ANALYSIS -- Republicans are yet to enact their “one, big, beautiful bill,” but both parties are confident about its impact on an election more than a year away. Ultimately, time and voters will decide whether the legislation, which includes changes to Medicaid, is politically popular or would jeopardize GOP control of Capitol Hill. The wide-ranging measure is chock-full of items for Democrats and Republicans to argue over, but there was also a rare moment of bipartisanship. Democrats, including House Minority Leader Hakeem Jeffries; Elon Musk; the Congressional Budget Office; and GOP Sens. Ron Johnson of Wisconsin and Rand Paul of Kentucky all agree that the bill would add to the federal deficit. According to the CBO, it would cut taxes by $3.7 million and add $2.4 trillion to deficits over the next 10 years. Of course, the White House and other Republicans are vocal in their opposition to that report, asserting that the CBO is not properly accounting for economic growth the bill would spur. “They are historically, totally unreliable,” Speaker Mike Johnson told Fox News last week. That’s a different tune than four years ago, when Johnson used CBO projections to question the effectiveness of the Democratic-led infrastructure bill. "Now that CBO has confirmed this bill adds nearly $400 BILLION to the deficit -- contrary to the White House's claim that the bill is paid for -- let's see if the moderate Democrats keep their promise to only vote for a bill consistent with White House estimates," Johnson posted on social media on Nov. 18, 2021. A couple of weeks earlier, he had referred to the “objective CBO score” of the total cost of that bill. While voters have expressed general concerns about the national debt and deficit, the change of heart on the CBO from some Republicans is unlikely to be the biggest issue of the 2026 midterm elections. Base Republican voters, including fiscal conservatives who bemoan the bill’s potential impact on the national debt, aren’t going to support Democratic candidates in droves. Medicaid, however, is poised to be a key component of the 2026 midterms. Democrats have reason for optimism considering the precedent for when parties have attempted to change the health care system. Democrats themselves lost 63 House seats and six Senate seats in 2010 in the wake of enacting the law known as the Affordable Care Act. Eight years later, Republicans lost more than 40 seats after unsuccessful attempts to repeal that law. Health care is likely to be a hot topic because of the scope of the impact. According to the CBO, an estimated 10.9 million people would lose health care coverage under the budget reconciliation bill by 2034, including 7.8 million from Medicaid and others from changes to ACA exchanges. Democratic campaign ads about Medicaid and benefit cuts almost write themselves. Republicans agree that people would lose coverage under the bill, but they argue the cuts would affect those who shouldn’t be receiving the benefit in the first place. In GOP terms, there would be eligibility cuts to 1.4 million people who are in the country illegally and people who are physically able to work but aren’t. Johnson and others have specifically targeted “29-year-old males sitting on their couches playing video games.” Changing entitlement programs is generally regarded as electoral suicide, but Republicans are still operating with the confidence of the 2024 elections that saw them win the White House, flip the Senate and hold the House. Broadly, the GOP believes voters gave them a mandate to root out “waste, fraud and abuse,” and removing certain populations from the Medicaid system falls under that mantra in order to strengthen the program for the rest of the beneficiaries. The potential risk is in the implementation. Using immigration as an example, the Trump administration has at times been inconsistent in enforcing its policies, leading to confusion and negative stories that can influence public sentiment. President Donald Trump’s overall job approval rating and his specific approval rating on immigration has declined since he took office. On Medicaid, it’s not hard to see people losing coverage over confusion about their immigration status or over the definition of being physically able to work. Overall, Republicans risk misinterpreting the 2024 results – which included Trump winning 49.9 percent of the popular vote and the party winning 50.1 percent of House seats and 53 percent of the Senate – as a blank check to pursue policy goals at all costs. The last election was more about the direction of the country, the health of the economy and a rejection of Democrats in power, rather than a full embrace of the Republican Party. Republicans are wise to try and get their legislation passed sooner rather than later and avoid one of the mistakes Democrats made back in 2010. President Barack Obama came into office vowing to be post-partisan by letting Congress work out the details of the ACA. But he didn’t get to sign the measure into law until March 23, 2010. Democratic candidates ended up trying to run away from it and wishing that Obama had done more to sell his signature piece of legislation. Republicans are now determined to send their bill to Trump’s desk by early July and spend the rest of the cycle justifying and explaining it, with the president a willing partner to sell the benefits. Ultimately, though, the current argument over whether these are benefit cuts or eligibility cuts will be decided by voters after they see and experience the bill for themselves and their friends, family and neighbors. And that will just take time. Overall, if voters feel confident in the direction of the country, then the GOP has a chance to maintain control of Congress in the 2026 elections. But if a majority of voters decides that the country is on the wrong track and that “one, big, beautiful” piece of legislation is partially to blame, it would be hard to imagine Republicans escaping accountability. Since it passed the House by a single vote, any GOP incumbent could be characterized as having cast “the deciding vote.”
