The Elephant Plots a Medicaid Heist—in the Dark

 The Elephant Plots a Medicaid Heist—in the Dark

J.Michael Pontious M.D.

April 24, 2025

I do worry about the Republican playbook these days.  There are subtle changes coming, you know like a car alarm at 3 a.m., but give them credit for at least trying to figure out the smoke and mirrors. Behind the repeated claims about "fraud, waste, and abuse" lies a strategy used by politicians to take away the remaining respect and support available to society's most vulnerable folks.  

You guessed it, the GOP is quietly sharpening the “scalpel” for Medicaid.

The strategy isn’t front-page news, because apparently, we’re all too busy distracted about SCOTUS rulings, disasters, and whatever unspeakable thing was tweeted after midnight on X. But if you listen real close you can hear it: Speaker Mike Johnson’s folksy Fox News sermon about “preserving integrity” in Medicaid, which, in translation, means gutting health coverage for millions to fund tax cuts and a new round of performative immigration spending.

I thought all this was supposed to make America functional again and save money at the same time.

Johnson, whose compassionate conservatism rivals a thief’s smile, insists that Medicaid should be reserved for “young, single mothers, down on their fortunes at the moment, the people with real disabilities, the elderly.” The rest, we have to assume,  are apparently, 29-year-old couch potatoes, gaming their way through taxpayer dollars. 

Let’s pause and savor the absurdity: The same party that takes pride in its “real America” bona fides is plotting to cut a program that provides health coverage to one in five Americans—including a good chunk of their own voters. In Johnson’s own Louisiana district, 38 percent rely on Medicaid. That’s not a typo my friends. That’s almost four out of every ten people who apparently don’t matter enough to keep their inhalers or insulin. 

 You do understand that the stock market has not done all that well recently, so your favorite billionaire needs to get another tax cut to maintain their fragile and vulnerable lifestyle.

I might remind you that this isn’t about fraud. 

No, this is the same old cultural war on the social safety net, dressed up for streaming TV and quietly slipped into budget “resolutions”.  You know that subtle kind of approach that they hope we’re all too distracted to even notice. The only thing more transparent than their motives is the pretense that these cuts will only hurt “undeserving” recipients—never mind that the line between “worthy” and “unworthy” …is a line that is real blurry these days.

So maybe next time, the Speaker can show up at a food pantry in his district and explain to the Medicaid moms how he’s bravely protecting them from themselves. No wait a second, they cut funding for those food pantries last week.  I am sure he can find a “photo op” around here somewhere.  Maybe he can tell them that universal health care is a pipe dream, but the rest of us can sleep soundly… knowing the couch-dwelling menace has been excised.

But let’s be real. Congressional Republicans aren’t losing sleep over Medicaid recipients. Their insomnia comes from worrying that someone, somewhere, might actually get something they need—without a hedge fund manager getting a tax break in the process.

And so the quiet sabotage continues. Because in Washington, the only thing cheaper than a promise to the poor is the excuse given when it’s broken.