Trump’s Budget Bill Has a New Trap For Democrats

Blue state leaders want to mitigate the harms of Trump’s budget bill. But will cleaning up another Republican mess only serve to let them off the hook?

As the rules set by the Centers for Medicare and Medicaid Services finally offer the states some guidance on how they may roll out the new compulsory Medicaid work requirements, blue states are doing the kinds of things you might expect. Liberal leaders are pursuing creative ways to minimize the impending damage, or even seek to delay its implementation. Here, they’re caught between a rock and a hard place: These good-faith efforts might mitigate some of the harms, but they may prove costly to Democratic accountability following Congress’s enactment of America’s broadest assault on the safety net.

H.R. 1, or the so-called “One Big Beautiful Bill,” was an earthquake to the American safety net. It not only imposed a 20 percent funding cut to our nation’s food assistance program, it also cut nearly $1 trillion from Medicaid, a bedrock safety net program on which low-income children and adults depend for health insurance. And as part of this historic cut, Medicaid expansion enrollees must document that they are still eligible, whether because they are working at least 80 hours per week or because they satisfy an exemption category.

In perhaps the clearest reflection of Republicans’ cognizance of the law’s impact on a health insurance program that has enjoyed bipartisan support, they carefully delayed the law’s most damaging effects until after the midterm elections and anchored many of the cuts in the imposition of administrative burden, a strategy far more covert than, for example, the “repeal and replace” rhetoric of 2017.

Medicaid, a health insurance program with shared responsibility between the state and federal governments, has historically left states with significant flexibility in administration. H.R. 1 marks a striking departure from this approach by compelling states’ implementation of work requirement programs that will result in more uninsurance and strain on regional health systems. Although adopting work requirements is compulsory, states retain meaningful discretion over how they are administered. Those choices will shape health care access for millions, but they may also carry unexpected political costs.

States can reduce the damage by relying on existing........

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