Saving Medicaid Is a Better Democratic Strategy Than Fighting DOGE. Matthew Yglesias

Saving Medicaid Is a Better Democratic Strategy Than Fighting DOGE. Matthew Yglesias 

February 25 — Read time: 4 minutes

Not about DOGE, not about Ukraine, not about Kash Patel, not about the president implicitly or explicitly comparing himself to Napoleon or a king. For Democratic leaders in both the House and Senate, the preferred topic of discussion is the fiscal framework currently wending its way through the House of Representatives, where trillions of dollars in tax cuts will be partially offset with cuts to health care and food assistance for the poor.

Even Senate Democrats are working on strategies to defend programs such as Medicaid and SNAP, despite the fact that their Republican counterparts are advancing a separate strategy that largely leaves these programs alone. Budget Chair Lindsey Graham’s resolution is much more modest in scope than the House draft, focused on cutting funds for clean energy in order to put more money into immigration enforcement and the military. His take is that Republicans should get this done fast, and then discuss the larger question of taxes and the safety net later in a separate bill.

Democrats are not really engaging with Graham’s resolution, which they see as a mere vehicle to get to the House’s framework. That may or may not be true. But what is true is that House and Senate leaders from both parties are fundamentally agreed on where Democrats’ strongest ground is: defending the social safety net.

Former President George W. Bush tried to privatize Social Security, and he failed. Former House Speaker Paul Ryan tried to cut Medicare, and he failed. In his first term, President Donald Trump tried to repeal the Affordable Care Act, and he failed. Right now DOGE is generating huge levels of excitement or alarm, depending on who you talk to, but dealing with relatively trivial sums of money.

Medicaid, by contrast, is a genuinely big and expensive program. If you want to enact major tax cuts without rattling bond markets, and have decided that programs such as Social Security and Medicare are off limits, Medicaid is the obvious choice.

The 10 Largest Categories in the Federal Budget

If congressional Republicans are serious about cutting spending, it will be hard for them avoid some popular programs

Still, Medicaid itself is popular. Eighty million people currently enjoy Medicaid benefits, two-thirds of adults say they have some connection to the program through a close family member. What’s more, though many state-level Republicans continue to oppose Medicaid expansion, it has proved popular and durable in states as red as Louisiana, Kentucky and Kansas. Cutting this program is going to be politically costly for Republicans.

That explains why Trump is saying Medicaid “won’t be touched” even though Republicans’ plans call for massive cuts. It also explains why House Republican leaders think the best way forward is to slip Medicaid cuts into a big legislative package crammed with other stuff that their members can easily defend — like an extension of Trump’s 2017 tax cuts. And it explains why Senate Republicans have adopted the reverse strategy — first pass a bill with no Medicaid cuts, putting some points on the board, and turn to slashing the safety net later.

Finally, it explains why Democrats are eager to skip past everything currently dominating the headlines and talk about Medicaid cuts instead. It’s not just that it’s a good issue for them. It’s a unifying issue for a party that is leaderless and struggling to regain its footing after a gutting defeat. Not only does Senator Bernie Sanders champion Medicaid, but so do red state governors like Andy Beshear of Kentucky and Laura Kelly of Kansas.

Meanwhile, over the last decade Trump has rebuilt the Republican coalition into something that is much more (as a salesman like him might put it) downscale. His 2016 campaign brought large numbers of low-income White voters into the tent. In 2020 and 2024, he posted significant gains with working-class Black and Hispanic voters. The upshot is that a much larger share of SNAP and Medicaid recipients is now voting Republican than in the past. That makes it harder to slash programs they depend on.

The alternative, of course, is for Republicans to slash taxes without offsetting spending cuts. That’s what they ended up doing in 2001, 2003 and 2017. DOGE’s ongoing antics could provide rhetorical cover for this course of action. The actual amount of money being saved is trivial relative to the cost of Republicans’ tax ideas, but there is certainly a lot of public discussion of spending cuts.

The problem is that — unlike in 2001, 2003 or certainly 2017 — the US is now in a fiscal environment where the budget deficit and the inflation outlook are weighing on interest rates. This is hurting consumers looking to buy cars. It’s making it harder for homebuilders to add new supply. And it’s even become a fiscal problem on its own terms. As old bonds roll over into new ones at higher interest rates, spending on debt service is soaring.

Basic budgetary tradeoffs are more real and more important now than they have been at any point in the 21st century. If Republicans want to be the party of large tax cuts — and, by all indications, they very much do — then they will also have to be either the party of large cuts to programs for the poor or the party of higher interest rates for the middle class. Merely pointing this out is the first step on the Democrats’ road to recovery.