Does Trump really not understand his huge bill cuts Medicaid?

A strange thing happened on the way to Republicans’ passage of their big Medicaid-cutting bill: We learned that President Donald Trump seems unaware the bill will cut Medicaid.

Trying to line up support for the bill in a private call Wednesday with House Republicans, Trump offered his advice that, if they want to win elections, they shouldn’t touch Medicare or Social Security — or Medicaid. His comments were reported by Riley Rogerson and Reese Gorman of NOTUS.

This is a bizarre thing to say, because Medicaid is the single program being cut the most in the bill. Estimates suggest that its spending could end up cut by as much as 18 percent, causing about 8 million people to lose Medicaid coverage.

And this isn’t a one-off thing. For months, Trump has publicly promised to protect Medicaid, and reports have described him as queasy about Congress’s plans to do otherwise.

This puts Vice President JD Vance, who has talked a big game about changing the GOP to appeal more to low-income voters, in an awkward place. On X this week, he attempted to change the subject from the bill’s Medicaid cuts, arguing they were “immaterial” and “minutiae” compared to the immigration enforcement money that really matters.

Privately, many Republicans know differently. “Group texts are blowing up and frantic phone calls are being exchanged among GOP lawmakers alarmed about the Senate Medicaid provisions,” Politico reported this week.

It would be no surprise if Trump and Republicans misled about these cuts in public — GOP officials have been claiming that the Medicaid cuts are purely about limiting waste, fraud, and abuse. But the fact that Trump misstated this so blithely in private, to a friendly audience, is more strange. It suggests he truly is unaware what his “big, beautiful bill” will do.

Why the bill ended up cutting Medicaid deeply despite Trump’s repeated promises not to

To at least try to understand what’s going on here, it’s worth grappling with why this bill cuts Medicaid in the first place.

Trump’s priorities for his bill were tax cuts, immigration enforcement money, and raising the debt ceiling. This is all very expensive, and most of it will just add to the debt.

But conservatives in the House insisted that at least some spending cuts had to be included, to partially offset the bill’s cost. So GOP leaders searched for cuts that would be sizable — in the hundreds of billions of dollars range. Joe Biden’s clean energy subsidies were one obvious target.

It’s hard, though, to come up with big cuts that aren’t politically toxic. As budget wonks know, the real money in the federal budget is in Social Security, Medicare, Medicaid, and defense. Trump had no desire to cut defense, and the Trump-era GOP has deemed the senior-focused Social Security and Medicare politically untouchable.

Medicaid, aimed at low-income people, is a different story. Conservatives have long viewed it, along with food stamps and welfare, with suspicion, arguing that government benefits like these disincentivize work and get exploited by the lazy and undeserving. Medicaid beneficiaries are also believed to be less likely to turn out at the polls.

These longstanding conservative arguments have been slow to adjust to the news that Medicaid recipients have been an increasing share of the Trump coalition, as he’s helped the GOP gain among low-income voters. Many low-income whites in rural areas are on Medicaid, as are low-income Latinos in areas where Trump has done well, such as California’s Central Valley.

That dissuaded congressional Republicans from even more extreme Medicaid cuts some had wanted — but they still hit the program hard. The Medicaid cuts that made it into the bill were, however, crafted in roundabout ways that Republicans argued were just aimed at waste, fraud, and abuse.

These included new work reporting requirements. In theory, a requirement to document your working hours in exchange for coverage may not sound like a cut; in practice, the process will likely be arduous and error-filled and result in many working people losing coverage.

The bill also limits the “provider tax” states may change — a key way many states help finance Medicaid, since provider taxes are reimbursed with federal matching funds — among other changes.

All that added up to hundreds of billions in savings, on paper. But behind those savings is 8 million people losing their Medicaid coverage, as well as a potentially devastating impact on rural hospitals that rely on Medicaid payments.

Trump may not be aware of this, but many in the party are — that’s why they set the most painful Medicaid cuts to happen only after the 2026 midterms. And eventually, many Medicaid recipients will feel the pain, too.

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