Why the GOP hates Medicaid

President Donald Trump made news when he abruptly switched gears and said that he wouldn’t keep his hands off Medicaid as he kind of sort of promised to do during the campaign.

Now, says Trump, Medicaid is fair game for a quick assault, namely the part of the program that some governors, including GOP governors, used to expand coverage in their states. This was made possible under a provision of the Affordable Care Act. But Trump ignored the warning that by attacking Medicaid it could screw up the timetable for the GOP congressional assault on Obamacare.

This is incidental to the real reason behind Trump’s broken promise and the GOP’s manic obsession with savaging Medicaid. The GOP’s stock argument of reining in Medicaid is about cutting costs, stopping federal intrusion in health care, and restoring health care to the states is hogwash. What they really detest is the program itself, who it benefits and what it means politically to the GOP.

The root of the GOP’s loathing of Medicaid starts with who created it and what it was created to do. It was a Lyndon Johnson era, Democratic Great Society, War on Poverty program that was unabashedly aimed at covering welfare recipients and the poorest of the poor. Though the outrageous and very serviceable myth that is still happily fanned by conservatives, and many in the media, that Medicaid is a gigantic taxpayer health care give-away to the black poor, the majority of Medicaid recipients have always been whites.

In time, Medicaid was tweaked, reconfigured and expanded to provide health care for millions more who had absolutely no access to affordable — if any — health care coverage. The greatest beneficiaries, though, remained the poor, and especially their children. Medicaid covers the cost of prenatal care and hospitalization. 

Medicaid has been wildly successful in controlling health care costs, providing poor and working families with coverage unobtainable in the private insurance market, and in providing a brake on runaway medical care cost coverage in the states. Conservatives have seen deep political peril in this. And they saw even deeper peril when Obamacare expanded coverage even more and bumped up the numbers of those now receiving health care coverage under the program to nearly 20 million persons.

When conservative GOP governors such Ohio’s John Kasich publicly took the expanded coverage deal with Medicaid, and publicly said it was a boon to the state, the die was cast; Medicaid had to be attacked. The political horror to the GOP is that as long as Medicaid is seen as a Democratic measure and more specifically an Obama measure to aid the needy, the possibility is real that many of those millions of voters in crucial swing states such as Ohio will begin to connect the dots. And those dots are that Medicaid is a health care program which helps families in need, the Democrats support it and fight for it, while GOP conservatives bitterly oppose it. Therefore, come election time those families just might cast a vote for the friends, not the enemies, of Medicaid.

This is an especially fragile political proposition for the GOP, given Trump won by only the barest margin in a handful of states, nearly all of Congress is up for re-election in 2018, and GOP governors and legislatures have only tenuous control in several states. Medicaid and the lies and stereotypes told about it appear to be a tailor-made issue to rally conservatives and hopefully keep the GOP political ducks in line in contested states. That’s only the start, since Medicaid, because of those lies and stereotypes, is regarded as the easiest of pickings to go after. If successful, that opens the gate wide to the next two perennial right-wing targets, Social Security and Medicare.

As with Medicaid, Trump claimed during the campaign that he wouldn’t touch Social Security and Medicare, but that almost certainly will go the way of his Medicaid hands-off promise. The two programs are and have always been seen as Democratic inspired and backed programs, and that has made them conservative whipping boys with the usual storehouse of lies about runaway costs, waste and heavy-handed federal intrusion.

Medicaid then is the proving ground to convince the millions that benefit from these foundational federal programs they aren’t really in their best interests. The GOP will try to pound home that there are better alternatives, and the GOP, not the Democrats, is the party that can provide those alternatives. Trump got that message and will take the point in trying to deliver it to those voters who have grave doubts about hacking away programs that have been lifesavers to them. For tens of millions, Medicaid has been at the top of that list of those life-saving programs. This is what makes it the enduring political target it is, or, put bluntly, why the GOP hates it.


Earl Ofari Hutchinson is a political analyst and author of “In Scalia’s Shadow: The Trump Supreme Court” (Amazon Kindle). He is also an associate editor of New America Media and a weekly co-host of “The Al Sharpton Show” on Radio One. Earl also hosts the weekly “Hutchinson Report” on KPFK 90.7 FM Los Angeles and the Pacifica Network.