Good afternoon, Press Pass readers. Today’s newsletter is free, but Thursday editions are exclusively for Bulwark+ subscribers. Grab the key to unlock it along with everything else The Bulwark offers: Sign up for a Bulwark+ membership with a free 14-day trial at the link below. I’ll keep it active for a little bit longer, so pick it up while you can! Today’s edition takes you into the Capitol where President Donald Trump gave Republicans a clear directive this morning: “Don’t fuck around with Medicaid.” That stern utterance doesn’t mean Medicaid recipients are out of danger, though, because it isn’t entirely clear which vision of Medicaid Trump is insisting should be preserved. The program remains the largest item being considered for cuts as the “big, beautiful bill” gets closer to a full vote on the House floor. But the cuts might also be happening on an even swifter timetable in order to win over GOP votes. And all this is happening as Trump is now guaranteeing that no one is going to lose health insurance under the bill! All that and more, below. What Does 'Don't F*ck With Medicaid' Mean? Depends Who You Ask.Plus: The federal deficit isn’t on anyone’s radar.
With just hours to go before a critical committee vote, there are still quite a few Republicans unwilling to support Donald Trump’s “big, beautiful” budget in its current form. Their recalcitrance prompted House Speaker Mike Johnson to bring the president to Capitol Hill to make the case to lawmakers himself. A visit from the boss is often all that skittish House Republicans need to find their courage to do ultra-MAGA things—even those their constituents might hate. But Trump’s lack of interest in policy details and his freewheeling style meant Republicans on Tuesday left the room with diametrically diverging interpretations of what he’d told them. “We have a tremendously unified party,” Trump insisted upon entering the Capitol. “I don’t think we’ve ever had a party like this. There’s some people who want a couple of things that maybe I don’t like or that they’re not gonna get.”¹ According to Punchbowl’s Jake Sherman, Trump told Republicans, “Don’t fuck around with Medicaid” in the closed-door meeting. It was unclear whether he meant don’t fuck with the program as it currently exists, don’t make additional changes to the program beyond those currently envisioned under the GOP bill, or keep any additional changes within reason. It was far easier to read the statement as simply meaning, “don’t make Medicaid into a political headache for me.” The plan from the get-go has been to cut Medicaid significantly. The budget resolution outlining how to pay for the tax cuts explicitly instructed the committee that oversees Medicaid to cut $880 billion from the program over the coming decade. And the proposed bill does make sweeping changes, with the Congressional Budget Office projecting that more than 10 million people could be removed from Medicaid enrollment over the next ten years. Some Republicans left the meeting in awe of the president’s ability to speak for any amount of time. “He’s a master salesman,” said Rep. Ralph Norman (R-S.C.). “He’s good.” Others listened intently and concluded that their own position had been confirmed. For instance, two Republicans from conflicting factions emerged from the meeting with entirely different takeaways on the matter of the Federal Medical Assistance Percentage (FMAP) rate, which determines how states receive matching funds for Medicaid. Rep. Tim Burchett (R-Tenn.), a conservative who is still an undecided voter on the budget, said he “understood” Trump to have signaled that FMAP adjustments are still on the table, adding, “I think they’re tweaking that.” Rep. Dusty Johnson (R-S.D.), a member of the Problem Solvers Caucus, came away with a different view. “The president said that we need to quit screwing around with Medicaid, that the bill as it is—that targets waste, fraud, and abuse—is a good work product,” he said. “The president did not mention FMAP and never suggested that that was an issue that was still live.” SALT modsMany of the so-called moderate House Republicans, who are preoccupied with securing a higher state and local tax (SALT) deduction rate in the tax portion of the bill, left the meeting opposed to the bill. The SALT deduction rate has been a priority for many of the frontline district Republicans in New York, New Jersey, and California. During the meeting, Trump called out Rep. Mike Lawler (R-N.Y.) directly as he instructed those Republicans to take the deal offered to them by the speaker and shift blame to their states’ Democratic governors. “We don’t want to benefit Democrat governors,” he told reporters before entering. Several of the SALT-focused Republicans left the meeting angry with the lack of action on their prized issue and wholly unconcerned with the Medicaid element. Rep. Nick LaLota (R-N.Y.) told reporters he remains a firm “no” on the bill. He and others at least appear to be holding firm until they can sufficiently maximize the tax cuts for their respective constituents. “I will never cast a vote that takes Medicaid away from eligible recipients who rely on this vital program, such as seniors, children, the intellectually and developmentally disabled, single mothers and families facing tough times,” Rep. Mike Lawler wrote last month in a response to an op-ed that criticized him for supporting cuts to the entitlement program. “Rather, my commitment has always been to strengthen these programs by cracking down on scam artists exploiting them at taxpayer expense.” Lawler then argued in support of the Medicaid work requirements that would effectively cut millions of Americans from the program. “That’s why I am advocating for common-sense reforms like work requirements for able-bodied adults without dependents, shifting eligibility verification to a quarterly review from the current annual review system, and ensuring benefits don’t go to ineligible recipients, including illegal immigrants,” Lawler wrote. “These steps aren’t about denying care to anybody. To the contrary, it is about directing resources to those who need it most.” Grand old slumber partyAs with the overturning of Roe in 2022, Republicans are on the verge of turning one of their stated goals—the kind that motivates the base, but which they have always known better than to try to actually accomplish—into a politically toxic achievement, this time by cutting social safety net programs like Medicaid. The plan, as of publication, is for them to take their next, pivotal step, with a vote in the Rules Committee an hour after midnight tonight. But getting the votes in line is tricky (as evidenced by the need to bring Trump today). The biggest movement has come in the direction of making steeper cuts to Medicaid, with Republicans now angling to have their proposed work requirements for beneficiaries implemented on an even swifter timetable. The work requirements were originally slated for implementation in 2029, but Republicans plan to insert language in the Rules Committee hearing Wednesday that would begin the rollout in early 2027, according to House Majority Leader Steve Scalise (R-La.). The GOP’s rhetorical framing of their planned Medicaid cuts have entailed a reimagining of what actually constitutes a “cut.” They took the same approach when Elon Musk and DOGE began slashing and altering services in the Social Security Administration. If any budget reduction can be described as a refinement or a new way to streamline efficiency, the thinking seems to go, then maybe Republicans can make the cuts they want without fear of catching consequences for doing so in elections. In addition, House Republicans seem unperturbed by accusations that they are conducting risky business under the cover of night (literally, by holding critical hearings at 1 a.m.) and trying to avoid scrutiny by speeding up the process. The story of this bill is playing out the way so many other GOP initiatives have over the past decade; Republicans who have often lambasted their Democratic colleagues for scheming and passing legislation without knowing its full scope have adopted those characteristics and turned them up to eleven. Deficit attention disorder “This bill does not add to the deficit,” said White House Press Secretary Karoline Leavitt Monday while responding to a question about how the House Republican (and White House endorsed) budget raises the deficit. “In fact, according to the Council of Economic Advisers, this bill will save $1.6 trillion, and the president absolutely understands and hears the concerns of fiscal conservatives and of Americans who want to get our fiscal house in order.” That is certainly not what the experts say. A model released Monday from Penn Wharton predicts a $3.3 trillion increase in primary deficits over the next decade. Penn Wharton also notes that this increase exceeds the allowed $2.8 trillion authorized in the budget resolution that provided the blueprint for this process. Where Leavitt found this magical number is likely in White House Management and Budget Director Russ Vought’s claim that the supposed “big beautiful bill” includes $1.6 trillion in savings, a figure that was not part of the CEA report. Savings would mean money the government is no longer spending, of course, but that does not have anything to do in itself with how much the government is adding to the federal deficit, to say nothing of actually lowering it. Vought wrote on X:
Deficits and debt have been a primary talking point for the GOP whenever they’ve been out of power. When they’ve been in power, it’s been a completely different story. The first Trump presidency approved more debt in a single term than any in recent history. Trump approved $8.4 trillion in new debt; President Joe Biden signed off on $4.7 trillion. Even if you exclude COVID-related spending, Trump still signed far more IOUs, adding $4.8 trillion to Biden’s $2.5 trillion. 1 “Tremendous” is the word of the day. Trump used some form of the word six times in the first minute after he arrived in the Capitol. You’re a free subscriber to The Bulwark—the largest pro-democracy news and analysis bundle on Substack. For unfettered access to all our newsletters and to access ad-free and member-only shows, become a paying subscriber. We’re going to send you a lot of content—newsletters and alerts for shows so you can read and watch on your schedule. Don’t care for so much email? You can update your personal email preferences as often as you like. To update the list of newsletter or alerts you received from The Bulwark, click here.
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What Does 'Don't F*ck With Medicaid' Mean? Depends Who You Ask.
May 20, 2025
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