Make no mistake: Republicans are getting ready to gut Medicaid

House Republicans could only lose one vote from their party to pass their budget blueprint – and they only lost one vote. The budget resolution passed 217-215, with Democrats not just uniting but moving heaven and earth to get there to vote against it.

This was a procedural vote and there's a lot more fight left to fight. But it made Republican intentions crystal clear: Yes, they really intend to slash Medicaid. While also slashing taxes for the very wealthy. This is not a hypothetical. House Speaker Mike Johnson's answer to a question about Medicaid cuts previewed the line of attack (an obvious one, and one we're seeing from Elon Musk nonstop about basically all federal spending):

"Hugely problematic because it has a lot of fraud, waste, and abuse." Johnson went on to say, "Everybody knows that, we all know it intuitively, no one in here would disagree." Slick little rhetorical move, there. "Experts" at a hearing estimated $50 billion a year in fraud. They want to save the program by rooting out that fraud, see?

$50 billion is a great deal of money, but it's also a small percentage of annual Medicaid spending of more than $870 billion. And, of course – of course – Johnson is exaggerating. The actual Health and Human Services Department estimate for improper payments is $31.1 billion. Still a lot of money, but also just a 5.09% improper payment rate.

Also, if what you want is to root out fraud, you want to empower the inspector general. As of December 2024, the Department of Health and Human Services Office of Inspector General was on track to recoup more than $7 billion through its investigations and audits.

Donald Trump fired the HHS inspector general – illegally, by the way – in January.

Republicans are embarking on a full-court press to massively cut a program that 46% of people say the federal government already doesn't spend enough on. They're going to blame it on fraud that they're lying about the extent of, after their leader illegally fired the person in charge of rooting out fraud. And Mike Johnson is going to package it in soothing "we all see that this is true, of course you know it's true, any idiot knows it's true" rhetoric that a lot of people in the media will report as fact rather than slick lies about cuts that will be unpopular to the extent people understand what's going on.

Make it unpopular. Keep talking to your friends and family about how the plan is not rooting out fraud but kicking millions of people off Medicaid and giving billionaires a sweet juicy tax break. Keep calling your representatives, even the Republicans. Maybe especially the Republicans.

In the end, Johnson needs to hold his people together for a vote to actually do the thing, not just say they want to do the thing. That's going to be harder no matter what. Let's make it a lot harder.