Republicans on the MAGA team were elected, in part, to shake up Washington. Business as usual, the alleged “deep state†and excessive government spending were all in the cross hairs of the new Senate and House majorities.
But campaigning and governing are two different things, and now Republicans find themselves trying to figure out where and how to reduce government spending while paying for the extension of President Donald Trump’s tax cuts.
One of the targets is Medicaid, the federal/state program that provides health care for the poor. It is massive, covering 72 million Americans. The House of Representatives Budget Committee has directed the House Energy and Commerce Committee, which has jurisdiction over Medicaid, to cut $880 billion in spending over 10 years.
West Virginia is heavily dependent on Medicaid. According to the Kaiser Family Foundation, 28% of the state’s population — about 500,000 individuals — are covered by Medicaid. That’s the fifth highest per capita rate in the nation.
A large number of those individuals, about 165,000 individuals between the ages of 19 and 64, are in the Medicaid expansion program. That is a federal program that West Virginia joined in 2024 which expanded coverage to individuals below certain income guidelines. The federal government pays 90% of the cost of care, while the state picks up 10%.
It is a relatively inexpensive way for West Virginia to provide health care for the most vulnerable population.
Republican budget cutters in Washington are eyeing the expansion program as one way to reduce spending. Another would be work requirements for able-bodied adults on Medicaid. Trump has said he does not want to cut Medicaid, but Congressional Republicans have another view. As The Hill reported, “Congressional Republicans are looking at rolling that [Medicaid expansion] back as part of their reconciliation plan to pay for an extension of President Trump’s tax cuts.â€
If Republicans reduce or eliminate the sizable federal match for the expansion, West Virginia and other states in the program would have a decision to make: They can fund it with state dollars, and in our state’s case that would be an estimated $160 million annually, or they can let the 165,000 West Virginians now in the expansion fend for themselves.
These are tough situations that West Virginians should be asking their Republican legislators and Congress members about, Rep. Carol Miller, R-W.Va., in particular. According to a New York Times analysis, 32% of the people in Miller’s Southern West Virginia district are on Medicaid. That’s the 16th highest of all Republican districts in the country. Forty percent of McDowell County residents are on Medicaid.
The MAGA/Republican ship was smooth sailing at election time in West Virginia, where 70% of voters backed Trump and Republicans swept statewide offices and the Legislative races. But now there are rough seas ahead where consequential decisions on things like Medicaid will have real life consequences.
Hoppy Kercheval is the retired host of “Talkline,†on MetroNews.
