Is federal Medicaid spending, which last year amounted to over $580 billion, a virtual sacred cow for which reform or cuts in spending are unthinkable?
House Republicans in Congress have called for a ten year trimming of the Department of Health and Human Services’ budget through reconciliation that would average cuts of about $88 billion a year. Are they playing with the third rail?
One recent survey suggests that all voters, even Trump-supporting Republicans, would strongly object to any changes to the current program. But in states like Maine, instances of abuse Medicaid raise questions about the need for reform. The answer to how people think about Medicaid may be less clear-cut than the massive programs advocates suggest.
The Center for Excellence in Polling (CEP), a project of the conservative Foundation for Government Accountability (FGA), raised a number of serious questions about the recent FabrizioWard poll claiming that there is “no appetite” for Medicaid reform “across the political spectrum” in a memo obtained by the Maine Wire.
The seven-page analysis details CEP’s critiques of the poll, focusing largely on concerns over the methodology employed by the prominent Republican pollster, including how questions were phrased and the order in which they were asked.
Tony Fabrizio of FabrizioWard has previously worked as a pollster for President Donald Trump (R) both in 2016 and 2024 campaigns, as well as for a number of other Republican presidential campaigns over the years.
The FabrizioWard poll in question was conducted on behalf of Modern Medicaid Alliance (MMA), which describes itself as “a partnership between Americans who value Medicaid and leading advocacy organizations.”
CEP also includes the results of its own poll concerning the GOP’s reconciliation bill, highlighting how the results of their survey can lead to a notably different conclusion.
According to the FabrizioWard poll published on April 2 of this year, 51 percent of those who reported voting for President Donald Trump (R) oppose “cutting Medicaid spending to pay for tax cuts.” These numbers rise to 67 percent among swing voters and 70 percent overall.
These results have since been quoted by major news outlets, including Politico, which published an article with the headline: “Trump Pollster Finds Medicaid Cuts Unpopular Among Trump Voters.”
In challenging these results and the precipitating claims, CEP argues that this may not be an accurate representation of how Americans really feel on this issue, suggesting that the results were used to make “unjustified bold claims.”
To support these accusations, CEP cites a handful of their own poll questions that were aimed at gauging the opinions of “likely voters” on some specific Medicaid reform policies.
For example, CEP found that 73 percent of Republicans and 71 percent of Trump voters support “requiring able-bodied adults with no young children at home to work, train, or volunteer for at least 20 hours per week as a condition of eligibility for welfare programs.”
As these questions are not direct analogs of each other, however, their results cannot be directly compared. Instead, juxtaposing these two poll questions serves to demonstrate how question wording and framing can have a significant impact on the results produced concerning largely similar topics.
In critiquing the FabrizioWard poll, CEP argued that the wording used by the pollster may have produced biased and inaccurate results.
Similarly, CEP suggested that the order in which the questions were presented may have impacted how respondents answered, including by priming them to have certain things in mind as they moved through the questionnaire.
To illustrate this, CEP points out that the first question included in the published results asks respondents about their personal connections to Medicaid.
Assuming that this was also the first question shown to those taking the survey, CEP argues that this would unfairly prime people to consider their personal ties to the program as they continued through the survey, perhaps artificially reducing their likelihood of expressing support for reducing Medicaid funding or programs.
CEP also raised doubts about one question in particular that asked: “How important is it that as many Americans as possible are covered by health insurance?”
Again predicated on the assumption that the question order in the publication reflects that of the survey itself, CEP suggested that placing this question ahead of those asking about individuals’ opinion on “cutting Medicaid” could potentially bias respondents to express opposition to any hypothetical cuts.
Nowhere in FabrizioWard’s official publication of the results, however, does it specify the order in which these questions were presented to respondents. Consequently, it is not possible to know at this time whether such biasing effects may have been present.
CEP also called into question the validity of the information included in the FabrizioWard poll, alleging that it misrepresented the nature of the Medicaid-related proposals currently included in the reconciliation bill, particularly given that some media coverage has directly linked these results to ongoing debates in Congress over the Medicaid-related aspects of the reconciliation bill.
The FabrizioWard poll included a section where respondents were asked whether or not a series of facts and statistics would make them more or less likely to “support preserving Medicaid funding.”
CEP argues that regardless of the accuracy of these statements, “not a single one of these individuals would be affected,” as the “the only people impacted by the proposed Medicaid reforms are able-bodied adults without young children at home.”
The group further takes issue with how the FabrizioWard/MMA poll asked respondents how they would feel about a variety of “possible changes” to Medicaid, including:
- “Cutting funding to the Children’s Health Insurance Program” (CHIP)
- “Cutting funding for long-term support and services, including nursing home care, for seniors who have spent down their savings,”
- “Cutting federal funding that helps low-income seniors afford their Medicare premiums,” and
- “Cutting federal funding that pays for prenatal, delivery, and post-partum care for low-income mothers.”
CEP alleges that, in this section, the FabrizioWard/MMA poll “present[s] false information about the proposed reform,” suggesting that “not a single one of these programs would be affected” by the proposals currently being discussed in Congress.
A CEP poll, published on March 6, found that 51 percent of respondents support the passage of a reconciliation bill “that would advance many of the Trump administration’s priorities for tax cuts and reducing federal spending.”
For the purposes of this poll, a reconciliation bill was defined as “a special legislative process Congress sometimes uses to quickly pass some tax, spending, and debt limit legislation.”
No specific policies — including any potential Medicaid reforms or reductions — were referenced in the poll question.
When broken down by political affiliation, a wide partisan divide emerges, with 75 percent of Republicans supporting the reconciliation bill compared to only 29 percent of Democrats.
Support among independents was largely reflective of the country overall, coming in at 51 percent.
According to Newsweek, the budget reconciliation framework currently on the table in Congress does not directly include any cuts to Medicaid or Medicare.
Instead, it is currently said to contain direction for the House Energy and Commerce Committee to reduce the Department of Health and Human Services (DHHS) budget by $880 billion over a ten-year period, which some have suggested would require reductions in Medicaid spending.
In an email to Newsweek, House Speaker Mike Johnson (R-LA) defended the proposals included in the reconciliation bill, emphasizing how the GOP-backed reforms are designed to help the program endure.
“Through budget reconciliation, House Republicans will strengthen, sustain, and secure Medicaid so we can preserve it for the vulnerable American populations it was designed to serve,” Speaker Johnson said. “Unlike our Democrat colleagues, we are committed to making commonsense reforms and rooting out waste, fraud, and abuse to make Medicaid work more efficiently and effectively.”
Rep. Don Bacon (R-NE) told Punchbowl News that there are “reasonable” Medicaid reforms that can be pursued through this legislation, but that cuts to the program will not receive widespread support.
“There are reasonable actions we can support like work requirements for able bodied adults without children and auditing the Medicaid list,” Rep. Bacon said. “But there will not be the votes to cut Medicaid for those who need it or to the hospitals that we need to preserve.”
Democrats like Rep. Alexandria Ocasio-Cortez (D-NY), however, have strongly criticized the Republican-backed proposals.
“This is heist on Medicaid, a heist on Medicare recipients, a heist on public health care in order to continue to finance Elon Musk’s defense contracts,” Rep. Ocasio-Cortez said in a statement.
Similar sentiments were echoed by Democratic House Leader Hakeem Jeffries (D-NY) in an April 10 statement.
“The budget resolution that passed the House today will set in motion some of the most extreme cuts to healthcare, nutritional assistance and the things that matter to everyday Americans in our nation’s nearly 250-year history,” said House Leader Jeffries. “It’s a disgrace.”
A dozen House Republicans from competitive districts sent a letter to GOP leadership explicitly stating that they will not support the reconciliation bill if it contains any cuts to Medicaid.
“We cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations,” they wrote in a letter first obtained by Punchbowl News.
The legislators went on to express support for some of the Medicaid reforms that have been put on the table so far, highlighting how waste and abuse in the program diverts resources away from those who need them.
“We acknowledge that we must reform Medicaid so that it is a strong and long-lasting program for years to come,” they wrote. “Efficiency and transparency must be prioritized for program beneficiaries, hospitals, and states.”
“We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women – those who the program was intended to help,” said the representatives.
Members later said that they are willing to “identify responsible savings” in Medicaid “through deregulation, streamlining federal programs, and cutting administrative red tape.”
Leads on the letter were Bacon and Rep. David Valadao (R-CA), alongside Reps. Jeff Van Drew (R-NJ), Rob Bresnahan (R-PA), Juan Ciscomani (R-AZ), Jen Kiggans (R-VA), Young Kim (R-CA), Rob Wittman (R-VA), Nicole Malliotakis (R-NY), Nick LaLota (R-NY), Andrew Garbarino (R-NY) and Jeff Hurd (R-CO).
“To strengthen Medicaid, we urge you to prioritize care for our nation’s most vulnerable populations,” the lawmakers concluded. “Our constituents are asking for changes to the healthcare system that will strengthen the healthcare workforce, offer low-income, working-class families expanded opportunities to save for medical expenses, support rural and underserved communities, and help new mothers.”
