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"If there are a lot of details still to be filled in," wrote one analyst, "the theme of the GOP's healthcare agenda is clear: cuts."
Having secured control of both chambers of the U.S. Congress and the White House starting in January, Republicans are making no secret of their intention to pursue sweeping healthcare cuts that would raise costs and imperil insurance coverage for millions of people across the country.
Rep. Jodey Arrington (R-Texas), chairman of the House Budget Committee, told reporters earlier this week that the GOP is looking to use the filibuster-evading reconciliation process to pursue cuts to "mandatory programs"—a category that includes Medicare, Medicaid, and Social Security.
Bobby Kogan, senior director of federal budget policy at the Center for American Progress, noted in response to Arrington's comments that Republicans attempted to cut both Medicaid and Affordable Care Act (ACA) tax credits that help enrollees afford health insurance.
The Republican Study Committee, of which Arrington is a member, proposed eliminating the ACA tax credits in its 2025 budget proposal—a move that could result in around 4 million people losing insurance.
The tax credits are set to expire next year, meaning Republicans could just do nothing and allow them to lapse.
Last time Republicans had a federal trifecta, they tried and failed to fully repeal the ACA—an effort that sparked a
wave of civil disobedience on Capitol Hill.
Both President-elect Donald Trump and House Speaker Mike Johnson (R-La.) said on the campaign trail that they're looking to try again.
"We're going to replace it," Trump said during his lone debate with Vice President Kamala Harris in September—while admitting that he did not have a fully formed alternative plan.
Johnson, for his part, said during a campaign stop in Pennsylvania last month that "healthcare reform's going to be a big part of the agenda." When a voter posed the question, "No Obamacare?" Johnson replied in the affirmative, "No Obamacare."
"The ACA is so deeply ingrained, we need massive reform to make this work," he added, "and we've got a lot of ideas on how to do that."
Sarah Lueck and Allison Orris of the Center on Budget and Policy Priorities
wrote Wednesday that Trump's return to the White House and the GOP's capture of both chambers of Congress poses "big risks to people's ability to access and afford health coverage in Medicaid and the marketplaces."
"While Republicans have moved away from talking about their plans for changing health coverage in the U.S. as 'repeal,'" Lueck and Orris added, "Trump's first term and Republicans' recently released policy agendas suggest they may pursue policies that would have much the same result: higher costs for people, reduced access to care for vulnerable groups, and more people who are uninsured."
"Just as a grassroots movement of Americans around the country succeeded in saving the Affordable Care Act during Trump's first term, we can save Social Security and Medicare."
Even if Republicans don't succeed at enacting major legislative changes to the nation's healthcare system, Trump will still have the power to do significant damage unilaterally. Lueck and Orris noted that the first Trump administration "took numerous administrative steps that made it harder for eligible people to get coverage" and weakened consumer protections, from adding new paperwork requirements to the Medicaid enrollment process to expanding so-called "junk" insurance plans.
Vice President-elect JD Vance also suggested during the 2024 campaign that a second Trump administration could seek to roll back protections for people with preexisting conditions.
"If there are a lot of details still to be filled in, the theme of the GOP's healthcare agenda is clear: cuts," Vox's Dylan Scott wrote days before the November 5 election. "Cutting regulations. Cutting spending."
Stephanie Armour of KFF Health Newswrote following Trump's victory that his second term "will likely bring changes that scale back the nation's public health insurance programs—increasing the uninsured rate, while imposing new barriers to abortion and other reproductive care."
Medicaid is particularly vulnerable, Armour noted, with Trump and the Republican Party potentially set to pursue "the imposition of work requirements on beneficiaries in some states" and changes to how the program is funded.
"Now, the federal government pays states a variable percentage of program costs," Armour explained. "Conservatives have long sought to cap the federal allotments to states, which critics say would lead to draconian cuts."
As for Medicare, the Project 2025 agenda authored by many former members of Trump's first administration calls for making privatized Medicare Advantage plans the default enrollment option for the nation's seniors—a change that advocates say would pose an existential threat to traditional Medicare.
"Trump and Republicans will try to cut our earned benefits," Alex Lawson, executive director of the progressive advocacy group Social Security Works, warned in an op-ed for Common Dreams on Wednesday. "But just as a grassroots movement of Americans around the country succeeded in saving the Affordable Care Act during Trump's first term, we can save Social Security and Medicare."
"The Republican Speaker of the House just told the tens of thousands of construction workers building New York and America's future they want to send them pink slips ASAP," said Senate Majority Leader Chuck Schumer.
On MSNBC Friday night, U.S. Rep. Alexandria Ocasio-Cortez issued an unexpected "thank you" to House Speaker Mike Johnson—expressing appreciation for his admission that the GOP will try to repeal the CHIPS and Science Act, which has created more than 115,000 manufacturing jobs, if the party wins control of Congress and the White House.
"What I would like to thank Speaker Johnson for is his honesty and his forthrightness about what they plan to do with a Republican majority in the House of Representatives," said Ocasio-Cortez (D-N.Y.). "You heard it straight from the horse's mouth and we'll see exactly what happens if we allow a Republican majority in the House and a Donald Trump presidency."
The congresswoman was referring to an interview by Luke Radel, a student journalist at Syracuse University, who asked Johnson (R-La.) about Trump's recent comments that the CHIPS and Science Act is "so bad."
"You voted against it," said Radel. "If you have a Republican majority in Congress and Trump in the White House, will you guys try to repeal that law?"
"I expect that we probably will, but we haven't developed that part of the agenda yet," said Johnson before attempting to pivot to talking about Rep. Brandon Williams, a Republican who represents New York's 22nd District, where a $100 billion Micron Technology chipmaking facility has benefited from the CHIPS and Science Act.
"The Republican Speaker of the House just told the tens of thousands of construction workers building New York and America's future they want to send them pink slips ASAP," said Senate Majority Leader Chuck Schumer (D-N.Y.).
The exchange grew increasingly awkward as Radel asked Williams whether he would vote to repeal the legislation, signed by President Joe Biden in 2022, that Micron has said will create 50,000 semiconductor manufacturing jobs in the Syracuse area.
"No, obviously, the CHIPS Act is hugely impactful here, and my job is to keep lobbying on my side," said Williams. "I will remind [Johnson] night and day how important the CHIPS Act is and that we… break ground on Micron."
Speaking with anchor Chris Hayes on MSNBC, Ocasio-Cortez said the CHIPS Act "is not a remote and faraway thing for workers" in Upstate New York, Michigan, Arizona, and other states where jobs have been created by the legislation.
For thousands of workers, the law represents "the jobs and especially the union jobs that result and are created, that people can actually take and will help them put food on the table without having to work triple or double overtime in order to accomplish that," said Ocasio-Cortez. "People in Buffalo, people in Upstate New York, people in Michigan, they hear about the plant that they work at."
The International Brotherhood of Electrical Workers (IBEW) echoed the congresswoman's sentiment, saying Johnson's plan to repeal the CHIPS Act would impact "tens of thousands of IBEW jobs created by this administration."
"We are NOT going back," said the union.
Johnson's remark got the attention of other politicians whose states have benefited from the law, including Sen. Mark Kelly (D-Ariz.), Rep. Jasmine Crockett (D-Texas), and Michigan Gov. Gretchen Whitmer.
Less than two weeks ago, Whitmer announced that through the CHIPS Act, the Biden administration had provided $325 million in direct funding to Michigan manufacturer Hemlock Semiconductor, allowing it to create over 1,000 good-paying construction jobs to build a new facility as well as 180 permanent manufacturing jobs.
"Mike Johnson's asinine admission that he would repeal the CHIPS Act if Republicans and Trump win the election is a complete disaster for thousands of Michigan workers relying on the jobs that this legislation provides," said the Democratic governor. "Make no mistake, a repeal of the CHIPS Act would kill thousands of good-paying manufacturing jobs right here in Michigan."
Johnson attempted to do damage control, saying he had "misheard the question," but Radel noted that he was standing close to the House speaker when he asked about the CHIPS Act and others commented that the word "repeal" was said clearly. Williams and Johnson also tried to backtrack during their exchange with the student journalist, saying they aimed only to reform the law—but as Radel noted, the former president has made clear he opposes the CHIPS Act.
Vice President Kamala Harris' Democratic presidential campaign said Johnson's threat to repeal the CHIPS Act is the latest of several recent questionable "promises" made by Trump and his surrogates in the last days before the election.
"Mike Johnson wants to lose Arizona, Georgia, Michigan, and North Carolina jobs," said James Singer, a rapid response adviser to Harris, posting an image showing where the CHIPS Act has created semiconductor manufacturing jobs.
Johnson's comments came as Ocasio-Cortez, United Auto Workers president Shawn Fain, Rep. Rashida Tlaib (D-Mich.), and others were rallying Michigan UAW members at a labor-focused get-out-the-vote event in Detroit.
"I do not see elections as an endpoint," Ocasio-Cortez told UAW members at the rally. "They are a waypoint... Because the larger task that we have today is organizing a mass movement of labor in the United States of America. We have a generational task ahead of us, and electing Kamala Harris is an opening silo to the movement that we are about to embark upon."
Think races for the U.S. House don't matter? Think again.
The scariest thing at Trump’s quasi-fascist Madison Square Garden rally was not the vulgar and offensive rhetoric by surrogates like unfunny comic Killer Tony’s comments about Puerto Rico being a “floating island of garbage” and Black Americans carving watermelons for Halloween, as disgusting as they were.
No, it was Trump’s threat that he and GOP House Speaker Mike Johnson have “a little secret” to upend the results of the election. As Rep. Dan Goldman warned, Trump and Johnson may try to go to the House and throw out the certification of the electoral vote and turn it over to the Republican House majority who would hand the election to Trump.
Here’s how it could go down: MAGA operatives in swing states could challenge the allocation of electoral votes with the goal of making it impossible for one or more counties or states to certify the electoral vote on time, block both candidates from receiving the necessary minimum of 270 electoral votes, and throw it into the House for a so-called “contingent election” where each state gets one vote and Republicans are likely to have the edge with a majority of 26 state delegations unless Democrats flip this in the upcoming election.
Although most states award their electoral votes to the candidate who received the most popular votes in their state, the Constitution does not require them to do so. According to Article II, Section 1 of the Constitution, each state has the right to decide how to appoint its electors. In many states, this would allow one or more electors (so-called “faithless electors”) to cast their vote for a candidate other than the one who received the most popular votes in their state. This has happened nearly 100 times in history, although so far it has not changed the ultimate results. It could be different this time.
According to various state laws in 15 states, a faithless elector’s vote isn’t counted and a replacement is named. But in 19 states, their votes would count. Some of these states have enforcement mechanisms, but others, including Pennsylvania, do not.
In July 2020, the U.S. Supreme Court held in Chiafalo v Washington that a State may "penalize an elector for breaking his pledge and voting for someone other than the presidential candidate who won his State's popular vote." But it doesn’t require them to do so.
Let’s say Harris carries all the safely Blue states plus only the swing states of Wisconsin, Michigan, and Pennsylvania. That would give her 270 electoral votes to Trump’s 268, the bare minimum for her to win. But let’s say there’s a faithless elector from one of the states that permit it, or a court challenge voids some electoral votes as discussed below. Then neither candidate would have an electoral college majority, which would throw the choice of the next president to the House of Representatives. Each state gets one vote and unless this election changes it, Republicans hold a majority of the states. So the House Republicans hands the election to Trump.
Meanwhile, there are several court cases that could flip the electoral college, particularly if the election is so close that it comes down to Pennsylvania.
In Republican National Committee v. Wetzel, the ultra-right wing 5th Circuit Court of Appeals just ruled that a state may not legally count a ballot mailed before election day that arrives for counting afterwards. As Mark Joseph Stern argued in Slate: “18 states and Washington, D.C., accept late-arriving ballots; the 5thCircuit’s reasoning would render all these laws illegitimate and void, nullifying hundreds of thousands (if not millions) of ballots.” SCOTUS could affirm or overturn the 5th Circuit. Although there’s probably no time to do so before election day, if it affirms the 5th Circuit between the election and the final certification of the electoral vote by Congress, it could disqualify the votes of countless Harris voters.
Meanwhile, in Genser v. Butler County Board of Elections the Pennsylvania Supreme Court ruled that voters whose mail-in ballots contained a technical error (they were not placed in a second “security envelope”) would be permitted to submit a second provisional ballot that could be counted.
The Republican Party filed a motion for the U.S. Supreme Court to intervene and bar provisional ballots from being counted. If SCOTUS rules in their favor, it could disqualify thousands of Pennsylvania votes. Remember that in 2000, Bush defeated Gore by only 537 votes in Florida, when SCOTUS stopped the vote count.
With a 6-3 extreme right majority, SCOTUS could again hand the election to the Republican, Donald Trump.
The only way to guarantee that the Trump/Rogers “secret plan” is to flip a couple of House delegation majorities from Red to Blue. That’s why it’s vitally important for Harris voters to vote in every state and cast their vote for the Democratic House candidate.