As House Republicans prepare to slash hundreds of billions of dollars from Medicaid, it’s been widely observed that these cuts will screw over countless voters who backed one Donald J. Trump in the 2024 election. As many Democrats note, such cuts undermine the idea that Trump is remaking the GOP as a “working-class party,” since they will fall heavily on the working poor—precisely the demographic Trump is supposed to be ushering into the GOP.
Guess who agrees with this criticism? Vice President JD Vance, that’s who. At least he did back before he became a full-fledged devotee of Donald Trump.
Back in 2017, when House Republicans were feverishly trying to repeal the Affordable Care Act during Trump’s first term, Vance repeatedly criticized the effort’s Medicaid cuts, castigating them as a serious betrayal of Trump voters—and, importantly, of the supposed working-class populism underlying Trump’s support. Trump voters, Vance said then, backed him because unlike other Republicans, he “wasn’t saying I’m going to take away … your Medicaid.”
This matters not just because it badly undercuts the current GOP push to slash Medicaid. It also sheds new light on Vance’s evolution as a public figure and the sordid compromises he’s made to rise to the pinnacle of MAGA politics.
The House GOP is currently hashing out the “big, beautiful bill” embodying Trump’s agenda, and it would impose work requirements and other bureaucratic hurdles on Medicaid recipients. That would result in at least seven million fewer people on the program, many from the ranks of the working poor, and many in red states.
These are precisely the types of voters who would have been hurt by the 2017 House GOP effort to repeal the ACA. That bill would have phased out the ACA’s Medicaid expansion and transitioned to block grants to states, booting millions off the program, many of them in Trump country, if the bill hadn’t failed in the Senate.
At the time, Vance was riding a wave of fame as his Hillbilly Elegy memoir and Trump’s surprise 2016 election victory turned Vance into a celebrated decoder of life in working-class white America, even as he personally remained an opponent of Trump. But Vance also emerged as a major public critic of that House GOP bill, especially its savage cuts to Medicaid spending.
In a 2017 interview with the Cleveland Plain Dealer, for instance, Vance faulted the GOP repeal effort’s Medicaid cuts, which he explicitly cast as a betrayal of Trump voters. Vance said Trump had been elected precisely because he refrained from saying, “I’m going to take away your Social Security and your Medicaid.” This, said Vance, had differentiated Trump from plutocratic Republicans who wouldn’t “take care of working-class people.”
Then, in a 2017 op ed for The New York Times, Vance argued that the GOP bill would shift large numbers of people “from Medicaid to the private market” without ensuring that they can “meaningfully purchase care in that market”—i.e., they’d lose coverage. Vance suggested that Republicans must stand for “some baseline provision of care” to working-class voters, meaning cuts to Medicaid would betray that principle.
President Trump actively championed that bill at the time. And though the Senate killed it, Vance didn’t forget what it had revealed about Trump and Trumpism. In 2020 private texts obtained by The Washington Post, Vance lamented that Trump’s first term had “thoroughly failed to deliver on his economic populism.” It is likely, given Vance’s criticism of the GOP repeal effort, that this was a partial reference to that.
The current GOP bill’s cuts to Medicaid aim at populations similar to those targeted in the 2017 bill, Robin Rudowitz, a vice president at the health care nonprofit KFF, tells me. Rudowitz notes that both populations broadly include “low-income parents as well as adults without dependent children,” people who are “largely in low-wage jobs and don’t have access to private insurance,” many with “at least one chronic condition.” There are a lot of people like that in Trump country.
Some might be tempted to dismiss the importance of Vance’s previous quotes. After all, it’s widely known that Vance was an early critic of Trump before converting to a major supporter and then becoming his running mate.
But that would constitute letting Vance off too easily. His previous criticisms were not merely aimed at things he disliked about Trump personally, such as his temperament. They constituted a broad statement of deeply held principles on his part, ones that took specific issue with the GOP’s policy priorities—and its penchant for governing against the interests of working-class voters, including those who elected Trump.
If Vance and Trump end up supporting some version of the deep Medicaid cuts in the GOP bill—which is very likely—then it should go without saying that Vance should be held to account for all the ways this move betrays those previously stated ideals.
Vance’s abandonment of principle in service of his embrace of Trump and conquest of MAGA politics is the subject of a deeply reported piece by The Atlantic’s George Packer. As it chronicles, Vance justified his conversion by insisting that Trump’s appeal was only superficially about his most vile theatrics. Behind all that, Trump was clearing new ideological space for Republican politicians to break from traditional GOP plutocracy and truly represent working-class voters on many issues. One of these issues, Vance said explicitly, was health care.
Yet as Vance rose higher in the MAGA firmament, he increasingly trafficked in the ugly lies, the hateful cultural appeals, and the proudly sadistic cruelties of MAGA—the very things Vance previously claimed constituted a negligible fraction of Trumpist politics. Vance stopped caring about all the ways that Trump-era GOP policies continued to screw over the working-class voters whom Trump was supposedly fighting for.
The truth is that savage Medicaid cuts fit comfortably under the ideology of Trumpism when it is properly understood. In Vance’s original telling, right-wing populism is supposed to embrace a robust government role in shielding working people from economic degradation. But at its core—see John Ganz and Matt McManus on this—Trumpism is ultimately hostile to the aims of the social democratic state. Trumpism is particularly averse to social democracy’s goal of mass empowerment, which treats universal access to health care as foundational to the ideal of liberal equality.
Instead, Trumpism actively embraces hierarchy and subjugation of the non-chosen. It wields the state to facilitate the division of Americans into MAGA “winners” and non-MAGA “suckers” and “losers.” Thus it is that the stated aims of the 2017 iteration of Vance so often seem to vanish when the state falls under Trump-MAGA control.
It is possible that Trump and Vance will ultimately oppose House Republicans’ cuts to Medicaid. On Tuesday, Trump privately directed them to refrain from cutting Medicaid other than eliminating “waste, fraud, and abuse.” But in the next breath, Trump also endorsed “commonsense work requirements.” So it’s likely that Trump will support all sorts of GOP bureaucratic chicanery that in the name of combating “fraud” actually pushes millions off Medicaid. And Vance, the great populist champion of the working poor, will go along with him every step of the way.
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