With the midterm elections still more than 14 months away, Democrats are already crafting their pitch to retake Congress around opposition to President Trump's signature tax and spending law. And in the key swing state of Michigan, the law's cuts to Medicaid are taking center stage.
Brian Peters, the CEO of the Michigan Health and Hospital Association, said it was too early to know exactly how the Republican bill – which institutes new work requirements and makes changes to some state funding mechanisms – will reshape health care in Michigan. But he expects a significant impact on coverage.
The association reports that nearly 2.7 million people in Michigan — more than a quarter of the state's population — are Medicaid recipients.
"The state of Michigan Department of Health and Human Services has estimated that as many as 700,000 Michiganders could lose coverage because of the reconciliation bill," Peters said, adding that a lot of people may fall off the rolls not because they are ineligible, but because of paperwork burdens. The new work requirements will necessitate that hundreds of thousands of enrollees document their eligibility every six months.
At a recent Democratic town hall in Macomb County, Michigan, the mention of the law — officially named the One Big Beautiful Bill Act — elicited boos from the crowd.
Former Rep. Gabby Giffords and her husband Sen. Mark Kelly, D-Ariz., headlined the event, held in a swing district with an open House seat next year.
"A lot of my Republican colleagues had an opportunity to suck it up and do the right thing," Kelly said of the vote on the package. "There are members who were like, 'Well, we can't cut funding to Medicaid. This is a bad decision.' This came from Republicans. But ultimately, you saw what happened. You know, they tend to fall in line."
All seven Republicans in Michigan's House delegation supported the law. The legislation narrowly passed the Senate in July, after Vice President JD Vance cast a tie-breaking vote in the chamber. Three Senate Republicans voted with all Democrats in opposition to the bill. Several others voiced concerns about the bill but ultimately supported it.
Republicans say they're fighting "waste, fraud and abuse"
Republicans who support the bill say Democratic messaging about the cuts amounts to nothing more than fearmongering. They say the GOP bill only targets "waste, fraud and abuse."
But Peters from the Michigan Health and Hospital Association counters that there's no evidence of widespread waste and abuse in the state's Medicaid program.
"When you look at the Medicaid population here in the state of Michigan, we know that almost all of those folks are working and working full time," Peters said.
State and local Republican party officials declined or didn't respond to multiple interview requests for this story.
Michigan State University political science professor Corwin Smidt said the sheer number of people who depend on Medicaid in the state could make the bill a "vulnerable issue" for Republicans.
Smidt pointed to a recent statewide survey that showed 82% of residents opposed cutting Medicaid to pay for tax cuts – as the GOP law does.
He also said the waste and fraud argument can cut two ways.
"It resonates with voters to say, 'there's waste and fraud,'" Smidt said. "When you find out that your hospital might be considered waste and fraud, and you're like, 'that provides essential services.' That's a much different story suddenly."
But he noted that many of the bill's Medicaid provisions won't take effect until after the 2026 midterm elections, so it's not clear how much the issue will motivate voters in next year's elections.
During the current summer recess, Republicans across the country have been emphasizing that the new law extended the tax cuts enacted during President Trump's first term — and that without that extension, Americans would have seen their tax bills go up.
A July memo from the National Republican Congressional Committee urged lawmakers to "sell our wins," focusing not on Medicaid cuts but on an expanded larger child tax credit, and reductions in taxes on tips.
Both parties are expected to spend the next year trying to shape the narrative around the law. The Trump administration is already sending cabinet and other high ranking officials on the road to sell the president's signature legislative package — with Small Business Administrator Kelly Loeffler making a stop this week in Michigan.
Fear and uncertainty among Medicaid recipients
While the political fight rages on, some Medicaid recipients in the state feel like they've been left in limbo.
Sharon Watson's son, Eli, was just shy of his fourth birthday, when she came downstairs one day to find him having a seizure.
"It just kept going and going and going," said Watson. "And 5 minutes passed and he was still going and his lips started to turn blue and his fingers started to turn blue and it looked like he was having trouble breathing."
Eli was diagnosed with epilepsy. That meant a battery of testing, daily medications and frequent doctor visits.
Watson's family enrolled in Medicaid after her husband left the Navy and couldn't work due to disability.
Now, the Howell, Michigan mother of three is worried about whether the Republican bill will affect not just her family's eligibility but also the quality of their coverage.
"I feel like one of the hardest things about this is how many uncertainties there are," she said. "[The hospitals] are honestly already overloaded. We have a shortage of specialists. And, you know, oftentimes the wait is already several months long just to see a specialist that we're already well established with."
If changes to coverage included in the new law hurt hospitals' bottom-lines, Watson fears wait times will get even worse.
Jennifer Middlin, 45, is also worried about Medicaid cuts. She never thought she'd find herself in need of the service until recently. But several months ago, she was injured in a car accident and subsequently lost her job.
"I was earning more than six figures. I have kids, I'm in a professional setting," Middlin said. "And within four months I go from that to being unemployed and desperately in need of medical care with nowhere to go."
"You're a lot closer to needing this than you might think – a heck of a lot closer," she added.
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