Jenny Braddock
April 30, 2025
The Republican Party’s quiet campaign to gut Medicaid is a masterclass in policy sabotage: don’t kill the patient, just cut off the oxygen and raise the deductible — death by premium.
As Los Angeles Times columnist Michael Hiltzik reported this week, the GOP’s strategy isn’t to launch a full-frontal repeal. It’s to wrap Medicaid in red tape like a ‘states’ rights’ anaconda — slow, silent, and suffocating. Waiver by waiver, they restrict access, tighten eligibility, and constrict the system until there’s no air left.
And nobody notices until the body goes limp.
Don Bacon, Greg Gianforte, Sarah Huckabee Sanders — to namecheck a few — are just lucky that Luigi’s already busy fending off the death penalty. Eh, Luigi’s locked up and not a threat. But if he’d gotten away with it, he might be 3-D printing up some new toys.
The latest tactic? Work requirements. Republican lawmakers in multiple states are pushing new rules that would force Medicaid recipients to prove they’re employed — or risk losing coverage.
The work requirement is based on a longstanding, factually incorrect but stubborn Republican fever dream: that Medicaid is full of lazy, able-bodied freeloaders. But Census data from 2023 tells a different story. 44% of Medicaid recipients worked full-time. Another 20% worked part-time. Of the rest: 12% were caring for family, 10% were sick or disabled, 6% were students, and 4% were retired. Just 2% were unemployed without explanation.
Work rules don’t promote responsibility — they punish the working poor for being poor. They don’t reward effort — they reward paperwork. They’re not designed to lift anyone up. They’re designed to trip people up, then blame them for falling. Like designing a maze, shoving someone in blindfolded, and then calling it a work ethic test.
The Biden administration axed these requirements early in Amtrak Joe’s term. But now, red states are bringing them back — with widespread Republican House and Senate tacit approval as cover. It’s not a coincidence. As Hiltzik and others have noted, this is part of a broader Republican campaign to dismantle Medicaid at the state level without the public backlash of repeal. Which, loosely translated, is MAGA for “starving the beast.”
And it’s not just Medicaid on the chopping block — this is a backdoor assault on the Affordable Care Act itself. You don’t need to repeal the ACA when you can quietly pull the pins out of its legal foundation and let it fall under its own weight. Medicaid isn’t just an access point. It’s the structural support beam for Obamacare’s low-income coverage. Remove it, and you don’t just break the law — you break the system.
Medicaid isn’t just about access — it’s about legality. Strip it away, and the ACA starts to buckle under its own design. You end up with millions who are too poor to qualify for subsidies, not eligible for Medicaid, and suddenly in violation of a law that no longer has a working mechanism to insure them. That’s when Republicans make their move.
And this wouldn’t just cut off benefits for a handful of edge cases — we’re talking about nearly 20 million people who gained coverage through Medicaid expansion under the ACA. That number is only likely to grow if Trump’s tariff-palooza increases unemployment as predicted, and plunges us into a recession. And many of them are Trump voters — the same folks who cheered for drain-the-swamp while getting drained at the pharmacy. In states like West Virginia, Kentucky, and Missouri, Medicaid isn’t a safety net — it’s half the damn infrastructure. Strip that coverage away, and the working poor don’t “shop for better options” — they just stop going to the doctor until something big and bad happens. But, hey, the bright side is that Trump’s other economic policies were going to bankrupt them anyway.
According to MSNBC, Trump allies are already working to roll back those gains. The GOP platform may not say “repeal Obamacare” anymore — but the Medicaid sabotage does it one waiver at a time. And per Politico, Rep. Don Bacon of Nebraska is leading budget hawks with a $500 billion “red line” for Medicaid cuts. They won’t say they’re slashing healthcare — just “reining in spending.”
It’s an old playbook: cut funding, pile on restrictions, blame the program when it buckles, then point to the wreckage as proof it never worked. And they prove their point that government doesn’t work by making sure that it can’t.
This isn’t fiscal prudence. It’s moral theater. A belief system that says poverty is a character flaw, and healthcare is a luxury — not a right.
And the cruelty? That’s not a byproduct. That’s the feature.
Filed from a waiting room where the blood pressure cuff is broken, but the billing system works fine.
