“Medicaid was originally intended for children and poor families, children and people who were disabled and couldn’t work to provide health care,” said Senator Lindsey Graham, Republican of South Carolina and chairman of the Budget Committee. “Count me in for that.”
The rub for Republicans is that with generous federal support, many states have greatly extended the reach of their public health insurance programs deep into the ranks of Americans holding down jobs that do not provide health coverage. The states and their residents have come to rely on Medicaid as a stable source of health care. History has shown that once voters obtain government aid under a program, they are not happy to see those benefits threatened, particularly if they are told that it is being done to underwrite tax cuts for affluent Americans.
Republicans also came under fire from within their ranks over the bill’s expected impact on the national debt. Senator Rand Paul, Republican of Kentucky, has for weeks taken aim at his G.O.P. colleagues for abandoning their professed anti-deficit ideology by promoting legislation that spills barrels of red ink while raising the federal debt limit by $5 trillion.
Mr. Paul warned colleagues who like to consider themselves deficit hawks that they would have no one to point fingers at when the bill comes due if the measure becomes law and the projections are realized.
“Republicans now own the debt, and Republicans now own the spending,” Mr. Paul said. “There is no more blaming — ‘Oh, it’s Biden’s fault.’ The deficit is fully, completely owned by Republicans.”
Top Republicans dispute the claims that their measure will drive up the deficit and say that the growth produced by the legislation will offset any revenue losses, a prediction that has proved to be overly optimistic under past Republican-only tax cuts.
“We want to grow the economy,” Senator John Barrasso of Wyoming, the No. 2 Senate Republican, said of his party’s legislation, in an appearance on Fox News. “They want to grow the government,” he said of the Democrats.
The Senate Republican projections of the fiscal impact of their legislation were enhanced by a bit of dexterous accounting that allowed them to unilaterally treat the cost of extending the tax breaks as zero in a maneuver that Democrats said perverted special Senate budget rules and undermined the filibuster.
Democrats said that approach would come back to haunt Republicans when Democrats regain control of Congress and use the same tactic to push through legislation Republicans oppose without the threat of a filibuster.
To try to soften the political impact of the health care changes, Republicans pushed off most of the start dates of the program cuts and new work requirements for Medicaid recipients past the 2026 midterm elections.
But Democrats intend to pound home the looming consequences of the cuts, and they may get some help from Senator Josh Hawley, Republican of Missouri. Though he voted for the legislation, Mr. Hawley said he was so opposed to the Medicaid provisions that he intended to spend the next two years trying to get them overturned.
It is worth noting that Democrats were crushed in the 2010 midterms even though the botched rollout out of the Affordable Care Act was years away as Republicans capitalized on voter anxiety about the coming health care changes.
Mr. Tillis reminded his colleagues of that fact and the impact on his own political career in North Carolina and Washington.
“That made me the second Republican speaker of the House since the Civil War, ladies and gentlemen, because we betrayed the promise to the American people,” he said about becoming head of the House in his home state after the tumult surrounding the Affordable Care Act. “Three years later, it actually made me a U.S. senator.”
Carl Hulse is the chief Washington correspondent for The Times, primarily writing about Congress and national political races and issues. He has nearly four decades of experience reporting in the nation’s capital.
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