The Washington PostDemocracy Dies in Darkness

As long as the Republican bill cuts Medicaid coverage, it’s likely to be unpopular

Protesters rally against the Republican Senate bill to replace President Barack Obama’s health-care law on June 27, 2017, in Salt Lake City. (Rick Bowmer/AP)

This article has been updated.

After the Congressional Budget Office released analysis of a draft Senate health-care bill showing a steep reduction in the amount of money spent on Medicaid, defenders of the bill went to great lengths to deny that those cuts existed. President Trump tweeted a chart showing how Medicaid spending would continue to grow — ignoring that the Better Care Reconciliation Act was a reduction compared with planned spending under the Affordable Care Act (a.k.a. Obamacare) and that, in adjusted 2016 dollars, it wasn’t much of an increase in spending at all.

At the same time, the administration and congressional Republicans have made a concerted effort to cast doubt on the CBO’s projection that millions of people would lose coverage under Medicaid under both the House and Senate plans. That anticipated decrease is substantial, as below, but Republicans argue that the CBO’s overestimation of increases in coverage under the ACA mean that its numbers on reductions are suspect.

We’d note, though, that the question of the CBO’s Obamacare estimates was one of scale, not direction. People gained coverage — just not at the rate the CBO initially expected (in part thanks to the Supreme Court’s 2012 ruling on the law).

On Thursday, Senate Republicans plan to announce a new version of their bill that reportedly would protect existing taxes that are part of Obamacare. Doing so would protect a revenue stream that could be used to, among other things, decrease the negative effects on Medicaid coverage.

Why’s that important? Because Medicaid is very popular with Americans, and cuts to it — even rollbacks to the expansion that occurred under Obamacare — are likely to draw enormous political pushback.

The Kaiser Family Foundation polls on health-care policy monthly and compiled a number of datapoints related to the popularity of Medicaid.

For example: Medicaid is viewed favorably by nearly three-quarters of Americans, including a majority of Republicans. A third of the country views the program very favorably — as do 1 in 5 Republicans.

What’s more, people have a positive view of how Medicaid is working for low-income Americans, including those who gained coverage under the ACA. More than half the country — again including more than half of Republicans — think it’s working well both nationally and in their own states.

Critically, nearly 9 in 10 Americans think that funding for Medicaid should either be maintained at the same rates or increased. Only 12 percent of Americans think it should be decreased. Even 1 in 5 Republicans think that the amount spent on Medicaid should be increased.

The news isn’t all bad for Republicans. Some of the possible changes to Medicaid included in their proposals are approved of by most Americans, including allowing states to impose work requirements on beneficiaries and mandating drug testing.

One big change, though, is not embraced. Republicans hope to switch the federal reimbursement process on Medicaid spending from payments based on the number of covered individuals in a state to a block grant that the state can allocate as desired — allowing them to decide whom to cover. KFF explained the two options to poll respondents; nearly three-quarters preferred the existing system.

The most significant poll question, though, was probably this one.

Nearly 6 in 10 Americans said Medicaid is important to their families to some degree, with 40 percent of the country considering Medicaid very important.

In light of that, it’s hard to see how a bill that cuts Medicaid spending — even one that cuts it by less than prior iterations of the bill — would avoid posing a political risk for politicians who support it.

Update: It appears that this political risk continues.