| The saying is that elections have consequences. One consequence of this month’s election, which delivered the White House and Congress to the GOP: Trump’s allies have begun eyeing changes to Medicaid and food stamps, seeking to pay for tax cuts, my colleagues Jacob Bogage and Jeff Stein report in a new story with me. House Budget Committee Chair Jodey Arrington (R-Texas) told reporters last week that a “responsible and reasonable work requirement” for Medicaid benefits could yield about $100 billion in savings. The backdrop: The discussions are driven by Trump’s 2017 tax bill, which lowered taxes for the vast majority of Americans. Major portions of that law are set to expire at the end of next year, and extending those provisions — as Trump has proposed — would add more than $4 trillion to the already soaring national debt over the next decade, according to congressional bookkeepers. Trump also campaigned on a bevy of new tax cuts — such as ending taxes on tips and overtime — that would tack trillions more onto the overall price tag. Medicaid — which provides health coverage to more than 70 million low-income Americans — has emerged as a potential target for GOP leaders hunting for savings to offset the cost of tax cuts. Republicans have long said Medicaid is bloated and inefficient, warning that the program’s structure puts outsize pressure on the federal budget. While states administer the program, the federal government provides matching payments that heavily subsidize it. But the bruising battles over Medicaid in the first Trump administration left scars. Republicans’ proposals to replace the Affordable Care Act in 2017 would have led to millions of Medicaid enrollees losing their coverage, according to projections by the nonpartisan Congressional Budget Office, prompting a voter revolt and even criticism from fellow conservatives. One emerging voice, a writer named JD Vance, blasted GOP leaders for seeking to gut a program that helped cover his family members. It’s not yet clear whether GOP leaders — a group that now includes Vice President-elect Vance — want to reopen those fights. The stakes: Medicaid enrollment has surged since the Affordable Care Act expanded it, drawing criticism from Republicans who argue it has diverged from its original intent as a safety-net program for the poorest Americans. At the same time, Democrats and public health advocates have defended it, saying Medicaid has become an increasingly essential part of the nation’s health-care framework. “Medicaid is the backbone of many aspects of our health care system,” Joan Alker, executive director of the Center for Children and Families at Georgetown University, wrote in an email. She noted that about one-quarter of Americans — including half of children — receive coverage through the program. “If you’re from a rural area, someone in your family has a serious and disabling physical or mental health condition, or your mom is reliant on long term care, Medicaid is even more important.” Possible targets: Some Republicans want to pursue work requirements for Medicaid, as the first Trump administration did, although there’s evidence from states that have tried work requirements that they lead to red tape and boot some eligible people from the program. This year, Paragon Health Institute, a conservative think tank, proposed Medicaid changes it said would save $500 billion over a decade, such as phasing down federal payments for Medicaid enrollees who received coverage through the Affordable Care Act’s expansion, so those payments reach parity with payments for traditional Medicaid enrollees. Paragon has argued that the current payments wrongly favor states for covering healthy, able-bodied adults through the ACA expansion, rather than for children, pregnant mothers, people with disabilities and other vulnerable populations that receive coverage through the traditional Medicaid program. The reaction: Democrats on Monday said they’d fight any efforts to touch Medicaid and food stamps, although the party’s powers will be limited next year. “You couldn’t come up with a better distillation of the real Trump agenda than paying for tax breaks for the rich by gutting Medicaid and increasing child hunger,” Sen. Ron Wyden (D-Oregon), chairman of the Senate Finance Committee, said in a statement. | 
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