Republicans Want to Gut Medicaid. They Might Regret It.

While President Trump has been busy with his executive branch rampage, congressional Republicans have been pursuing a plan to extend and enlarge Mr. Trump’s 2017 tax cuts, which favor the richest Americans.

But the math is stubborn, particularly since Mr. Trump has repeatedly pledged to avoid cuts to Medicare and Social Security. And that has put Medicaid, the federally subsidized program run at the state level that provides health insurance or long-term care coverage to more than 70 million Americans, in the G.O.P.’s sights — even though Mr. Trump said this month that Medicaid, too, wouldn’t be “touched.”

On Tuesday, House Republicans took the first step toward Medicaid cuts by passing a budget resolution that could mean up to $880 billion in cuts to Medicaid over 10 years. Now they have to actually identify specific cuts to the program — deciding which patients, providers and state governments will lose, and how much.

Republicans are fooling themselves if they think it will be easy. Gutting Medicaid means attacking a program backed by a wide range of organizations — from the AARP to the American Hospital Association — that also enjoys broad public support. Even longtime Trump ally Steve Bannon recently warned: “A lot of MAGA’s on Medicaid,” adding, “just can’t take a meat ax to it, although I would love to.”

The federal government spends around $600 billion a year on Medicaid. It reimburses states for at least 50 percent of program costs. (Rich states like New York and California typically get 50 percent, while some poor states, like West Virginia and Mississippi, get over 70 percent.)

Significant cuts to this funding would send fiscal shock waves through state governments across the country as billions of dollars in federal funding stopped flowing, forcing states to decide where and how to cut their Medicaid programs — whether to eliminate coverage for some beneficiaries, reduce payments to physicians, deny home care to some seniors or raise state taxes to make up the difference.