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As I write this Thursday afternoon, Republicans appear poised to pass their “megabill” tax-and-spending legislation, which will go a long way to defining President Donald Trump’s legacy, and the country’s direction for years to come. At the moment, Democrats’ best hope for stopping it may be the hours-long speech Hakeem Jeffries is giving … provided he can keep talking until after the 2028 election.
Still, it seems all but certain the bill will reach Trump’s desk. Because nothing anyone else has said — including some Republicans — has stopped the bill either.
“I really think this legislation is a gamble,” said Berwood Yost, who regularly polls Pennsylvania in his post at Franklin & Marshall College. “I think it’s clear many of the provisions are things that not a lot of people support.”
Indeed, while backers tout provisions to leave income from overtime and tips untaxed, polling shows the proposal is underwater with voters nationwide by margins well into the double-digits, amid concerns about whether it would benefit them. And a focus for that concern is the $1 trillion the plan would cut from Medicaid, an insurance plan that covers lower-income people, during the next 10 years.
Nearly one-quarter of Pennsylvanians are enrolled in the program, many of them in rural areas represented by the GOP. Nationwide data suggests rural areas are more dependent than more densely populated regions: In southwestern Pennsylvania, for example, Republican Mike Kelly represents far more Medicaid recipients than Democrat Chris Deluzio in the district next door.
Republicans say the measure will cut costs by booting recipients who don’t deserve benefits, such as illegal immigrants and those who could be working. But independent analysts say the bill could cost more than 10 million people their coverage, with potentially brutal impacts on health care providers who rely on Medicaid to stay open.
That fear, again, is concentrated in rural areas, where hospitals are already struggling and warning the spending plan will deepen the already-existential risk they face. Five such hospitals are potentially vulnerable in southwestern Pennsylvania alone.
None of this is news to the GOP. In April, for example, U.S. Rep. Rob Bresnahan, whose 8th Congressional district has the state’s highest concentration of Medicaid recipients outside Philadelphia, co-signed a letter to the administration that insisted, “We cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage. … Many hospitals — particularly in rural and underserved areas — rely heavily on Medicaid funding.”
But Bresnahan joined every Republican but one, eastern Pennsylvania’s Brian Fitzpatrick, in moving the measure forward.
There was support for the bill outside the Beltway too. Pennsylvania Treasurer Stacy Garrity, a potential 2026 candidate for governor who touts her own rural roots as a native of Bradford County, hailed the measure as a “historic plan” that would “put money back into YOUR pockets.”
Asked by WESA if she had any misgivings about its impact on rural areas, she said in a statement that the bill represents “transformational change in our beautiful country” and “puts the interests of the taxpayer first.”
She was similarly upbeat in an interview this week with Philadelphia radio host Dom Giordano, who asked whether she saw “anything in the bill that is really going to doom health care in rural Pennsylvania?”
“We have too many rural hospitals closing, that’s for sure,” she said. “But even dumping all the money that we’ve dumped into it hasn’t changed that trajectory.”
But in a radio appearance of his own, Gov. Josh Shapiro blasted Garrity and other Republicans for “claim[ing] to be champions of rural communities, and here they are throwing hundreds of thousands of Pennsylvanians, including about half who live in rural communities, off of Medicaid.”
Shapiro posted those criticisms on social media, too, where he provided estimates of how many Medicaid recipients are at risk in each Republican’s Congressional district.
It’s not clear how these estimates were compiled: WESA was told they reflect “data based on Shapiro administration analysis.”
Republicans did not exactly welcome the feedback. Congressman Dan Meuser, another potential Shapiro challenger next year — dismissed it as “misleading” and declared, “No one who is eligible for Medicaid or [federal food benefits] will lose coverage.”
Whatever the costs to individuals’ coverage, meanwhile, Republicans have left themselves some cover.
As Garrity pointed out to Giordano, the megabill does set aside some $50 billion to help shore up needy hospitals — though Republicans have reportedly expressed private misgivings about whether that will be sufficient.
And perhaps more crucially for office-seekers, the sharpest Medicaid cuts don’t take place until after the 2026 midterms, when every House race and the governor’s mansion are on the ballot. Can Democrats keep the issue in view until then? Some of them get cranky when asked to stay with it overnight.
Expectations for the GOP may be low in any case. A WESA/Campos Pulse survey queried 400 southwestern Pennsylvania residents about their expectations for Trump’s administration. Asked which institutions would likely fare the worst under Trump, the No. 1 answer for Democrats and Republicans was “safety net programs like food stamps and Medicaid.” (Republicans were most optimistic for improvements in the military, federal agencies, and foreign policy: Democrats largely didn’t expect anything to get better.)
This would not, of course, be the first time that Democrats have bemoaned the fact that Republican officials act against the interests of their voters. Just look at today’s political landscape to see how compelling a message that has proven.
Still, some pundits say it might work this time.
“The Republican coalition has changed under Trump to include a lot more working-class people,” notes Yost, and many of those 2024 voters might be more sensitive to economic factors.
“If rural hospitals are in trouble and these changes start forcing the closure of these places, you could see it coming back to haunt Republicans.”
“You can imagine a lot of individuals who will be affected negatively by [the megabill] will remain loyal to the president,” said Christopher Borick, a pollster at Muhlenberg College in Allentown. “But that loyalty doesn’t always transfer to Republicans in off-year or mid-term elections.”
The political implications of the megabill “might be dissipated if the full impacts aren’t felt for the next few years,” he added. “But they have a way of catching up with you.”