More broadly, it encapsulates an argument that could expose deeper vulnerabilities — Trump’s embrace of the orthodox GOP drive to shred government programs for poor and working people; his hollow, impulsive, reckless threats; his divisiveness and megalomania.
The White House is set to propose a new budget that includes hundreds of billions of dollars in cuts to Medicaid. It also reportedly calls for at least $2 billion in new spending on Trump’s wall — above and beyond the billions Trump has already been trying to reprogram for it.
This new budget is being widely described as a blueprint for Trump’s argument for a second term. It’s actually a very good argument against a second term.
Trump’s big betrayal
It’s hard to overstate how dramatically Trump’s efforts to gut Medicaid have betrayed his campaign promises. As Jeff Stein and Erica Werner note, in 2015 Trump vowed not to cut Medicaid, Medicare or Social Security — but once in office, he only exempted the latter two and has been ferociously swinging his ax at Medicaid ever since.
Trump and Republicans tried mightily to repeal the Affordable Care Act — and its expansion of Medicaid, which has been adopted by three dozen states. Though they failed, Trump continues to support a lawsuit that could wipe out the law entirely, which could cost nearly 20 million people their coverage, many on the Medicaid expansion.
Trump vowed during the campaign to not let people “die on the streets” from lack of health coverage. This, plus his promise not to touch entitlements, was absolutely central to the broader story that Trump told — that his brand of economic nationalism would conspicuously decline to embrace orthodox GOP hostility to public spending and bedrock welfare state programs. Trump sold out on both.
It’s not yet clear exactly how big the Medicaid cut in the new White House budget will be, but Stein and Werner of The Post estimate it to be hundreds of billions of dollars.
“There’s no way to make cuts that deep to the Medicaid program without millions of people losing coverage and worsening access to care for many more,” Aviva Aron-Dine, vice president for health policy at the progressive Center on Budget and Policy Priorities, told me.
Trump’s reelection strategy
Trump’s own advisers know that to win reelection, he must win back untold numbers of suburban, affluent white voters, mostly women, who deserted the GOP in 2018, helping Democrats capture the House.
In a deep dive into Trump’s reelection strategy, the New York Times reports that Trump’s own advisers are aware that the very things that supercharge Trump’s non-college-educated, mostly rural and exurban, aging white base — the abuse of political opponents, the rhetoric slamming immigrants — risk keeping those alienated voters away.
To get them back, Trump’s advisers are stressing the strength of the economy, which they believe will appeal to suburbanites. But it’s not clear whether the Trump team views his embrace of orthodox GOP plutocracy as a factor in alienating those voters. It’s often treated as an article of faith that Trump’s economic record is a uniform winner with them, as if only his personal qualities have alienated them.
Recent history suggests otherwise. The shift of voters that drove the Democratic takeover of the House came after an outpouring of anger at Trump and Republicans over their effort to repeal the ACA.
What’s more, in 2019, Democrats won governor’s races in deep red Kentucky and Louisiana, and seized total control of Virginia state government, in no small part due to the Trump/GOP record on health care. Democrats won in part by advocating for the Medicaid expansion.
Importantly, these wins were driven in part by gains in the suburbs. The pollster for the victorious Democrat in Louisiana recently told your humble blogger that the Medicaid expansion was a big selling point even among moderate and suburban voters.
Medicaid, then, has the potential to bridge the gap between the young, urban, and/or nonwhite voters in the Democratic base and the suburban and/or relatively affluent whites that Democrats hope to keep in their anti-Trump coalition through 2020.
Many of those voters were surely driven away by his anti-immigrant demagoguery as well. And the wall obsession has only gotten worse. Trump’s vow to make Mexico pay for the wall is widely treated as “just Trump being Trump,” but this was a hugely consequential broken promise, as we’re seeing now with the billions in spending he’s dumping into it. That, too, will likely resonate for swing voters.
Indeed, it’s even possible that Medicaid cuts could alienate a segment of the Trump base that Ron Brownstein has identified as soft in its support for him, and potentially gettable by Democrats: Non-college-educated, nonevangelical white women.
It’s one of the stranger subplots of this presidency that Trump and Republicans keep gunning for health care, despite the deep unpopularity of those efforts. Perhaps this reflects a sense that Trump is untouchable. Or maybe they believe Trump’s structural advantages in the electoral college are so unassailable that public opinion just doesn’t matter.
Trump is at least a 50-50 shot for reelection, due to incumbency and the economy. But Trump is giving Democrats a big weapon to wield against him, and they should seize it, just as they did in 2018. Trump’s acquittal has reinforced a sense among some pundits that he’s invulnerable, but his health-care record is still a major liability — and there’s just no reason to think that’s changed.