Republicans alarmed by political effects of cuts to Medicaid, other services

There are few things more sacrosanct in the American political system than Social Security, Medicare and Medicaid, the trio of programs that provide a basic income and medical care to poor, disabled and aged Americans.

But in the madcap early days of the Trump Administration, there are growing fears that major cuts to one or more of those programs are in the works. 

Republican lawmakers are among those who are alarmed, as they have been on the receiving end of hundreds of thousands of phone calls, emails and texts from worried constituents. House Speaker Mike Johnson has been trying to quell some of those fears. In a CNN appearance Wednesday, Johnson ruled out major cuts to Medicaid to help pay for Trump's legislative agenda and said the GOP would not support cuts to the programs that insure more than 70 million Americans.

While that may be so, the stark truth is that the vast majority of federal spending -- roughly 75% -- goes to the military and the Social Security-Medicare-Medicaid triumvirate. Another 8% goes to pay interest on the federal debt. These are what is known as "mandatory spending," expenses that must be paid pretty much regardless of budgetary considerations.

Add that up and there simply aren't many places left where budget cuts can make a significant difference. And not everyone agrees that the federal debt and deficit spending in general are damaging. 

Generally speaking, Democrats accept that while government may sometimes operate at a deficit, its primary responsibility is the care and safety of its citizens rather than a perfectly balanced budget.

Trump himself has at times called for elimination of the federal debt limit but is simultaneously pursuing, with the help of Elon Musk, an aggressive program to reduce the size of the federal workforce and trim other expenses.

The driving force behind the fervent budget-cutting is apparently Trump's desire to win renewal of his 2017 Tax Cuts and Jobs Act (TCJA), which provides major tax cuts to billionaires and many wealthier millionaires. That program is estimated to add $5 trillion to the national deficit over the next five years.

Trump argues that the tax reductions are beneficial because the wealthy reinvest their tax savings in the economy, generating job growth and prosperity. 

According to the Tax Foundation, the plan would significantly lower marginal tax rates and the cost of capital, which would lead to 3.5 percent higher GDP over the long term, 2.7 percent higher wages, and an additional 890,000 full-time equivalent jobs.

"On a static basis, the plan would lead to 0.9 percent higher after-tax income for all taxpayers and 3.4 percent higher after-tax income for the top 1 percent in 2027," the foundation's published analysis said.

Where can the savings come from?

So where can the savings be found? Trimming foreign aid won't do it. US AID accounted for approximately 0.3% of the total federal budget in fiscal 2024, so trimming it won't produce huge savings. 

Since federal workers are estimated to amount to about 8% of the federal budget, trimming their ranks drastically will not produce nearly enough to offset the tax cuts, which is why Medicaid and the Supplemental Nutrition and Assistance Program (SNAP) are being eyed for $2 trillion in annual reductions.

Defense accounts for 21% of the federal budget and is regarded by most Americans as essential to national security and is thus largely impervious to huge cutbacks. Defense Secretary Pete Hegseth has ordered the Pengtagon to find about $50 billion in cuts from next year's defense budget, but Congress may well refuse to go along. 

That leaves what was once regarded as the "third rail" of American politics -- Social Security and the other health and welfare programs that millions of Americans rely on.

In other words, it's money the federal government gives back to its citizens to help them with essential expenses. In a democratic society, where voters are in charge, drastically trimming those expenses isn't easy, or perhaps not even possible in the long term.

Republicans are nervous

That's why Republicans are edgy. While they may have the votes to pass draconinan cuts today, they fear that they will pay for it at the polls tomorrow. Stuck in the middle of this dilemma are the Americans who receive pensions, healthcare and help with disabilities and nutrition.

How many millions of people are we talking about? According to Pew Research:

• Social Security: Approximately 68.6 million individuals receive Social Security benefits, which include retirement, disability, and survivor benefits.
• Medicare: Around 67.3 million U.S. adults are enrolled in Medicare, the federal health insurance program primarily for those aged 65 and older. 
• Medicaid: More than 70 million Americans are covered by Medicaid, the joint federal and state program providing health coverage to eligible low-income individuals and families. 
• Supplemental Nutrition Assistance Program (SNAP): In April 2023, approximately 41.9 million people in 22.2 million households received SNAP benefits, commonly known as food stamps.

Some of these programs were once known as "entitlements." The term has somehow become regarded as derogatory but it is, in fact, how Americans feel and seems like a fair description. 

For their entire working lives, after all, consumers have had a portion of their wages deducted with the promise that they would be taken care of in their old age and when illness, disability or poverty strikes.

There is hardly a politician alive who wants to argue that the deal is no longer valid. And that's exactly why Republicans are feeling nervous about their leader's plans to trim those sacred programs to support tax relief for millionaires. 

That is why Democratic consultant James Carville, known as the "ragin' cajun," is recommending that the Dems stage a "tactical retreat." As he put it in a recent New York Times op-ed, "the most radical thing we can do is nothing at all."

"Give them all the rope they need," Carville wrote. "Then let dysfunction paralyze their House caucus and rupture their tiny majority. Let them reveal themselves as incapable of governing."

Carville's idea may be sound tactically but it could leave many millions of Americans in dire straits while the situation works itself out over the next few years.