CNN
\n \u00a0\u2014\u00a0<\/p>\n
\n Senate Republicans have yet to finalize their version of President Donald Trump\u2019s sweeping domestic policy proposal<\/a>, but GOP lawmakers up for reelection in 2026 are bracing for the political impact of the bill\u2019s Medicaid cuts.\n <\/p>\n \n Sen. Susan Collins of Maine is pushing for a provider relief fund. Sen. Thom Tillis of North Carolina has warned GOP leaders about how many in his state could lose care. And Sen. Joni Ernst of Iowa has picked up a crop of Democratic challengers campaigning off her \u201cWell, we all are going to die\u201d response<\/a> to a town hall protester.\n <\/p>\n \n Tens of thousands of people could lose coverage in each of those three senators\u2019 states, according to a KFF analysis on the version of the bill passed by the Republican-led House last month. Beleaguered Democrats, meanwhile, hope that laser-focusing on health care will help them chip away at the Republicans\u2019 53-seat Senate majority and take back the House.\n <\/p>\n \n A key part of Democratic messaging has been to tie the Medicaid cuts, which would largely affect low-income Americans, to tax breaks for the wealthy. The Congressional Budget Office estimates the changes would reduce federal Medicaid spending by roughly $800 billion over 10 years, largely by instituting work requirements for certain adults eligible for Medicaid and postponing a Biden administration rule intended to simplify enrolling and renewing coverage.\n <\/p>\n \n \u201cIt is crazy politics for them to do this,\u201d said Brad Woodhouse, a longtime Democratic operative and executive director of Protect Our Care, a health care advocacy group that launched a $10 million campaign this year to oppose Medicaid cuts. \u201cEveryone is going to be unhappy with this bill, unless you\u2019re a very high net worth individual: a millionaire, a multi-millionaire, a billionaire, or a large corporation.\u201d\n <\/p>\n \n Many Republicans have argued that the cuts to Medicaid are meant to sustain the program for those who need it most. They\u2019re also betting that the rest of the bill will be more popular.\n <\/p>\n \n Paul Shumaker, a longtime North Carolina GOP strategist who advises Tillis and other Republican leaders in the state, said he was \u201cbullish\u201d on the midterm elections because he believes voters will support Republican arguments about rooting waste, fraud and abuse out of Medicaid. He also thinks voters will back other policies in the legislative package like cutting taxes on tips and overtime pay and raising the child tax credit.\n <\/p>\n \n \u201cDemocrats are basically staking themselves out on issues that resonate with one-third of the voters, whereas Republicans have staked themselves out on issues that resonate with two-thirds of the voters,\u201d Shumaker said. \u201cThey have put themselves into a box.\u201d\n <\/p>\n \n Democrats are betting that a narrow focus on the bill\u2019s health care provisions will have the most impact, even in states like Iowa, where Democrats are hoping to oust Ernst, contest an open governor\u2019s seat and two US House seats.\n <\/p>\n \n Ernst, who is seeking a third term next year, picked up a Democratic challenger earlier this month after she told a town hall protester \u201cwell, we all are going to die\u201d in response to comments about cuts to Medicaid. Ernst doubled down on the remarks in a video filmed in a cemetery.\n <\/p>\n \n An Ernst spokesperson pointed to Ernst\u2019s full comments<\/a>, in which she said she wants to leave Medicaid funding for the \u201cmost vulnerable\u201d and \u201cthose that are eligible.\u201d\n <\/p>\n \n \u201cWhile Democrats fearmonger against strengthening the integrity of Medicaid, Senator Ernst is focused on protecting Medicaid for the most vulnerable,\u201d reads a statement from the senator\u2019s office. \u201cShe will continue to stand up for Iowa\u2019s rural hospitals, clinics, and community health centers that serve our state.\u201d\n <\/p>\n \n Iowa state Rep. J.D. Scholten announced his campaign soon after Ernst\u2019s town hall, becoming the second candidate in the race after Democrat Nathan Sage, who announced in April. Some election forecasters shifted the race slightly \u2013 from solid to likely Republican \u2014 after he launched his campaign.\n <\/p>\n \n \u201cWe\u2019re seeing people, just everyday people calling Ernst \u2018Joni Hearse,\u2019\u201d Scholten told CNN. \u201cYou just get that sense, politically, that if we can tap into that \u2026 this is where our foot\u2019s in the door to a lot of voters who have not been voting Democrat.\u201d\n <\/p>\n \n It\u2019s also motivating Democratic voters in the state. Melinda Magdalene Wings, a 65-year-old retired hospice nurse from Iowa City, Iowa, told CNN she\u2019s worried cuts to Medicaid funding would impact the assisted living home where her 86-year-old parents, including her mother who has advanced dementia, reside. In February, she started writing her representatives about the bill.\n <\/p>\n \n \u201cAs Iowa\u2019s elected officials, I expect them to vote for what\u2019s best for Iowa \u2014 for the people of Iowa \u2014 and not for this administration,\u201d she said. \u201cMoney going to millionaires doesn\u2019t make any sense.\u201d\n <\/p>\n \n A handful of Senate Republicans, including Tillis and Collins, have raised concerns about the impact the reconciliation bill could have on their states, particularly a Senate proposal that would limit how much states can raise provider taxes, a key source of revenue. The provider tax provision is among a handful that Senate Republicans are revising after the chamber\u2019s parliamentarian ruled they didn\u2019t meet the strict budget rules that allow the legislation to pass with a simple 51-vote majority.\n <\/p>\n \n \u201cI\u2019ve been very concerned about the cuts in Medicaid and the impact on my state, but other states as well,\u201d Collins told CNN\u2019s Manu Raju on Tuesday. \u201cI\u2019ve also been concerned about the health of rural hospitals, nursing homes, health centers and have been working on a provider relief fund. But that doesn\u2019t offset the problem with the Medicaid cuts.\u201d\n <\/p>\n \n Tillis said Tuesday that while the bill\u2019s Medicaid cuts are \u201cdirectionally right,\u201d Republicans \u201chave to do it at a pace that states can absorb, or we\u2019re gonna have bad outcomes, political and policy.\u201d\n <\/p>\n \n Tensions within the Senate GOP caucus have also spilled out into the open. Kentucky Sen. Mitch McConnell told colleagues with concerns about the bill during a private GOP conference meeting that \u201cfailure is not an option\u201d and people in their states raising concerns about the bill\u2019s Medicaid provisions would \u201cget over it,\u201d according to a report from Punchbowl News<\/a>.\n <\/p>\n \n Democrats quickly latched onto the comments. \u201cI hope Republicans can \u2018get over it\u2019 when they lose their seats in the midterms,\u201d DNC communications director Rosemary Boeglin said in a statement.\n <\/p>\n \n A spokesperson for McConnell said the senator was referring to people who are \u201cabusing\u201d Medicaid and \u201cshould be working,\u201d and the need to \u201cwithstand Democrats\u2019 scare tactics\u201d on the issue.\n <\/p>\n \n \u201cSenator McConnell was urging his fellow members to highlight that message to our constituents and remind them that we should all be against waste, fraud, and abuse while working to protect our rural hospitals and have safety nets in place for people that need it,\u201d the statement read.\n <\/p>\n \n Nearly 8 million more people would be uninsured in 2034 because of the Medicaid provisions in a version of the bill passed by the House last month, according to an analysis from the Congressional Budget Office. Most of those cuts come from the legislation\u2019s work requirement, which calls for able-bodied adults without dependent children to work or volunteer at least 80 hours a month.\n <\/p>\n \n A proposal unveiled by the Senate this month would expand that requirement to adults with children over the age of 14, which would likely result in even more people losing coverage.\n <\/p>\n \n Republicans have argued they are reforming Medicaid to sustain the program for people who need it the most. They\u2019ve focused their messaging on work requirements, which are popular with voters, and policies that would penalize states for covering undocumented immigrants with their own funds.\n <\/p>\n \n \u201cPresident Trump and Senate Republicans are working to protect Medicaid for Americans who truly need it,\u201d Nick Puglia, a National Republican Senatorial Committee spokesperson, said in a statement to CNN. \u201cVoters will reject Democrats\u2019 lies, fearmongering, and attempts to use taxpayer benefits to subsidize illegal aliens and their open border policies.\u201d\n <\/p>\n \n Republicans are also framing a vote against the reconciliation bill, which extends the individual income tax cuts in the 2017 GOP tax policy overhaul that are set to expire at the end of the year, as a vote for tax increases.\n <\/p>\n \n \u201cI think in the end, this bill will play out on the Republicans saying, \u2018We got it done. We passed it, the economy\u2019s good. We spared you from having to pay more taxes,\u2019\u201d David McIntosh, the president of Club for Growth, told reporters recently. \u201cAnd then pivot to say, \u2018but if my Democrat opponent gets elected, they want to undo it \u2026 vote for us so that we can stop them from raising your taxes.\u2019\u201d\n <\/p>\n