Republicans Threaten to Destroy Red State Funding Model | Opinion

President Donald Trump's allies in Congress have their targets set on the voters who elected the president to fight for them. Billionaire Elon Musk and the Department of Government Efficiency (DOGE) are not the only ones who are shooting first and asking questions later. Republicans on Capitol Hill are pushing massive Medicaid cuts that would hurt many of their own red state budgets and lead to significant state and local tax increases.

There is no denying that Republicans are cutting services, and their next act is a plan to raise taxes on the backs of working people to pay for tax cuts for billionaires. Their major target is the Medicaid program that provides coverage to over 79 million Americans.

President Trump repeatedly promised Americans he would not cut Medicaid, pledging to "love and cherish" the program. A recent poll from President Trump's own pollster showed a strong majority of Trump voters oppose cutting Medicaid, as well as two-thirds of swing voters. Yet, with President Trump's apparent support, House Republicans are laying the foundation to dismantle it. Their recently passed budget resolution proposes an $880 billion cut to Medicaid to pay for tax cuts for the wealthy.

Republicans are ignoring the millions of Trump voters who rely on this program for basic health care. As the first Republican candidate to win the poorest third of Americans since the 1960s, President Trump's own voters would be disproportionately denied access to care from these draconian cuts. Cutting Medicaid would shutter hospitals and cost jobs in many rural, Republican areas, including in my home state of Louisiana. Whether they are red or blue, Trump voters or otherwise, Medicaid serves those who need help the most. Cuts would hurt all Americans from sea to shining sea.

However, what has received far less attention is the impact the Medicaid cuts would have on red states' budgets. One of the key features of the House plan is to eliminate or cut back what's known as provider fees. As The Wall Street Journal recently reported, provider fees "boost a state's budget for funding Medicaid." These programs might not be widely known outside of policy circles, but they play a crucial role in how states—especially red states—fund Medicaid. These fees collect money only from hospitals, giving states flexibility to draw down Medicaid dollars without raising general taxes on residents. Hospitals pay the cost share, and working families get health care. Republicans are trying to cover their tracks by calling this fraud and abuse, but as a Louisiana hospital executive recently said, cutting provider fees "is really a Trojan horse ... to disguise and distract from their real goal of cutting Medicaid payments."

Most states, including reliably Republican ones like Texas, Mississippi, and Alabama, use this system to maximize federal Medicaid funding while keeping state taxes low. Eliminating provider fees would blow a hole in state budgets, forcing state legislatures to make a painful choice—either enact steep tax hikes or drastically cut health care for vulnerable residents. In just Florida alone, this will cost the state over $2.7 billion.

What makes this even more ironic is that this policy disproportionately punishes Republican-led states. Many of these states have refused to expand Medicaid under the Affordable Care Act, relying instead on provider taxes to fund their narrower Medicaid programs. By eliminating the provider tax mechanism, Republicans are undermining their own governors and legislatures, creating a fiscal crisis that will force them to do the one thing they hate most—raise taxes.

The Republican Party has long railed against tax increases, arguing that states should live within their means and that Washington should stay out of their business. Yet, here they are, pushing a policy that will force red states to raise taxes, expand Medicaid, or impose unthinkable service cuts.

Republican governors may soon find themselves in a position they never expected—raising individual citizen taxes to clean up Washington's mess. And when that happens, Democrats must remind voters exactly who put them in that position.

Cedric Richmond is a former Louisiana congressman and senior advisor to former President Joe Biden.

The views expressed in this article are the writer's own.