These are dark days for Democrats. Their party’s favorability rating is at a record low. Its working-class support has collapsed. A new book confirms the White House covered up President Biden’s mental decline. The Democratic National Committee is embroiled in internecine war. President Trump’s relentless forward motion makes him look strong, while Democrats look weak and woke.
But Republicans should beware. They have two big messaging problems. If not confronted soon, they could create major difficulties in the 2026 midterms. This column will address the first challenge, Medicaid.
The current House Republican proposal would cut the program’s spending by nearly $700 billion over the next decade, according to preliminary Congressional Budget Office analysis. That’s a big number. GOP leaders, however, seem disinclined to explain what they’ll cut and why. It’s as if they believe that if they’re discussing Medicaid, they’re losing.
If so, that’s wrong. GOP silence will make the inevitable Democratic assault more powerful. And Republicans have a lot of ammo with which to prevail on this front. The federal government admits it made $543 billion in inappropriate Medicaid payments from 2015 through 2024. Some experts think the real number is $1.1 trillion. Either way, it’s close to what the GOP wants to cut.
Here’s a possible script for a Republican Medicaid offense:
Start by declaring a strong commitment to save the program. Because of Democratic policies, Medicaid is spending hundreds of billions on people it shouldn’t—those who are able-bodied and working-age. Republicans want this assistance to go to the people it was meant for—the elderly poor, disabled, and children in low-income families. Without reform, the program on which those Americans depend is at risk of rapidly becoming unsustainable.
The GOP should say that able-bodied adults on Medicaid should be required to work or look for work. “No freeloaders” on a program meant for the truly vulnerable is a powerful argument. A Feb. 25 Kaiser Family Foundation poll found 62% of Americanssupport “requiring nearly all adults to work or be looking for work” to qualify for Medicaid, while 38% were opposed. If told that such a requirement “could ensure that Medicaid is reserved for groups like the elderly, people with disabilities, and low-income children,” it was 77% support, 22% oppose.
Also drive home that—unlike radical Democrats—Republicans oppose illegal immigrants getting Medicaid. House Energy and Commerce Committee Chairman Brett Guthrie (R., Ky.) estimates that 1.4 million illegal aliens receive Medicaid. That isn’t only wrong; it encourages more aliens to try to cross our border illegally.
Make clear that Republicans want to end fraud while Democrats are content to perpetuate it. Specifically, Democrats have made it harder for states to check their rolls frequently for ineligible Medicaid recipients. For the sake of fairness and accountability, the GOP will make it easier to find and remove those who don’t qualify.
In sum, Republican reforms will help stop the government from wasting Medicaid dollars that elderly and disabled Americans need.
On Tuesday, President Trump’s team posted on X a video of him declaring: “We don’t want any waste, fraud, or abuse. Very simple—waste, fraud, abuse. Other than that, we’re leaving it.” That may be sufficient for the White House, but GOP candidates facing voters next year need to do more. They must embrace reform and show they’re comfortable talking about Medicaid. They have to shout from the mountaintops that Democrats oppose work requirements, favor giving Medicaid to illegal aliens, and won’t allow states to remove ineligible recipients from their rolls.
Republicans should admit that their changes will cost some people coverage, then endlessly drive home who those people are: illegal aliens, able-bodied people who refuse to work, and others who don’t qualify for Medicaid under existing law. Most Americans will find this argument entirely reasonable.
