Recently, House Republicans approved the broad outline of their major legislation for this year, which includes $4.5 trillion in tax cuts and $2 trillion in spending cuts. To get there, the Energy and Commerce Committee was charged with finding $880 billion in cuts — something would be impossible to do without slashing Medicaid, now the single-largest health insurance program in the US.
But some House Republicans are wary of voting for Medicaid cuts, forcing the White House and congressional leadership to scramble. President Donald Trump has so far sworn off major cuts to the program.
Between Medicaid’s expansion under the Affordable Care Act and the two major economic downturns in the past 20 years — the Great Recession and the economic downturn following the start of the Covid-19 pandemic — an increasing number of Americans receive its benefits. By enrollment numbers alone, Medicaid is the single largest health insurance program in the country.
That’s why Republicans find themselves in such a bind: Medicaid is really popular these days and most Americans — even Republicans living in red states — don’t want to lose it.
According to a new KFF poll published Friday, more than half of Americans, 53 percent, say they or a family member have been covered by Medicaid. KFF’s poll, a nationally representative survey of 1,300 US adults, also reported that 96 percent of Americans say the program is “very or somewhat important” to people in their local community.
In the new KFF poll, 42 percent of Americans support raising Medicaid spending, 40 percent want to maintain it, and just 17 percent said it should be cut. Even among Republican voters, two-thirds think the program’s spending should grow or stay flat; only one-third want cuts.
These responses aren’t a one-off. A January 2025 YouGov poll found 80 percent of Americans have a favorable view of Medicaid. Nearly 40 percent of Americans said they had been enrolled in Medicaid, and nearly 50 percent said a family member had. (In a 2013 YouGov survey, only 39 percent said they had a favorable view of the program and 30 percent said they had no opinion at all.)
As Republicans have increased support among low-income voters, their voter base among people who depend on Medicaid has grown. Given this constituency, I asked Michael Perry of PerryUndem, who conducted that YouGov poll, to break down the results more granularly. He told me that conservative respondents generally felt the same way: Two-thirds of Trump voters said they supported Medicaid and more than 60 percent of people in Republican states opposed spending cuts to pay for tax cuts.
As Congress finalizes the budget, these are the headwinds Republican leaders are facing.
So, they are trying a new message. Trump himself said last week of Medicaid: “We’re not going to touch it. Now, we are going to look for fraud.” Most voters do believe that fraud and waste are major issues in Medicaid and they support trying to do something about it.
While it may be a better political argument for Trump and congressional Republicans, in reality, there almost certainly isn’t as much actual fraud as Republicans claim — which ends up making this pivot more of a mirage. Senior GOP officials are openly talking about making large cuts but labeling them as “fraud, waste, and abuse.”
The US Senate still needs to pass its own budget resolution before the legislative debate can move forward. But this will be the political tug-of-war that will determine the future of Medicaid in the next few months. Can the GOP sell its spending cuts with a new branding — or is Medicaid now so entrenched, and so popular, that they won’t be able to get the votes to slash it?
