The proposed federal Medicaid cuts have ignited a significant debate across the United States, raising concerns about healthcare access for millions. To truly understand where this debate stands, it’s crucial to consider the perspectives of those directly affected: Medicaid enrollees themselves. This report delves into the viewpoints of Medicaid recipients who voted for both President Trump and Vice President Harris, revealing a striking consensus despite their political differences.
The Republican-led Congress is currently exploring substantial reductions to Medicaid funding, potentially exceeding $880 billion. These cuts are primarily intended to offset the costs of tax reductions. Medicaid, a vital program, provides comprehensive health coverage and long-term care to one in five Americans and constitutes nearly 20% of all healthcare spending in the nation. These proposed reductions could have far-reaching consequences, impacting not only enrollees but also healthcare providers, insurance plans, and state budgets. While various policy options are being discussed to achieve these savings, the level of support for specific measures within the Republican party, including from President Trump, remains unclear.
This congressional debate occurs against a backdrop of strong public support for Medicaid. KFF polling data indicates that a significant majority (77%) of the public holds a favorable view of Medicaid, with even stronger support (84%) among those enrolled in the program. Furthermore, nearly half of all Americans (46%) and almost two-thirds of Medicaid enrollees (62%) believe that the federal government is currently underfunding the program.
To gain deeper insights into the lived experiences of Medicaid enrollees and their perceptions of potential program changes, KFF conducted virtual focus groups in January. These groups included participants who voted for President Trump and those who voted for Vice President Harris in the 2024 election. Participants were asked to share their experiences with Medicaid, their views on the government’s role in healthcare, and their reactions to the recent election. Crucially, they were also asked for their responses to proposals aimed at reducing federal Medicaid spending and implementing work requirements. The findings revealed a powerful common thread: despite their differing political choices, participants consistently expressed positive experiences with Medicaid and deep apprehension about potential cuts to the program.
Key findings from these focus groups illuminate where the real debate lies, moving beyond political rhetoric to the core concerns of those reliant on Medicaid:
-
Economic anxieties dominated voting decisions, but healthcare concerns are present. While the economy was a top voting issue for both Trump and Harris voters, with some Trump voters also focusing on immigration and some Harris voters on women’s rights, most participants did not recall significant campaign discussions about healthcare programs, including Medicaid. Most agreed on a governmental role in affordable healthcare, although some Trump voters favored private sector cost control. Views on Medicaid fraud varied, with some Trump voters blaming ineligible enrollees, countered by others who pointed to provider and insurance fraud as more significant issues.
-
Opposition to Medicaid cuts for tax cuts is strong across party lines. Most participants were unaware of proposed Medicaid cuts. Some Trump voters speculated cuts were aimed at undocumented immigrants (who are already ineligible for federal Medicaid). Critically, both Trump and Harris voters opposed cutting Medicaid to fund tax cuts they believed wouldn’t benefit them. Fears of jeopardizing the program, losing healthcare access, worsening health, and increased costs were widespread. Some Trump voters expressed faith that President Trump would not implement cuts, believing he understood their financial struggles.
-
Medicaid coverage is highly valued for healthcare access and financial security. Both Trump and Harris voters deeply valued Medicaid for providing access to essential healthcare services, mental health support, and medications for themselves and their families. They emphasized Medicaid’s role in preventing financial ruin, reducing stress, improving health outcomes, and supporting their ability to work. Losing Medicaid was described as “devastating,” with severe consequences for physical and mental well-being and existing financial hardships anticipated.
-
Work requirements raise concerns despite some support. Working participants were generally confident in meeting work requirements but worried about monthly reporting burdens. Many participants across parties stressed that access to chronic condition management, including medications and mental health care, was crucial for their work capacity. While more Trump voters supported work requirements, some non-working Trump voters believed they would qualify for exemptions. Non-working participants, including both Trump and Harris voters, expressed difficulty meeting requirements due to disability or caregiving responsibilities, highlighting the complexities of such policies.
-
Focus on Medicaid improvement, not cuts, is desired. Both Trump and Harris voters urged policymakers to improve Medicaid, suggesting enhancements like better dental benefits, increased doctor availability, and fewer prior authorization hurdles. Participants implored policymakers to consider the human impact of Medicaid cuts on health, financial stability, and their ability to contribute to society.
General Situation: Financial Hardship and Health Challenges
A significant commonality among focus group participants was their experience with financial difficulties and the management of various physical and mental health conditions. Medicaid eligibility inherently means participants have low incomes. Many described struggling with rising living costs, particularly food prices, and reported recent years as financially strained. Some faced job market challenges, injuries, or disabilities hindering their employment prospects. Participants managed a range of health issues, from common conditions like hypertension and diabetes to more complex and debilitating illnesses. Adding to these personal challenges, some were also caregivers for family members in nursing facilities.
Alt Text: Quote from a 50-year-old white female Trump voter in Nevada describing tough financial times due to high prices and health issues, emphasizing the need for Medicaid.
Experiences with Medicaid: A Valued Lifeline
Participants overwhelmingly valued their Medicaid coverage, emphasizing the critical access it provided to healthcare services, mental health support, and necessary medications for themselves and their children. Beyond routine check-ups, Medicaid enabled access to specialists, mental health and substance abuse treatment, surgeries, and prescription drugs. For those managing chronic conditions requiring frequent specialist visits and multiple daily medications, Medicaid was indispensable.
Alt Text: Quote from a 35-year-old white female Trump voter in North Carolina expressing gratitude for Medicaid covering her 30 daily pills and specialist visits, highlighting medication access importance.
Medicaid was consistently described as affordable, offering crucial protection from financial devastation and reducing stress related to healthcare costs. Participants expressed gratitude for minimal or no cost-sharing for essential medications and appreciated the absence of premiums and low out-of-pocket expenses. The peace of mind afforded by Medicaid in managing unexpected medical bills was a recurring theme. Many had experienced periods of being uninsured before enrolling in Medicaid, leading to delayed or forgone medical care. They were now thankful for regular access to healthcare. Those with prior experience with private insurance found Medicaid to be a significantly more affordable option.
Alt Text: Quote from a 61-year-old white female Trump voter in Kentucky praising Medicaid for affordability, doctor appointments, mental therapy, and dental help, contrasting it with expensive employer-based insurance.
While generally satisfied with Medicaid, participants identified areas for improvement, including enhanced dental benefits, greater availability of doctors accepting Medicaid, and streamlined prior authorization processes. Difficulties in finding Medicaid-accepting doctors and navigating prior authorizations were common frustrations. Other concerns included high provider turnover at Medicaid clinics and limitations on covered prescriptions. Many participants expressed a strong desire for better dental coverage within their state Medicaid programs.
Alt Text: Quote from a 59-year-old white male Harris voter in Pennsylvania noting limited doctor availability under Medicaid as a disadvantage, despite satisfaction with his current doctor.
Views on Government’s Role in Health Care: Access as Essential
Participants overwhelmingly believed that easy access to affordable healthcare is fundamental to their ability to work and lead productive lives. Across party lines, a majority agreed that healthcare access is a right, particularly for “life or death” situations. Many emphasized that healthcare access enables them to work, contribute to society, and maintain productivity. However, a minority of Trump voters emphasized individual responsibility for health, suggesting healthcare is not a universal right.
Alt Text: Quote from a 52-year-old Black female Trump voter in Pennsylvania arguing healthcare is a right necessary for Americans to work and contribute, linking health to national productivity.
Most participants agreed on a government role in making healthcare affordable and accessible. However, some Trump voters expressed reservations about extensive government involvement in healthcare, suggesting private businesses might be more efficient in controlling costs. More Harris voters, and some Trump voters, advocated for a stronger government role in ensuring universal healthcare access and system improvement. Comparisons to countries with nationalized healthcare systems were made by both groups, with differing interpretations. Some Trump voters cited long wait times in other countries as a reason to avoid socialized medicine, while others, including both Trump and Harris voters, pointed to these systems as models for providing free care for all citizens.
Alt Text: Quote from a 45-year-old Black male Trump voter in Kentucky suggesting the private sector is better at lowering healthcare costs and providing options compared to government control.
Alt Text: Quote from a 61-year-old Black female Harris voter in Kentucky asserting healthcare as a right in a rich country like America, comparing it to other nations where it’s a citizen’s right.
Election Experiences: Economy First, Healthcare Second
For both Trump and Harris voters, economic concerns were paramount in the 2024 election. Pocketbook issues like housing and grocery costs heavily influenced their voting decisions. Some Trump voters felt their living standards were better under the previous Trump administration, while some Harris voters feared benefit cuts under a Trump presidency. Immigration was a key issue for some Trump voters, particularly in border states. A few Harris voters prioritized women’s issues and democracy preservation.
Alt Text: Quote from a 43-year-old white male Trump voter in Pennsylvania recalling a better standard of living during the Trump administration from 2016-2020, linking economic well-being to political leadership.
Alt Text: Quote from a 45-year-old Black female Harris voter in Ohio expressing voting motivation to support candidates who wouldn’t cut essential social programs like food stamps and housing assistance.
Most participants reported a lack of campaign focus on healthcare programs, including Medicaid. Dominant issues like immigration and the economy overshadowed healthcare discussions. Some Harris voters recalled Harris discussing women’s health and abortion access, and a few participants mentioned hearing about Trump’s plans for the Affordable Care Act (ACA). However, healthcare was generally not a central election issue for these voters.
Alt Text: Quote from a 56-year-old white male Trump voter in Arizona stating he didn’t hear about healthcare during the election, emphasizing immigration as his primary concern, indicating issue prioritization in voter awareness.
Alt Text: Quote from a 25-year-old Black female Harris voter in Pennsylvania recalling Kamala Harris discussing women’s healthcare and abortion rights, with limited recall of Trump’s healthcare plans, except through external sources like “Project 2025”.
Proposals to Reduce Federal Medicaid Spending: Unawareness and Varied Interpretations
Most participants were unaware of proposals to cut federal Medicaid spending at the time of the focus groups. Trump and Harris voters offered differing explanations for the proposed cuts. No Trump voters and very few Harris voters were aware of the congressional proposals, expressing surprise upon learning about them. While most were unsure of the reasons behind the cuts, some Trump voters speculated they were related to crackdowns on illegal immigration and aimed at removing undocumented immigrants from Medicaid, despite their ineligibility for federal funds. A few Trump voters doubted President Trump would enact cuts, believing he understood their financial struggles. Some Harris voters viewed the proposals as part of a broader Republican effort to reduce benefits for low-income Americans.
Alt Text: Quote from a 59-year-old Hispanic female Trump voter in Arizona speculating Medicaid cuts are aimed at reducing costs associated with undocumented immigrants receiving social services in border states.
Alt Text: Quote from a 58-year-old Black female Harris voter in Ohio interpreting Medicaid cuts as part of a broader agenda to deprive resources from ordinary people, benefiting the wealthy.
Alt Text: Quote from a 45-year-old Hispanic male Trump voter in Arizona expressing belief that Trump understands people’s financial difficulties and wouldn’t cut Medicaid, at least not immediately.
Regarding Medicaid fraud and abuse, participants across both groups acknowledged its existence but differed on its primary source. The Trump administration has justified spending cuts by citing the need to combat fraud, waste, and abuse in government programs. While many participants agreed fraud exists in Medicaid, opinions varied on whether it was a major problem. Some Trump voters attributed fraud primarily to ineligible enrollees. However, other participants, including both Trump and Harris voters, argued that state verification processes made large-scale individual fraud difficult, suggesting provider and insurance company fraud as more likely. They cited examples of provider fraud convictions in their states.
Alt Text: Quote from a 56-year-old white male Trump voter in Arizona acknowledging the likely prevalence of fraud in Medicaid, similar to other systems, due to potential for abuse when access exists.
Alt Text: Quote from a 59-year-old Hispanic female Trump voter in Arizona questioning the ease of individual Medicaid fraud, citing income verification processes and suggesting organizational fraud by providers is more likely.
Alt Text: Quote from a 45-year-old Black female Harris voter in North Carolina stating most Medicaid fraud she’s aware of originates from providers billing for services not rendered, shifting blame from individual recipients to healthcare providers.
Both Trump and Harris voters opposed Medicaid cuts, fearing they would jeopardize the program and restrict healthcare access for low-income individuals. Due to their reliance on Medicaid, participants strongly opposed spending reductions, using forceful language to describe potentially dire consequences. Some predicted coverage losses, while one participant suggested economic repercussions due to the inability of those losing care to work. Others anticipated benefit reductions, particularly for mental health and prescription medications, and provider withdrawal from the program.
Alt Text: Quote from a 60-year-old Black male Trump voter in Missouri opposing Medicaid cuts, emphasizing the unfairness of making vulnerable people suffer for proposed reductions and advocating for alternative funding sources.
Alt Text: Quote from a 55-year-old white female Trump voter in Oklahoma predicting Medicaid cuts would cause widespread suffering, inability to work, and economic decline due to lack of healthcare access.
Alt Text: Quote from a 29-year-old white male Trump voter in Pennsylvania opposing Medicaid cuts simply because many people rely on it and would be negatively affected, highlighting the program’s importance for a broad population.
Participants opposed cutting Medicaid to finance tax cuts they believed would not benefit them. Given their low incomes and tax brackets, they did not expect significant tax changes. Both Trump and Harris voters preferred maintaining Medicaid coverage, arguing that negative consequences of Medicaid changes would outweigh any minor tax cut benefits. They suggested targeting other government spending areas for tax cut funding.
Alt Text: Quote from a 50-year-old white female Trump voter in Nevada prioritizing Medicaid over potential tax cuts, stating her low income means tax cuts are irrelevant compared to the essential healthcare Medicaid provides.
Alt Text: Quote from a 56-year-old white male Harris voter in Ohio suggesting proper taxation of wealthy individuals before considering program cuts, arguing the tax burden disproportionately falls on lower-income groups.
Participants anticipated significant Medicaid program changes if federal funding was reduced and worried about coverage loss or increased costs. Potential cuts felt deeply personal, causing anxiety about out-of-pocket expenses, doctor availability, and covered benefits. Some described life-threatening consequences of losing access to mental health care and medications for chronic conditions. Others focused on financial implications of coverage loss and its impact on their ability to work and afford needed care. For those with family members in nursing homes, home care seemed an overwhelming challenge.
Alt Text: Quote from a 45-year-old Hispanic male Trump voter in Arizona expressing extreme worry that Medicaid cuts would lead to loss of antidepressants and psychiatric care, potentially causing severe personal crisis.
Alt Text: Quote from a 45-year-old Hispanic male Harris voter in Arizona predicting states will reduce Medicaid enrollment, particularly targeting single, childless individuals, as a consequence of federal funding cuts.
Alt Text: Quote from a 45-year-old Black female Harris voter in Ohio anticipating increased out-of-pocket healthcare costs for herself and her family due to Medicaid cuts, highlighting financial strain on low-income families.
Work Requirements: Complexities and Concerns
While some participants worked full-time, many working part-time or unemployed expressed a desire to work more but faced barriers like disability or caregiving responsibilities. Participants held various jobs, often in sectors without employer-sponsored health insurance, necessitating Medicaid. Illness, disability, childcare, and eldercare were cited as reasons for part-time or non-employment. Those seeking work mentioned needing support services like affordable childcare, transportation, and better local job opportunities.
Alt Text: Quote from a 52-year-old Black male Trump voter in Missouri describing his self-employment with Instacart to manage work flexibility alongside caring for his father in a nursing home and his mother’s increasing healthcare needs.
Alt Text: Quote from a 41-year-old white female Trump voter in North Carolina explaining her inability to work due to a back injury, worsened by lack of healthcare access when uninsured, illustrating the cycle of health and employment.
Alt Text: Quote from a 51-year-old Black female Harris voter in Oklahoma describing job search struggles due to physical pain preventing her from meeting job requirements like standing or sitting for long periods, highlighting disability as employment barrier.
Participants who were working emphasized Medicaid’s role in enabling their employment by providing necessary healthcare, particularly medication, and financial security. Managing chronic conditions was crucial for maintaining work capacity, especially for those whose jobs exacerbated health issues. Maintaining Medicaid eligibility while working was challenging, with one participant describing a month-long coverage loss due to exceeding income limits, highlighting the precariousness of coverage for low-wage workers.
Alt Text: Quote from a 45-year-old Black female Harris voter in North Carolina stating that Medicaid-provided pain management enables her to work part-time, emphasizing healthcare’s role in maintaining even limited employment for individuals with health issues.
Alt Text: Quote from a 35-year-old white female Trump voter in North Carolina highlighting Medicaid’s benefit in allowing her to pursue part-time work she enjoys while managing health appointments and being immunocompromised, enabling work-life balance for health-compromised individuals.
Alt Text: Quote from a 59-year-old Hispanic female Trump voter in Arizona recounting losing Medicaid for a month due to unknowingly exceeding income caps, illustrating the precariousness of Medicaid eligibility and potential coverage gaps for working recipients.
Non-working participants expressed concerns about Medicaid work requirements. Many, across party lines, felt they would struggle to meet requirements due to chronic pain or disabilities. Despite not currently working, some described demanding previous jobs they had to leave due to health issues. More Trump voters supported work requirements, but some non-working Trump voters believed they would qualify for exemptions due to disability or caregiving. However, many with disabilities did not receive disability income (SSI), which might not meet exemption criteria in past proposals, creating potential gaps in exemptions.
Alt Text: Quote from a 57-year-old white female Trump voter in Missouri stating chronic pain prevents her from meeting potential work requirements for Medicaid, highlighting disability as a barrier to employment and program compliance.
Alt Text: Quote from a 39-year-old Black female Harris voter in North Carolina pointing out the lack of job opportunities in rural areas as a barrier to meeting Medicaid work requirements, indicating geographical disparities in employment access.
Alt Text: Quote from a 34-year-old white female Trump voter in Kentucky conditionally supporting Medicaid work requirements for able-bodied individuals but citing childcare costs as her personal barrier to employment, illustrating nuanced views on work requirements and individual circumstances.
Alt Text: Quote from a 57-year-old white male Harris voter in Pennsylvania expressing confidence in exemption from Medicaid work requirements due to disability, but acknowledging inability to meet requirements otherwise, demonstrating awareness of exemption policies and personal limitations.
Working participants generally felt capable of meeting work requirements but expressed concerns about monthly reporting burdens. While confident in meeting hourly requirements, opinions differed on monthly work status reporting. Some already submitted similar information for programs like SNAP and were less concerned. Others worried about the burden of monthly reporting, potential forgetfulness, and the consequences of coverage loss for reporting lapses. They suggested automated income verification, similar to renewal processes, as a more efficient alternative to paperwork.
Alt Text: Quote from a 45-year-old Hispanic male Harris voter in Arizona expressing confidence in easily meeting potential Medicaid work requirements, despite physical limitations, highlighting willingness to comply if able-bodied.
Alt Text: Quote from a 45-year-old Black female Harris voter in Ohio worrying about losing Medicaid coverage for her household due to potential forgetfulness in monthly work hours reporting, emphasizing the human error factor in administrative burdens.
Alt Text: Quote from a 50-year-old white female Trump voter in Nevada expressing concern about potential clerical errors in Medicaid paperwork processing, leading to coverage disruptions despite correct submissions, highlighting system reliability issues.
Consequences of Losing Medicaid Coverage: Devastating Impacts
Both Trump and Harris voters agreed that losing Medicaid would be “devastating,” leading to severe physical and mental health consequences. Participants emphasized that Medicaid-provided healthcare and prescriptions were essential for their survival and their children’s well-being. Across groups, they anticipated financial hardship and anxiety about affording medications, doctor visits, or increased premiums, exacerbating existing financial vulnerabilities. While unaware of specific congressional proposals, all participants resided in Medicaid expansion states, making those eligible through expansion particularly vulnerable to program changes.
Alt Text: Quote from a 58-year-old Black female Harris voter in Ohio describing the potentially devastating impact of losing Medicaid, emphasizing the worry about basic needs like food and healthcare, and the essential role of Medicaid for accessing doctors and specialists.
Alt Text: Quote from a 55-year-old white female Trump voter in Oklahoma stating that losing Medicaid would likely lead to her death due to reliance on it for survival, and highlighting severe but survivable impacts for her son with allergies and hearing issues, underscoring life-or-death dependence on Medicaid.
In response to proposed Medicaid cuts, participants implored policymakers to consider the negative human impact of these changes. They felt federal funding reductions would severely harm Medicaid recipients, many of whom lacked alternative healthcare options. Some Trump voters urged policymakers to focus on improving Medicaid rather than cutting it. Across groups, participants asked policymakers to remember the human element and the real-life consequences of program changes.
Alt Text: Quote from a 45-year-old Hispanic male Trump voter in Arizona arguing against Medicaid cuts because they merely shift problems elsewhere, hurting one group to benefit another without overall benefit, emphasizing the interconnectedness of social welfare and unintended consequences of cuts.
Alt Text: Quote from a 57-year-old white female Trump voter in Missouri simply stating “Leave it alone and make it better” regarding Medicaid, advocating for program improvement rather than detrimental cuts, reflecting a desire for positive change and stability.
Alt Text: Quote from a 39-year-old Black male Trump voter in Ohio pleading with policymakers to maintain medical coverage for those who need it, emphasizing his daily reliance on medication and expressing fear of life without Medicaid, appealing to policymakers’ empathy and responsibility.
Alt Text: Quote from a 39-year-old white male Harris voter in Kentucky urging policymakers to recognize Medicaid recipients as individuals, not just statistics, emphasizing the real-world consequences of policy decisions on people’s lives and well-being.
Alt Text: Quote from a 59-year-old white male Harris voter in Pennsylvania posing a question to policymakers, urging them to consider how they would act if they or their family members were personally affected by potential Medicaid cuts, prompting empathy and personal reflection on policy impacts.
Where Is The Debate heading? The voices of Medicaid enrollees, regardless of their political affiliations, paint a clear picture. The debate transcends partisan lines when considering the human cost. While the political debate in Congress may center on budget priorities and fiscal responsibility, for those relying on Medicaid, the debate is about access to healthcare, financial security, and basic survival. Understanding these perspectives is essential for a comprehensive and compassionate approach to healthcare policy decisions.
