The following is a lightly edited transcript of the May 15 episode of the Daily Blast podcast. Listen to it here.
Greg Sargent: This is The Daily Blast from The New Republic, produced and presented by the DSR network. I’m your host, Greg Sargent.
The House GOP is forging ahead with its massive domestic policy bill implementing President Donald Trump’s agenda, and it’s becoming absolutely clear that it will seriously screw over Trump voters. But you don’t have to take my word for it. Senator Josh Hawley, a staunch ally of Trump, went on CNN and said this in strikingly direct terms. He decried the bill’s cuts to Medicaid and confirmed that they are a betrayal of voters who support Trump and the GOP. All this poses a real test for both Trump and the MAGA movement. Will they see the Medicaid cuts the way Hawley does? Or will the same old scam kick in where Trump and Republicans pretend to be a pro–working class party while shafting working-class voters to pay for huge tax cuts for the rich? Today, we’re talking about all this with Jonathan Cohn, senior national correspondent for The Bulwark and one of the best working health care reporters out there. Good to have you on, John.
Johnathan Cohn: Thanks for having me on the show, Greg.
Sargent: So let’s start here: House Republicans are racing to finish their big bill. The bill extends Trump’s 2017 tax cuts, which overwhelmingly benefited the rich and corporations. And to offset this, it also dramatically slashes the safety net with large cuts going to Medicaid. John, can you explain what the bill does on Medicaid exactly?
Cohn: Yes. There’s a couple of different baskets of cuts. The biggest one is a set of work requirements, which you probably heard about. You have to show that you’re working or you can’t stay on the program. There’s a second set of changes which sounds super technical about how often your eligibility gets checked and your enrollment, but makes it basically harder to stay on the program. There’s a third set of changes which affect the way states finance their benefits. And then there’s a couple of miscellaneous changes. There’s different justifications for all of them. They add up to about 800 to $900 billion. The thing to remember, I always say, is that you can go into the pros and cons for either one of them—but at the end of the day, if you take that much money out of Medicaid, it’s going to translate to less health care for people.
Sargent: There’s no doubt that this cuts Medicaid benefits, right? Can you go into that?
Cohn: Yeah. One way or another. The basic rule here is if money is coming out of Medicaid, for the most part, it is coming out of health care for people. Either it’s going to be fewer people covered, or it’s going to be fewer benefits for people who are on Medicaid. Now it won’t always look like that directly; a lot of times, it’ll be these technical adjustments on various formulas or procedures. But one way or another, less money is going into the program. And one of the realities, what’s going to happen is.... Again, sometimes people are going to lose coverage. Certainly, I count that as cutting benefits. What’s a benefit cut? Well, if you’ve taken someone off Medicaid, they’ve lost all their Medicaid benefits. So to me, that’s a benefit cut.
But there’s a second, more indirect way that benefit cuts can happen, which is that states have a lot of latitude over how they design their Medicaid programs. It’s a very complicated law, and there are whole sets of benefits that people like you and me would take for granted—like prescription drugs, some forms of long-term care. And basically, when states get squeezed, when they don’t have enough money, sometimes they’ll react by pulling back on those benefits. And they might say, We’re no longer going to offer this, or, We’re no longer going to offer this optional benefit to certain classes of people.
And then there’s an even more indirect way they can cut benefits, which is that states have a lot of leeway over what they pay for services. Remember, Medicaid is an insurance program. So it’s paying doctors, it’s paying hospitals, it’s paying therapists. Well, if you’re a state and you’re trying to save money, sometimes what you do is you tell all the hospitals and the doctors and the therapists you’re paying them less. That’s fine, but if you do that, it’s going to be harder for people who get those benefits to find providers, to find their services. So that, to me, is also an indirect way of cutting benefits.
Sargent: Well, Senator Josh Hawley of Missouri really does think the bill does cut Medicaid benefits rather substantially. He recently wrote a New York Times op-ed urging the GOP not to cut Medicaid, saying, “Our voters support social insurance programs and depend on them.” On CNN, interviewer Manu Raju asked him about this claim and the current House GOP bill’s Medicaid cuts. Then this happened.
Josh Hawley (audio voiceover): Republicans now, thanks to Donald Trump, are the party of the working class, Manu. You referenced the returns from the last election. The big majority of working-class voters voted for the GOP. That means now the GOP needs to deliver for them. And we do that by giving them tax relief. We do that by bringing down their health care bills. We don’t do it by cutting Medicaid.
Manu Raju (audio voiceover): If this bill becomes law, are you concerned that Republicans could face a severe blowback in the elections next year?
Hawley (audio voiceover): This bill is not going to become law in its current form, not least because President Trump won’t sign it. Manu, I’ve talked to him about this personally multiple times. He has been crystal clear in public, too—no Medicaid benefit cuts. We need to give a tax cut to working people, not raise their taxes when it comes to health care, not take away their health care benefits. I hope this bill will get refocused on delivering relief for working families. That’s what we ought to be doing.
Sargent: So Senator Hawley’s MAGA credentials are pretty good. And here he suggests that the House GOP bill’s cuts to Medicaid are a serious betrayal of Trump GOP voters. That’s quite an admission about the Republican Party. Your thoughts on this, John?
Cohn: Yeah. I was listening to that CNN interview and my my first thought was, If you didn’t tell me who was speaking and you told me that was coming from a liberal Democrat or somebody like Henry Waxman, the great senior and now retired member of the House who was like a father of the modern Medicaid program, I would believe it because it sounded like something they would say. And then I immediately thought ahead to the next election. And I’m thinking, If I’m a House Republican running for reelection and I voted for some of this, I’m going to be running in an ad. Someone’s going be quoting Josh Hawley in that ad. They’re just going to run his sound and say—especially if it’s a place like Missouri where they know Josh Hawley—Representative X voted for Medicaid cuts. Josh Hawley, MAGA Republican, said, “These will harm working-class voters.” You could literally quote him. So it was really remarkable. And the op-ed in the Times was really the same thing. The rhetoric was indistinguishable from what a liberal defender of Medicaid would say.
Sargent: Well, I want to flag something else that Senator Hawley said in the CNN interview. He said, “Trump won’t sign this bill,” because Trump sees all this his way. Has Senator Hawley forgotten that Trump tried to repeal the Affordable Care Act entirely during his first term? Has he forgotten that the Republican Party’s central obsession for more than a decade—up until very recently—was to destroy the ACA? The GOP philosophically hates social insurance programs. Can you talk about this big picture?
Cohn: Yes. The record of the Republican Party on Obamacare, on extensions of Medicaid, and then on the broad level—the whole idea of government health care programs—[is] hostile. It’s in the Republican conservative DNA. And look, principle conservatives have very honest intellectual arguments for why they think these programs are bad. They waste money. We should have to ... whatever. You’re a conservative, you believe that, you should argue that. That’s why we have these political debates. Josh Hawley surely knows about.... Let’s not forget when he was attorney general in Missouri, he signed on to one of the lawsuits challenging part of the Affordable Care Act. So my answer to “Does Josh Hawley not remember?” [is] I suspect at this point consistency is maybe not the most important value for him—or he’s done his own switcheroo.
Having said all that, it is absolutely true that one of big differences between now and 2017 when they were trying to repeal the Affordable Care Act [is] Trump’s rhetoric. He has been very clear rhetorically that he is not excited about taking Medicaid away from people. There have been multiple leaks from his pollsters and his advisers saying that if we cut Medicaid, this is not going to go well for us politically. Steve Bannon was out there saying that months ago. Now, who knows how much of this is Trump trying to send a message or how much is Trump’s advisers trying to send a message for whatever reason—I don’t know. It is absolutely true, though, that as the Republican coalition has changed and gotten more working-class and lower-income voters—and as Medicaid has become more more vital to this population—the prospect of cutting Medicaid comes with much greater political peril for the Republicans than it did even five years ago.
And Missouri is your classic example. Why does Josh Hawley care about this so much? Because Missouri now has expanded Medicaid. They did it by ballot initiative. And by the way, they did it with a constitutional amendment—that is not something they can change easily. So they are on the hook for paying for Medicaid. If the federal government, one way or another, is paying less for Medicaid, the state of Missouri is in a whole lot of trouble financially because they’ve to find that money somewhere.
Sargent: Absolutely true. Good point. Another good point you made in one of your pieces is that for Republicans, cutting social insurance to fund tax cuts for the rich and corporations is a matter of their actual philosophical position. But the thing is they know it’s unpopular, so they try to package both those things as pro–working class. Tax cuts for the wealthy are supposed to spur investment and working-class job creation, and cutting Medicaid is supposed to be about rooting out waste and fraud and abuse—which working-class voters are supposed to see as being in their own interests. But the thing about these Medicaid cuts is that they will hurt the working poor. Can you talk about that?
Cohn: Yes. They are desperate to.... The last whole two months—this entire debate as it has unfolded so far—has been one attempt after another by the Republicans to present their Medicaid cuts as something other than Medicaid cuts. We’re making the program more efficient. We’re actually protecting.... We’re really fortifying it so it really serves the most needy people. And you saw—especially in the last two weeks as they were trying to get the language together to put into a bill—there was, every day, a new leak of a new way they were going to cast Medicaid cuts, a new form for the cuts. It was almost like you could just see them trying to throw things against the wall. What’s going to work? What’s going to work? What’s not going to sound like a cut? But the problem is they want to take this money out of it, and there is no way to do it without hurting working-class voters.
And you just go down the line: What is Medicaid by? What does Medicaid do? Well, in a state like Ohio or West Virginia, it is the biggest financier of substance abuse disorder treatment. You look across the South—really across the United States—it’s the single biggest payer for live births, for maternity care. It is deeply embedded in the life of working-class Americans and, by the way, their communities too. You know this, Greg—but in any congressional district in America, what’s the biggest employer? It’s a hospital. And those hospitals need Medicaid money. If you take money out of Medicaid, they’re going to suffer, and those communities are going to suffer.
Sargent: Well, the Republican Party really is devoted to screwing over Trump voters. That’s just the fact of the matter. The money is either going to go to the wealthy and corporations or to the working poor, and they can’t paper that over. That’s the fundamental math problem. So John, I hope Hawley is right that Trump won’t sign this bill. But I think one possibility is that Trump will just say that all the bill does is cut waste and fraud and abuse—and pretend it doesn’t cut Medicaid for the working poor. Then he’ll go and sign this bill or some version of these cuts anyway. What do you think?
Cohn: I wish I knew the answer. I don’t know how it’s going to go. I could make a credible argument either way, I feel like. Clearly, there is pressure. There’s a sensitivity to the fact that their own voters are now depending on Medicaid. The party is different than it was years ago. That is why Josh Hawley is like this. That is why Trump is talking like he doesn’t want to cut Medicaid. So there is a real reluctance to go there. On the other hand, this is still the Republican Party. They want their big tax cuts. There’s powerful constituency in the party that wants to pay for those. There’s another powerful constituency in the party that just hates government and wants to shrink it. Those two are going to do battle, and I don’t know where this comes out. Maybe it comes out somewhere in the middle where there’s some cuts—but not all the cuts—and then they go out and try to sell it as, Hey, these aren’t real cuts. These are just making the program better. But again, if people feel the impact, it’s going to be hard to escape the consequences for that, I think.
Sargent: Isn’t the basic fact here that in essence, at its core, the Republican Party really still is a plutocratic party? There’s a major wing of the party that’s allied with the donor class. The big donors to the party are the hedge fund managers, the big CEOs, the billionaires. There’s just no getting around that for the Republican Party, is there? You see that tension playing out here in the sense that the Republican Party is delivering a massive tax cut for the very wealthiest and for the corporations, right?
Cohn: Yeah. Look, this is the way I think about it: At end of the day, you can tell what a party’s identity is by what really matters to them. What is the one thing they won’t give up on? They don’t have to make any cuts to Medicaid if they don’t want to. Why are they cutting Medicaid? Because they’re cutting taxes. That’s where they start. If they want to be the working-class party, if they don’t want to be the party of the plutocrats, then don’t do big tax cuts for the rich. If you do big tax cuts for the rich? Well, people are going to think you’re the party of the rich—and they’ll be right.
Sargent: And I think that’s what’s going to end up happening. Jonathan Cohn, it’s so good to talk to you, man. Thanks for coming on.
Cohn: Thank you. Thanks for having me.
Sargent: You’ve been listening to The Daily Blast with me, your host, Greg Sargent. The Daily Blast is a New Republic podcast and is produced by Riley Fessler and the DSR Network.
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