States of Care, three in four Americans say health care will be one of the top three issues deciding their vote, and nearly as many reported feeling “frustrated, overwhelmed, or helpless” about health care costs.

Health care is also the number one issue in Senate advertising and the number two issue in House advertising, according to the nonpartisan Cook Political Report’s Battleground Issue Tracker, which found that Democrats are airing tens of thousands more ads and spending tens of millions more on the issue than Republicans.

Republicans in competitive races, meanwhile, have run a total of just four TV ads about the Big Beautiful Bill since the beginning of last year, according to the tracking firm AdImpact.

Consultant Jason Roe, who is working on Republican Rep. Tom Barrett’s campaign to hold onto his Michigan seat, argued that the GOP is rightfully focused on the issues voters care about most, and said health care ranks lower on that list.

“It has not been showing up in our polling, and we have not been hearing a lot about it in the district,” he said of the Medicaid cuts. “I do think that you'll continue to see a focus on affordability as it relates to gas, groceries, and broader inflation more than health care.”

But Larry Buschon, a Republican doctor who represented Indiana in the House for seven terms before retiring last year, warned last year that the Medicaid cuts his colleagues pushed through could threaten the GOP’s midterms prospects. Now, he’s seeing them struggle to defend them.

“A good part of the impact will be on states that are rural and red states, and it definitely has put some Republican candidates in a position of needing to explain the policy, which is complicated and difficult to explain,” said Buschon, now a senior policy adviser in the lobbying practice at Holland & Knight. “And as they say in politics: if you're explaining, you're losing.”

Democrats, meanwhile, argue their attacks on the legislation have been especially effective in the states where a high share of the population depends on Medicaid.

In New Mexico, for instance, where the percentage of residents enrolled in Medicaid is the among highest in the country, at 41%, former Secretary of the Interior Deb Haaland and the state Democratic Party have made it the leading message in her campaign for governor.

“There's a lot of fear out there across New Mexico about health care, and the president has pretty much caused all of it,” Haaland said in an interview with POLITICO. She added that she hopes to mitigate the cuts with state funding if elected, as the state’s current Gov. Michele Lujan Grisham has done with the enhanced subsidies for Obamacare plans that Congress allowed to expire.

Haaland is also pledging to hire teams of state navigators to help New Mexicans navigate new Medicaid work requirements that will take effect in January — rules that congressional scorekeepers estimate will cause millions to lose insurance.

“I'm going to do whatever I can to keep as many people on Medicaid,” she said. “And I'll do whatever I can as a state to fill in the gaps where Donald Trump is really yanking health care away from people.”

A similar dynamic is playing out in Alaska, where more than 36% of the population is on Medicaid and where Democratic Rep. Mary Peltola’s health care-focused campaign is threatening to topple longtime GOP Sen. Dan Sullivan.

“My immediate priority is reversing the damage to Medicaid and restoring health care tax credits that Dan Sullivan voted against seven times,” she said in Thursday night’s debate. “He voted for the Big Beautiful Bill and had the audacity to call it the Alaska Opportunity Act. This has been the opportunity for a third of Alaskans to have their Medicaid benefits reduced.”

Sullivan, like his fellow Republicans around the country, retorted that the bill’s Rural Health Transformation Fund is an “exciting opportunity” for the state, arguing it would “transform Alaska's health care system.”

Other GOP midterm candidates made similar arguments in recent debates when attempting to deflect Democrats’ criticisms of the Medicaid cuts.

“I guess she doesn't support rural hospitals,” Sen. Darline Graham (R-S.C.) said after Democratic challenger Annie Andrews criticized the One Big Beautiful Bill.

Rep. Mike Collins (R-Ga.) echoed this jab when Democratic Sen. Jon Ossoff accused him of voting for “the biggest Medicaid cut in history,” saying Ossoff “should answer for why he was not willing to help these rural hospitals survive.”

Roe, the Republican strategist, said the rural health program is also helping his party’s prospects in Michigan, noting that the “influx of money that came in” has “mitigated that situation politically.”

Yet some of the state officials who are now implementing those rural health grants say voters are keenly aware of the program’s shortcomings because hospitals continue to close or reduce the services they provide. And not only do the Medicaid cuts dwarf the rural health funding, they are permanent while the rural health grants will sunset in four years.

“Whether you get your health care through Medicaid or you get it through an employer or some other avenue, every one of us is going to be impacted by this, because when a hospital in an area closes down, whether you get a health [insurance] card or not doesn't make any difference if you don't have a hospital to show up to,” Whitmer said. “The public's not stupid, and we're all already absorbing a lot of additional costs that we shouldn't have to because of Republican decision-making in Washington D.C.”