Name: How Republicans can win the Medicaid Debate
Uploaded: 2025-06-08T13:59:00Z
Duration: 6 min 31 s
Description: Journal Editorial Report: Paul Gigot interviews political strategist Karl Rove.

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Journal Editorial Report: Paul Gigot interviews political strategist Karl Rove. Photo: Kevin Dietsch/Getty Images

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Journal Editorial Report: Paul Gigot interviews political strategist Karl Rove.

How Republicans can win the Medicaid Debate

This bill will preserve and protect the programs, the social safety net, but it will make it much more common sense. Look, one out of every five or $6 in Medicaid is improper. We have illegal immigrants on the program. We have able-bodied working adults that don't have a work requirement. Those are something that's very important to institute. That's what this bill does. No one will lose coverage as a result of this bill.

As the Senate prepares to roll out its version of the Big Beautiful Bill, White House officials are carefully crafting their message on the modest Medicaid reforms that Republican lawmakers included in the House legislation. With Office of Management and Budget Director Russell Vought insisting this week that the GOP is protecting and strengthening the program, not slashing it. Democrats are making Medicaid spending cuts the centerpiece of their campaign against the bill and hope to use the issue to defeat Republicans in next year's election. So can the GOP win the Medicaid messaging war? Let's ask "Wall Street Journal" columnist and Fox News contributor Karl Rove. He served as a senior advisor to President George W. Bush. Karl, welcome. Let me ask you first about the Musk/Trump feud. Who's gonna win that one if it continues?

Nobody, both of 'em are gonna lose. The President looks like he can't pick the best people to be around him who will support him. And Elon Musk looks slightly unhinged. This is not a pretty sight and it's not gonna end well for either man.

Yeah, okay. Let's turn to the entitlement question. The Republicans are getting hammered on Medicaid, even though the reforms are hardly radical. But you had some experience in the White House when your president tried to reform social security in the second term and it didn't go anywhere. What lessons do you draw from that experience?

Well, first of all, the Republicans can win this battle if they go on the offense. I mean, think about the reforms, you're right, modest but important. Able-bodied people ought to work if they're gonna be on Medicaid. Let the Democrats defend able-bodied people not having to work. Say really, you want people who could work to get something free from the government paid for by those that are working? No illegals. They get rid of the 1.4 million illegals who are on Medicaid. Again, go on the offense. Really, you want illegal aliens to be attracted here because we're promising 'em free healthcare? And finally, the Biden administration said, states cannot check as frequently as they like to find out ineligible people on the rolls. So say, yeah, really, you don't want people who've moved or people who shouldn't be getting a check to be getting a check? You really don't want to have the ability of states to manage their own rolls, which cause them to spend money? So, go on the offense. Nobody who works, who's able to work should be able to get something free. This is a program designed for American citizens, not illegal aliens, and states ought to have all the tools available to find the fraud. That means, as the OMB director said, one out of every $5 is inappropriately spent. Give 'em the tools to get rid of the waste. Now, if they go on the offense, I think that's gonna be a very positive message. Let the Democrats say lots of people are gonna be taken off the rolls. The Republicans can say they weren't supposed to be on the rolls in the first place if they won't work, they're illegal aliens, or they're ineligible under the existing laws of the United States.

There is this problem though, Karl, politically with Republicans and entitlements, and particularly the healthcare. I mean, they just are so afraid of actually tackling the issue. I'm talking about the rank and file here.

Right.

There are Republicans over time who've tried to do it and have had very constructive reforms. And clearly the people thinking about this now have put together some reforms, but they could do a lot more here.

Right.

If they really wanted, particularly changing the fact that able-bodied people who get, because of Obamacare, the states are reimbursed 90% for those people who join the rolls. Whereas traditional Medicaid, it's only, could be as low as 50% for some states. That's an inequity that I doubt the American people understand. But the Republicans have failed to address that. Yet they're getting hit for even these modest reforms. Why not go further?

Oh, I agree. I mean, for example, look, we ought to be talking about empowering the consumer, the patient, if you will, by allowing people to put money into health savings accounts to augment what they get under Medicaid. But you're absolutely right, think about it. Medicaid is designed for the vulnerable among us. It's designed for poor seniors, children in poor families, and the disabled. And we're paying 90% for able-bodied people under Medicaid that get coverage because of Obamacare under Medicaid. And we're paying 50% or 70% depending on the category for the ones who are really, truly vulnerable. But look, if we can't win the battle on, you gotta work if you want to be on Medicaid, if you're able-bodied. We're not gonna have illegals on it. And we're gonna let the states check as frequently as they want to see if ineligible people are still being carried on their rolls and getting money as a result. If we can't win that battle, we can't win the battle on these other issues.

Well, so the President basically is saying, waste, fraud, and abuse, waste, fraud, and abuse. And along with that, he says, well, we're not gonna cut Medicaid. He's not making any of the points you are making. Without presidential leadership explaining this, that makes it much harder for Republicans to do it. And waste, fraud, and abuse, I think there's a kind of cynicism among voters on that front. They say that's what politicians always say, instead of making some of the real substantive points that you make.

Yeah, absolutely, I couldn't agree more. The biggest voice on behalf of these changes is the person who's gonna sign that bill, the President of the United States. If he goes out and says exactly what we've been talking about, able-bodied gotta work, no illegals, and states ought to be able to check for fraud and inappropriate payments as frequently as they like. That would be enormously powerful. Right now we've got two voices, the voices of the Congressional Republicans and the voices of Congressional Democrats. And the media is gonna amplify the voice of the latter and not of the former. They're gonna be giving the headlines to all the people who are gonna be losing coverage. And the Republicans need the President to engage, to say, if you're losing coverage, it's because you're able-bodied and refuse to work. You're an illegal alien, or you weren't eligible for the program in the first place.

WSJ Opinion: How Republicans can win the Medicaid Debate

From the award-winning opinion pages of The Wall Street Journal, the Journal Editorial Report sees columnists and members of the Journal Editorial Board debate the major economic, political and cultural issues of the day. 
From the policy debates to the political fights, each week get critical perspective and the analysis you need on developments from Washington.

WSJ Opinion: How Republicans can win the Medicaid Debate

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