"Elbows Up" For Medicaid and Science
Trump hands Democrats a unifying issue
Trump used his first hundred days to sign only five pieces of legislation into law, but he issued 141 executive orders. Stanford political scientist Frank Fukuyama summarized them as delivering:
“large and unpredictable tariffs, undercutting support for Ukraine, illegally firing thousands of federal employees and closing entire agencies, claiming Greenland and Canada, snatching people with legal rights off the streets and deporting them to foreign prisons, and attacking universities and academic research institutions with a meat cleaver.”
Fukuyama concluded that Trump is “an authoritarian hoping to turn the United States into an authoritarian country.”
At first, Trump’s display of shock and awe immobilized Democrats, who were justifiably stunned by a second loss to Trump. This may be about to end. This week, Trump did for the United States what he had already done for Canada: he asserted policies that can mobilize massive opposition. Following Canada, Americans are about to put our elbows up.
Trump’s Budget
This involves a rare legislative push. The House has already started marking up Trump’s budget, the “one big beautiful bill” that proposes to cut both taxes and spending. The tax cuts would spike the deficit by $3-5 trillion dollars, partially offset by the largest cuts in history to Medicaid, scientific research, food assistance and more. The budget Trump submitted to Congress would cut non-defense programs by $163 billion, including $800 billion in cuts to Medicaid over 10 years.
Trump also proposes unprecedented cuts to the budgets of major federal science agencies, including a 37% cut to the National Institutes of Health (NIH) and more than 50% at the National Science Foundation (NSF). These are the country’s two major funders of scientific research. Trump also seeks to eliminate most federal spending on climate research and would cut NASA’s science budget by more than half, turning planetary missions over to Elon Musk.
Trump’s budget hands Democrats a powerful weapon. It will be both good policy and smart politics for Democrats to use it to unite their caucus and put Republican lawmakers on the defensive. They should focus relentlessly on protecting Medicaid and scientific research.
Medicaid serves more than 70 million low-income children, seniors needing nursing care, people with disabilities, and struggling families across the United States. It is extraordinary not just because it is enormous, but because it is popular far beyond its beneficiaries. Medicaid routinely polls higher than any other social safety net program, consistently receiving overwhelming bipartisan public approval, even deep within Republican states.1
Polls regularly show Medicaid approval ratings above 70%, including solid majorities in red states. That’s because Medicaid doesn't just cover health care—it supports local economies, especially in rural areas and small towns. Hospitals, nursing homes, and clinics rely heavily on Medicaid payments. Medicaid cuts are as politically toxic in red states as in blue.
Medicaid’s popularity allows it to bridge divides within the Democratic party coalition. Centrists appreciate Medicaid's direct impact on middle-class and rural communities, while progressives champion it as a cornerstone of social justice and economic equality. Even most Republicans oppose Medicaid cuts. It's rare to find such broad consensus in American politics (which occurs in part because many people confuse Medicaid with Medicare, which serves people over age 65).
Scientific research. The dollars we invest in scientific research are trivial compared with Medicaid, but they are critical to keeping America at the frontier of global science. Economists calculate that federal research funds return $5 for every dollar invested. The average research investment may contribute to valuable knowledge but not have commercial value, but handful of breakthroughs prove to be extraordinarily valuable. We need to reform both NIH and NSF, but if they truly self-finance, we should invest more, not less.
Scientists warn that the United States risks losing its lead in cutting-edge research and its ability to attract top scientific minds from around the world. Labs nationwide have begun laying off workers and canceling projects during the past month. This includes halting clinical trials already underway. Top universities, including Harvard and Penn, have announced hiring freezes. France and other countries are now actively recruiting American scientists, promising a more welcoming environment. We taught them how to do that.
Elbows Up
Democrats should focus relentlessly on saving Medicaid and scientific research for the duration of the budget fight.
Aggressively spotlight the real-world benefits of Medicaid and Science. Democrats need to focus on states represented by vulnerable Republican senators. Amplify stories of nursing homes, rural hospitals, and local clinics that would shutter without Medicaid funding. Use local voices, not just national figures, to highlight the immediate harm Trump's cuts would cause.
Likewise, Democrats need to highlight how cuts to scientific research affect our future. Remind voters that the Internet began when the Defense Department created a network of university computers. Google started as a student research project funded by the National Science Foundation. Virtually every drug and a great deal of commercial agriculture rely on research supported by federal dollars. Recent research by the Federal Reserve credited at least a fifth of postwar productivity growth to government investments in research and development. Our living standards do not just grow on their own.
Starting this week, Democrats are running TV ads in twenty Republican Congressional Districts warning that hospitals are at risk of closing and millions of people could lose coverage if Republicans cut Medicaid “to fund massive tax cuts for Elon Musk and billionaires.” We need similar campaigns defending our investments in science.
Link proposed cuts in Medicaid and science to tax breaks for wealthy families. Messaging should be direct and straightforward: Republicans are trading your grandmother’s nursing home care and your future living standards to pay for tax cuts for millionaires. Framing cuts to the poor and benefits to the rich in moral terms makes it difficult for Republican legislators to counter.
Activate the grassroots in Republican districts. Democrats should galvanize people who depend on Medicaid or whose communities benefit significantly. Mobilize local organizations, faith groups, and health providers to voice opposition, ensuring that the pressure Republicans feel comes directly from voters they cannot afford to alienate.
To be clear, Republicans hate the budget that Trump submitted. They are eager to distance themselves from a president whose approval ratings are at 40% and closer to 30% with independent voters. If Democrats can convince enough Republicans to vote against deep cuts to Medicaid or scientific research, Trump will not raise taxes to cover spending. Instead, he will do what he did in 2017 – borrow even more money to pay for his tax cuts.
Can Democrats be honest about deficits?
A plan to pay for tax cuts with borrowed money allows Democrats to argue for fiscal responsibility. This isn’t the first instinct of most Democrats and will require the party to exercise budget-balancing muscles that have atrophied since the early years of the Clinton administration. However, Democrats must point out that the United States is progressing toward unsustainable debt levels.
Democrats need to be fiscally responsible. Traditionally, Democrats have raised taxes to fund spending. However, the Biden administration increased spending on pandemic relief, student debt forgiveness, and healthcare subsidies without raising taxes. This led to unprecedented levels of peacetime borrowing. Democrats should call for reduced spending and increased taxes to stabilize the debt trajectory.
Debt has become expensive. It was a mistake to borrow so heavily during the Covid crisis, but with money very cheap at the time, it was not costly. However, as interest rates have normalized, the cost of servicing the national debt has climbed rapidly. It now accounts for 14% of all federal spending. More ominously, we see evidence of capital flight as investors decide to hold less US debt.
It is a lot to ask politicians to defend against cuts in valuable public programs and take unpopular votes to control deficits. But there is a third job that Democrats should not overlook: reforming the programs we protect. There is no doubt that Medicare, the NIH, and the NSF need an overhaul and potentially a fundamental rethinking. So do universities. That is tomorrow’s debate, but an important one. Today, we need elbows up to keep Trump from cutting vital programs to finance unjustified tax cuts and to exact revenge on universities that criticize him.
Democrats need to hammer the issue of Medicare and scientific research unrelentingly. They should not become distracted by shock and awe. Centering Medicaid and science can unite the Democratic coalition, appeal to independent voters, and force Republicans to defend deeply unpopular policies. It enables Democrats to strengthen the widely shared moral intuition that health care is a fundamental right and that scientific research lights America’s path to a more prosperous future.
“Elbows Up” Coda
In case you missed the best advertisement of the Canadian election…
Democrats should maintain a steadfast focus on Medicare, but we should not overlook the Veterans Administration, which provides benefits to over 9 million veterans. Trump has cut some 83,000 positions from the VA, about 17% of its workforce. Trump’s budget proposes to eliminate the Toxic Exposures Fund, which was established to provide benefits to veterans exposed to hazardous substances like burn pits and Agent Orange. He proposes substantially reducing veterans' housing, health care, and education benefits.]