GOP's Proposed Cuts to Medicaid Are Political Suicide

Evan Barker, a former Democratic operative turned Trump supporter, explains in this guest column why these healthcare cuts should be off the table.

This guest opinion column is from Evan Barker, a writer living in San Francisco. Evan is a former Democratic campaign operative. Listen to her podcast, “Not Going Back,” follow her on X @Evanwch, and read her previous writing about the woke billionaire fundraising circuit.

Cue the chainsaw sounds!

I can see the Democrat attack ads in 2026 and 2028 all over the airwaves!

House Republicans are planning to vote on a budget resolution determining the path forward to enacting President Trump's policy agenda. The current proposal is an almost one trillion-dollar cut to Medicaid to finance the slew of tax cut renewals.

The attack ads pretty much write themselves. I predict this is precisely what they will look like: Elon Musk is on stage at CPAC, waving a chainsaw in slow motion, with doom music in the background; cut to a frame with Donald Trump promising no cuts to Medicare, Medicaid, or Social Security, and a final quick transition to a man speaking directly to the camera: "I lost my job, and when I tried to apply for Medicaid, I was turned down. Two weeks later, I got brain cancer. Now I'm homeless because I had to sell my house to pay for chemo." It sounds dramatic — but the drama is how Dems roll. These ads will be blasted in key swing states in 2028, with the numbers of those who lost healthcare coverage since 2024 tallied on the screens.

As someone who wrote and produced ads for high-profile Senate and House races during the last midterms – I know precisely how Democrats think and how they will attack.

I've also had the experience of being both sick and poor in America. In 2015, I was in between jobs, looking for work in a new city while simultaneously dealing with the reality of having a genetic lung condition called Primary Ciliary Dyskinesia, a disease similar to Cystic Fibrosis.

When I started to get very sick, with fevers and shortness of breath, I knew I needed to go to the emergency room. But I was terrified because I didn't have health insurance yet. I had just moved to California, and coming from Kansas, a state that doesn't offer Medicaid to people based on low income, I wasn't sure how to navigate these waters.

At the hospital, they determined I had pneumonia and needed emergent care. I was there for over seven days, receiving antibiotics intravenously. Because I wasn’t employed and was living without health insurance, a social worker helped me file paperwork from my hospital bed to get Medi-Cal (Medicaid).

It was approved, and the state retroactively applied coverage. It was a miracle. I would have been slapped with a massive bill for that long of a hospital stay otherwise, likely totaling over $100,000. Through the California Medicaid program, I was able to find a pulmonologist in San Diego who would help keep me out of the hospital with preventative PCD care.

When I left the Democratic Party this past August, I didn't foresee voting for Donald Trump. I became active in Democratic politics when I was still in high school, interning for Barack Obama's first presidential campaign because I wanted protection for people with pre-existing health conditions. This experience became a career spanning most of my adult life, as I eventually became a political strategist, fundraiser, and ad-maker on major campaigns throughout the country.

The Democrats have utterly disappointed me over the last four years, and this election, I decided to cross "enemy lines," giving Donald Trump a try and even telling people I did it publicly. Many people advised me not to share how I voted, saying that it would only discredit me when I tried to critique either side in the future, as I still maintain my status as an Independent. But it was more important to my integrity to not hide this fact. After all, the Democrats needed to know why they lost me, and the Republicans needed to understand why they won me. I am reflective of many voters across this country.

It took me years to see this: but I believe Donald Trump is a different type of Republican. In many ways, he is more like an old-school Democrat who wants a protectionist economy, speaks out against the exporting of American jobs, and has an unorthodox approach to foreign policy, wanting peace instead of endless proxy wars abroad. Trump didn't campaign to increase the social security age; that was Nikki Haley. What’s more, he promised not to roll back the Affordable Care Act like when he was president the first time around — and acknowledged the previous attempt reflected the demands of the old GOP establishment. This time would be different.

But right now, I need to warn House Republicans: Plans to cut Medicaid through "work requirements" represent an existential threat to their winning coalition, not just for the 2026 midterms but also in 2028.

Last week, Missouri's conservative Senator Josh Hawley even broke ranks with every Republican in the Senate except Susan Collins, voting yes on a provision to bar tax cuts for the very rich if just $1 is cut from Medicaid in the new spending bill.

Your instinct might be: "Well, why would any of them vote not to cut fraud, waste, and abuse? Any reasonable and sensible person would be in favor of this."

But it's important to note that these cuts are being made outside of the DOGE program and are in addition to fraud, waste, and abuse cuts.

Speaker Johnson has floated the idea of initiating the cuts of $880 billion through Medicaid work requirements of 20 hours a week to be eligible for the program. You might be asking yourself:

"But Evan, what is SO wrong with requiring work requirements for Medicaid?" As Speaker Johnson said, "People find dignity in work," and aren't there many people out there abusing the system?

Let me explain why "work requirements" sound good on paper but are, in reality, just a way to get people off the program.

Many people go on Medicaid when they become unemployed. How will federal work requirements of 20 hours a week affect these people? So far, plans have not outlined any provisions for protecting people recently laid off, fired, or unemployed and, therefore, without employer-based health insurance. This effectively prevents them from getting insurance while searching for a job.

Speaker Johnson did say some individuals would be protected from work requirements, including those with disabilities, parents of young children, children, pregnant women, and seniors.

However, the reality is that many people on Medicaid are undergoing the years-long process of becoming legally declared disabled. This means they are sick enough that they cannot work, but because disability usually involves a lot of paperwork and years of fighting for approval. In fact, 67% are declined on their first application. This new change in policy could effectively kick these people off Medicaid rolls.

Lastly, there's another group of people who are currently working part-time already, and such a change would effectively put them in a "you get screwed" category. For example, Joe in Missouri makes $22 an hour, working 15 hours weekly. The other 15 hours a week, he goes to school. Even though he's under 26, Joe's parents do not work jobs where they can provide him insurance as a dependent. Joe adds 5 more hours to his work schedule to appease the new work requirements outlined by Speaker Johnson. He goes from making $15,840 a year to $21,120 a year. In Missouri, you are disqualified from receiving Medicaid if you make more than $20,030 in a single household income.

Usually, a person in this situation could go to the Obamacare marketplace and qualify for a subsidy to help them afford insurance. However, these subsidies are set to expire at the end of 2025, and there has been no mention of the new Congress plans to renew these subsidies. Without a commitment to continuing these subsidies, many people could be effectively kicked off Medicaid without any way to afford healthcare. This is the "you get screwed" category.

We know these onerous requirements do not serve America's most vulnerable. Georgia instituted some of the most paperwork-intensive work requirements for its state alternative to the Medicaid system. As a result, in a state with about 1.3 million living below the poverty line, only 6,500 people could enroll in the program.

Establishment GOP members must understand that cutting Medicaid by almost one trillion dollars over the next ten years is a bad political move, especially when the party is on the cusp of holding power in 2026, 2028, and beyond. 72 million people in the U.S. are on Medicaid, which is 20% of the country's population. These are huge numbers—tens of millions of voters.

My former party is an utter trainwreck. The Democrats are rudderless and in the wilderness right now in every respect, and the rot of wokeness and out-of-touch ideas run so deep that I don't see them clawing their way out of irrelevance any time soon.

Unless, of course, Republicans make cuts to healthcare.

Remember in 2017 when Republicans tried to overturn the ACA? This move had significant consequences and ushered in a blue tsunami in 2018, with Democrats picking up over 40 house seats and bringing in some of the most lefty progressives, including Alexandria Ocasio-Cortez!

While the Democrats are terrible at defining themselves ideologically or messaging on anything substantial beyond social justice issues, there is one thing they are still good at, and that's showing voters how Republicans have gone awry while in power. Being "anti-Trump" was their only fundraising model for years.

Donald Trump just won more working-class support than any GOP candidate in a generation. Republicans have created a large, sweeping, broad-based coalition, including black men, Latinos, and many ex-Democrats like me. They have a significant opportunity to hold power for a long time, truly get the country back on track, and appeal to the common sense held by the masses and disdained by modern Democrats.

The best way they can continue this coalition is to listen to Donald Trump's instincts—which is not to slash a dime of direct benefits in precious programs like Medicare, Medicaid, or Social Security. After all, it's been proven that his political instincts are pretty damn good. He had the most extraordinary political comeback of all time. I hope that America's comeback will come next, and with Trump in office, I believe it can. Still, it means the old-guard Republicans will need to understand that being the new party of the American working class means no cuts to the healthcare of millions.

Photo of Evan Barker canvassing for Bernie in 2020 while undergoing medical treatment via a PICC line (intravenous IV) in left arm.