Republicans got their health care cuts. Now they're trying to hide them

GOP is worried the voters will punish them

President Donald Trump signs tax and spending bill last week, as congressional Republicans look on.

The political cost for cutting $1 trillion from Medicaid will be steep.

Thus, the GOP spin cycle has been turned on high.

Republicans who voted for the Big Ugly Bill that was signed into law last week know Americans are angry. Multiple opinion polls show “voters broadly dislike” the measure according to Politico, with one of the polls it cited showing that almost half the public said they wanted more spending on Medicaid, not less.

So, it’s no surprise Republicans are trying to hide the damage.

Sen. Josh Hawley of Missouri, who initially criticized the Medicaid cuts but flip-flopped to vote for them, is trying to convince people that the Senate’s harshest reductions won’t even happen. Meanwhile, Republican-friendly columnists are arguing the health care cuts won’t be that bad. I’ll explain more about that claim later in this column.

Contrary to what Hawley is saying, I wouldn’t be surprised if GOP hardliners push for even more cuts. They’ve never liked Medicaid—or Medicare, for that matter—so it wouldn’t be surprising to see them agitate for even harsher reductions in the future.

The hardliners don’t like the idea of adding $3.3 trillion to the federal debt, which the Big Ugly Bill does, so these fair-weather deficit hawks who caved and voted for the law will eventually want their pound of flesh.

Report: Iowa may see 19% reduction

Even if it doesn’t get worse, the $1 trillion in cuts baked into the books will hit Iowa and other states hard. Iowa is a heavy user of the kind of revenues congressional Republicans are restricting, and the Kaiser Family Foundation issued a report last week estimating Iowa might see a cut of between $8 billion and $14 billion in federal funds over 10 years.

The midpoint of that range is $11 billion, or $1.1 billion a year on average. These cuts amount to a 19% reduction in 10-year federal baseline spending in Iowa, according to Kaiser.

For a state spending $9 billion overall on Medicaid in fiscal year 2025, including state and federal funds, those are big cuts.

The new rules Congress is putting in place will reduce the number of people who have Medicaid coverage in Iowa by tens of thousands of people. But they probably won’t be the only ones hurt. Iowa is bound to lose a lot of money. The Senate restrictions on the ability of states to impose provider taxes and state-directed payments are significant.

This won’t be easy for state lawmakers in Des Moines to deal with, either.

Already, the state is running a $900 million operating deficit, the result of Republicans passing a flat tax that delivered much of its benefit to upper income Iowans.

(A brief aside: The GOP promised that these tax cuts would usher in a new era of prosperity for Iowa, but the opposite has happened. The US Bureau of Economic Analysis issued a report a couple weeks ago showing that Iowa’s Gross Domestic Product plummeted 6.1% in the 1st quarter of 2025. It’s true 38 other states also saw their GDPs fall, but Iowa was tied with Nebraska for the biggest drop in the nation. As I have previously written, this is just part of a long-running problem for Iowa’s ailing economy.)

Now, lawmakers will have to deal with a historic shortfall in federal funding for Medicaid, which is one of its largest programs. Which made it all the more predictable right-wingers would try to fool people by telling them these cuts won’t actually happen.

Republicans try to undermine the referees

Then there are others who say, if they do happen, the health care cuts won’t be as bad as expected. They’re selling this idea by trying to undermine the credibility of the non-partisan Congressional Budget Office, which estimates that nearly 12 million Americans will lose health insurance by 2034 because of the Big Ugly Bill. About 5 million others will lose coverage because of Republican rule changes and the decision not to extend enhanced tax credits for Obamacare.

Republicans say the CBO is biased because it underestimates revenue effects from tax cuts, while overestimating the impact of spending cuts. In essence, they say, CBO is biased against Republicans. You know, like the media, colleges and universities, the courts, the federal bureaucracy, public health experts, the Government Accountability Office, social media, etc., etc.

This also is a red herring.

I don’t doubt estimates 10 years into the future are tough and are sometimes, perhaps even often, wrong. The CBO itself acknowledges its estimates are subject to error. In both directions.

However, I don’t believe the CBO is biased toward spending or Democrats. The fact Republicans regularly cite its estimates should disprove those claims. What’s more, some of the statements Republicans are making are clearly false.

Earlier this year, congressional Republicans said the CBO underestimated revenues generated by Trump’s 2017 tax cuts by more than $1 trillion. However, as the Committee for a Responsible Federal Budget pointed out, two-thirds of the $1.5 trillion in additional nominal revenues between 2018 and 2024, occurred because of the effects of inflation, not any real change. The rest was due to a post-Covid revenue surge that happened five years after the original Trump tax cuts were passed.

In other words, one had nothing to do with the other.

Which didn’t stop the GOP from claiming they did.

The truth is, it’s farcical to believe $1 trillion in Medicaid cuts won’t hurt real people; that a 19% reduction in expected federal health care revenues over a decade in Iowa will not affect the poor, disabled and elderly in this state.

Already, the Iowa Medicaid program has massive waiting lists, the largest of which has grown by 11% this year alone. Already, hospitals in the state say stagnant Medicaid reimbursement rates put them in financial jeopardy.

Of course, these cuts will hurt.

If you don’t believe me, look at the most powerful evidence of all: Republicans have structured this law, so the vast majority of these spending reductions won’t occur until after the 2026 elections.

Some won’t even take place until 2028.

There’s a reason for this. Republicans hope that by the time elections roll around, people will forget they chose tax cuts for the rich over health care for the poor. And in case people haven’t forgotten, the GOP is trying to con them into believing this law does the impossible: That it simultaneously raises the incomes of Americans by more than $10,000, shrinks the federal deficit, makes historic cuts in federal spending and yet still doesn’t harm a soul—except for people who refuse to work and some illegal immigrants.

Nobody with an ounce of common sense would believe this.

The challenge for Democrats is to make sure the American people know the real truth. To accomplish this, they need to remind people constantly of the harm Republicans did last week.

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