The following is a lightly edited transcript of the August 22 episode of the
Daily Blast podcast. Listen to it here.
Greg Sargent: This is The Daily Blast from The New Republic, produced and presented by the DSR network. I’m your host, Greg Sargent.
JD Vance just delivered a speech in Georgia that has been widely billed as a reset in the battle over President Trump’s abysmally unpopular budget bill—the big, ugly bill—enshrining Trump’s agenda. Vance lied ham-handedly about the bill’s health care cuts, tried to distract his audience with crude demagoguery about undocumented immigrants, and viciously attacked a nonpartisan agency for telling the truth about the bill’s true intentions. This comes as local headlines from many states are showing that people deep in MAGA country know they’re going to get royally screwed by this bill. The level of scamming of Trump voters that Vance attempted here is remarkable, even for him. So how is the battle over this bill going to unfold? Do Democrats have a strategy for keeping the public focused on its horrors all the way through Election Day 2026? Today we’re talking about all this with Michael Linden, an economist and Democratic strategist who is organizing against the bill and understands the pitfalls that lie ahead. Thanks for coming on, Michael.
Michael Linden: Thank you very much for having me, Greg.
Sargent: So just to recap, the top line of the big, ugly bill is that it’s going to knock at least 10 million people off Medicaid to fund a huge tax cut for the rich. During his speech, JD Vance addressed the health care cuts. Listen to this.
JD Vance (audio voiceover): We know what the president United States made a promise, a sacred promise, that the only people who are going to lose access to health care are illegal aliens who shouldn’t be in this country to begin with. Because I happen to believe that Medicaid belongs to American workers and American families. I happen to believe that when you are struggling in this country, we’re generous people and we want to help you. But we want to help the people who have the legal right to be in the United States of America. So it’s not about kicking people off the health care. It’s about kicking illegal aliens the hell out of this country so that we can preserve health care for the American families who need it.
Sargent: Michael, as you know, that’s complete nonsense. The bill cuts $1 trillion from Medicaid and cuts more on top of that. Can you quickly recap for us what the bill does overall on health care?
Linden: Yes. And it’s important to understand that what the vice president said was completely false, just straight=up false. The bill cuts, as you said, $1 trillion from Medicaid. It does so in a couple of very specific ways. The most important ones are it imposes new requirements for existing recipients on how to make themselves eligible every six months based on a whole set of new requirements, new paperwork. That’s going to kick millions of eligible Americans off the bill. It also limits the ways that states can finance Medicaid. Medicaid is a federal and state partnership. Both the states and federal government put money into Medicaid. This bill actually makes it harder for states to do that and shifts more of the costs onto states at the same time.
So the overall impact of those things is about 10 million people will lose their Medicaid coverage. And that’s to say nothing of the 5 million people who are going to get priced out of Affordable Care Act coverage because the benefits for them are going to be dramatically reduced. So 15 million people total. And to be very, very clear, none of that has anything to do with illegal immigrants.
Sargent: We will get to that in a second. I want to talk about the rural hospitals component of this. A big part of this bill is going to be the impact it has on those. They’re already in very rough shape. Let’s recap what some local newscasts are saying. One in Kentucky says that 35 hospitals could close. One in Mississippi says the bill’s cuts are putting 11 nursing homes at risk of closing. One in Louisiana says cuts to food stamp programs feeding half a million poor families are facing cuts. In Texas, more rural hospitals are at risk of closing. There’s just tons more like that. Can you give us the overview of why that particular thing is happening and what the human toll of that is really going to be going forward?
Linden: Yeah, it’s actually quite simple. Medicaid is the primary payer of health care for a lot of rural hospitals and for many nursing homes. In fact, Medicaid pays for half of all nursing home coverage in the country. So when fewer people are eligible for Medicaid, that means fewer hospitals and nursing homes are able to get reimbursed for the care they provide to those people. And therefore the economics of running those hospitals and those nursing homes goes to zero. Basically, they can’t do it and they have to close. What that means in very plain terms is that people will not be able to find a hospital that’s nearby them because hospitals [have] to close. Nursing homes will close and people will have to find either new care for their parents or maybe no care at all. This is a very bad situation for the vast majority of Americans.
Sargent: And in rural America in particular, right? Can you talk a little bit about why that’s important? One of the big reasons rural America is suffering right now is the state of their rural hospitals. So this goes directly to the jugular here on something that’s already making life hard in these places and makes it worse, doesn’t it? People are going to die, right?
Linden: Yeah, that’s right. You’ve got lots of places in America where there’s one hospital within 100 miles or 150 miles. It’s very tough for those hospitals to stay afloat as it is, and a huge amount of their revenue comes from Medicaid. It’s the federal government and the state governments reimbursing them for care provided to people who are eligible for Medicaid. And if those people are no longer eligible for Medicaid, those hospitals cannot survive and everybody who relies on that hospital is going to pay the price—not just the people who’ve lost their Medicaid. This is particularly acute, as you said, for people in rural areas where there’s only one, maybe two hospitals in a three county area.
Sargent: So in his speech JD Vance addresses the bills threats to rural hospitals. Listen to this.
Vance (audio voiceover): So what we did is we put a lot of resources and a lot of changes in regulations to make it possible for our rural hospitals to stay open despite what the Biden administration did to them for four years. So our policy is very simple. Whether you’re in a big city or a small town, we’re going to fight for your access to healthcare. Whether you’re an American citizen who’s been here for 70 years or an American citizen who’s been here for two years, we’re going to fight for your access to a government that serves you. But if you’re an illegal alien, you do not deserve government paid health care benefits. You need to get out of our country. And that’s as simple as that.
Sargent: Note again the ugly demagoguery about undocumented immigrants. He’s actually saying pretty much straight out, Hey, Trump voters, don’t think about what you’re hearing about this bill’s impact on you. Think instead about how many undocumented immigrants are going to get hurt. It’s just beyond disgusting. Your thoughts on that part of it?
Linden: Yes, it’s beyond discussing. It’s also just straight-up false. The bill includes a $50 billion fund for rural hospitals. But if you give hospitals $50 billion on the one hand and you take away $250 billion on the other, which is what the bill does, they’re $200 billion down. The vice president is treating people like they’re stupid, and they’re not stupid. They understand that when you take with one hand and give a little bit back on the other, they’re worse off. And that’s actually a great metaphor for the whole bill: You take a ton away from working people on the one hand and then give a tiny little bit and hope the people thank you for it. American people are not fooled by this. That’s why the bill is so unbelievably unpopular.
Sargent: Let’s talk about the distributive consequences because I think that’s what you’re getting at there. The benefits such as they are that will go to working people will be in the form of pretty minuscule tax cut, which gets extended for those people. But at the same time, the bill cuts taxes enormously for people at the very top of the income spectrum. And then on top of that, if you put together all the features—the health care cuts, the cuts to food stamps and other safety net programs, plus the array of tax cuts mostly benefiting the wealthy—what you get overall is a large redistribution of wealth upward. Can you talk about that?
Linden: Yeah, very simply, people in the bottom will pay more, people at the very top will pay less. That’s what this bill does. It’s exactly for the reasons you said. There are tax cuts mostly for people at the top, very small tax cuts for people in the middle, almost no tax cuts for people at the bottom. And then on top of that, you have increases in costs like health care, food, energy, and education for the vast majority of low- and middle-income people. You put it all together, most Americans are going to actually end up paying more or be no better off, and people at the very top will pay a lot less in taxes. And on top of that, Republicans are going to come back and say, Oh my God, the debt is so high. How did the debt get so high? Never mind that we just spent $4.5 trillion on tax cuts. We have to cut even more from middle-income people. They’ve got to pay more in state taxes. They’ve got to pay more in energy prices because the debt’s too big, even though they are the ones who caused it to rise. So you put all that together, it’s a tax cut for rich people paid for by everybody else.
And that is, by the way, the way that most Americans see it. And it is the reason why JD Vance is out there lying about the bill, because they know this is a massive vulnerability for them. This is the worst thing that could happen for them: that the American people understand that they’ve been betrayed.
Sargent: Well, Vance, in fact, was asked specifically about an analysis that actually found exactly what we’re saying here, that there’s a large upward redistribution of resources. Here’s what Vance said in that exchange.
Reporter (audio voiceover): There was a nonpartisan Congressional Budget Office report that came out last week showing that the bottom 10 percent, the poorest Americans, would lose about $1,200 a year on their income while the top 10 percent would add about $13,000 annually to their income. Can you justify for those poorest Americans those differences?
Vance (audio voiceover): Well, first of all, the Congressional Budget Office, sometimes they put out reports that are absolutely atrocious, and I think this is a good example of a very atrocious report. The most important thing for people who are living at the bottom of the income ladder is that they not pay taxes on their income sources. So if you’re working hard and you’re working overtime, you’re to get a big fat tax cut.
Sargent: This is the thing. They can’t paper over the basic distributive consequences of this bill. They can’t paper over what the purpose of the bill actually is. And I think the almost desperate sounding floating of weird tropes about undocumented immigrants really gets at the core of that. They really, really need an argument to distract their own voters from what this bill is actually going to do to them.
Linden: That’s exactly right. Cutting Medicaid is overwhelmingly unpopular, including among Republican voters. Cutting taxes for rich people is overwhelmingly unpopular, including among Republican voters. So obviously they can’t talk about that. So they have to pretend that these cuts are to some scary immigrants or to the people who are undeserving. But the fundamental problem is exactly what you said. There are $1 trillion of cuts to Medicaid. There’s $500 billion of cuts to food assistance. There’s cuts to clean energy. There’s cuts to education. You don’t get those kinds of magnitudes of cuts and you’re only limiting it to the vanishingly small number of illegal immigrants, who maybe in one or two states got once a reimbursement from Medicaid. You get those “savings” by kicking people off Medicaid. That’s where it comes from. And so, like you said, you can’t paper over that. That just is what it is.
Sargent: That’s such a good point, especially this idea that you get this enormous amount of money from just cutting benefits to a few undocumented immigrants. That’s what really shows how insultingly stupid the lies are here.
Linden: It’s incredibly insulting. Undocumented immigrants are not eligible for Medicaid. They’re not eligible for food stamps. Cutting them off does not save any money, but the bill “saves”—I’m using quote fingers here—$1.5 trillion by cutting off Americans from these programs. And that’s just the truth. And it’s not—of course they have to blame the referees. Of course they have to criticize the CBO, but CBO is not doing anything special here. If you know who benefits from Medicaid (low- and middle-income people), who benefits from food stamps (low-income people), who benefits from assistance sending their kids to college (low- and middle-income people), who benefits from tax cuts for high-income capital gains, estates, corporate income (rich people), you don’t need to be CBO to figure this out.
It’s very difficult to understand why Donald Trump and JD Vance and the Republican Party decided after an election that was all about the cost of living—and where, as you said, they won working-class people by some metrics—they would decide to directly attack those same people and raise their costs in the service of tax cuts for billionaires. But that is what they did. And it is the long-standing Republican policy of cutting taxes for rich people and paying for it by making everybody else pay more. The so-called populist wing of the Republican Party was nowhere to be seen in this particular fight. And I think they’re going to pay the price for it.
Sargent: It’s an extraordinary scam. Now onto the difficult part here involving Democrats. The polling on this bill has obviously been terrible for Trump and Vance. The polling shows very clearly that majorities of Americans see the bill the way we’ve described it here. They understand the basics of what it does, the distributive basics. So there are two models for thinking about this. One is the Trump tax cuts of 2017. Democrats successfully ran on that in 2018 and they won something like 40 seats—and the Trump tax cut for the rich was a huge part of that. People forget that. The second model for this is maybe what happened after the passage of the Affordable Care Act in which the ACA passed in 2010 and then Democrats lost even more seats that fall. How do you see this one unfolding? Are there lessons to be drawn both from those two past fights and also from what you’ve been through over the last six months or so?
Linden: Absolutely. I think what you’re going to see is a combination of both of those things where Democrats will point to every failure of the health care system that we are about to see over the next year and attribute it, correctly in my view, to this bill. At the end of the day, this was a health care reform bill. Dr. Oz said it: They bought it, they broke it, they own it. And so if the American people are unhappy with the cost of health care over the next year, if they lose their coverage, if their hospital closes, if a clinic shuts down or has fewer hours, all of that is attributable to the Republican tax scam. Plus, we have an incredibly unpopular set of tax policies that overwhelmingly help the rich when everybody else is feeling really strapped. So you put those two things together, and that’s got to be the core argument over the next year.
And look, that has been the core argument over the last eight months. And it’s why the bill is so unpopular. As you said, Republicans wanted this to be about undocumented immigrants or waste, fraud, and abuse and a middle-class tax cut. But it wasn’t about that. The American people saw through that. They saw through to the core of it, which was that it’s higher costs for everyday people to pay for tax cuts for rich people. That’s going to become real over the next year: higher health care premiums this fall; hospitals and clinics closing; food banks overstretched over the course of the next year. Next year, Donald Trump is going around promising people the world’s largest tax cut. Most Americans in the bottom 60 percent will see no change to their taxes next year relative to what they paid this year. They’re going to be asking rightly, Where’s my giant tax cut that I’ve been promised?
They have a huge vulnerability. So Democrats do need to keep talking about it. The biggest challenge that we have—we know this—is that most Americans have busy lives and they’re just trying to make it one day at a time. And they need to hear about this bill. The dots need to be connected.
Sargent: What is going to be the direct life impact for a lot of voters going from this bill next fall—in the fall of 2026? What will voters be feeling from the bill right then?
Linden: Right. So as soon as this fall, 20 million people who get their health insurance through the exchanges are going to see higher premiums because this bill made changes to the Affordable Care Act and deliberately allowed an expansion of the tax credits for that health insurance to expire. So 20 million Americans are going to see their premiums go up this fall as they renew their health care for next year. So that’s a pretty big impact right away. That’s just your costs go up. Hospitals and clinics, as you’ve already said, are going to start closing even in advance of those Medicaid changes. These are businesses that have to look several years in the future. They’re not looking just in the next three days. They’re looking next three months, three years. So that’s going to start happening. And there are going to be effects on the health care system that we can’t predict. You pull $ 1 trillion out of the health care system, people are going to make changes that we can’t exactly predict now. So I think there’s going to be a lot of upheaval.
But it’s also worth remembering the 2010 example is a good one in some ways—and it’s instructive—because the American people punished the Democrats that year for passing the Affordable Care Act. And there had been no changes to the health care system by the time the election rolled around, right? The bill was passed in the beginning of 2010 and the election was later that year. Nothing had changed by then, but people were angry about the ideas that had been part of that bill, rightly or wrongly, and they took it out on Democrats. And I think that’s what’s going to happen here too. People are going to be angry about the idea that Republicans cut Medicaid despite the fact that the American people were very clearly saying, Don’t do that. So even if Medicaid cuts start right after the election, I think the voters are going to hold Republicans accountable for cutting that program.
Sargent: A lot will be on Democrats here to make sure aloof voters are focused on that.
Linden: That’s exactly right. Democrats have to make that the issue. They have to talk about it. They have to remind voters that Republicans did it. They can’t let it drop to the tenth most important thing. It’s got to be in the top three no matter what else is going on. It is a winning issue. It’s an issue that has 80 percent support. Eighty percent of Americans did not want to cut Medicaid. So you just got to keep talking about that and pair it with those tax cuts for rich people—because, man, if there’s one thing less popular than cutting Medicaid, it’s cutting Medicaid to pay for tax cuts for rich people.
Sargent: Well, that’s exactly the most important component of this that has to be nailed down. And Senator Jon Ossoff of Georgia actually took a stab at saying something like this before JD Vance’s speech. Listen to this.
Jon Ossoff (audio voiceover): Vance is being sent on this little errand to come and play defense in Georgia, defending a bill they can’t defend, trying to sell the unsellable. And let me just say this about JD Vance, because he was supposed to be this avatar of a new GOP that was for working-class people in the U.S. His legacy forever now is casting the decisive vote to throw millions of Americans off health care, throw seniors out of their nursing home beds—all to serve the wealthiest and most powerful people in the country. He has zero credibility as a champion for America’s working class and the damage control he’s trying to do in Georgia this week is going to fall flat. And Georgians have already rejected this policy.
Sargent: That was pretty strong stuff, Michael. What do you think? It seems almost like that’s a pretty good template for how to do this.
Linden: Spot on. Exactly right. Has the benefit of being true. That’s always useful when the facts are on your side; not always enough, but it is the truth in this case. And I think he’s exactly right. Look, JD Vance and Donald Trump and Republicans in Congress talked a big game about being for workers these days. And when push came to shove, what did they do? They took health care away from workers. They took food away from workers. They cut education aid for workers. They raised costs for workers and they gave a tax cut to billionaires and corporations. And that is the fact of the matter. It’s what the American people believe and they can’t run away from it. And if we’re having this back and forth where JD Vance’s argument is something, something undocumented immigrants and John Ossoff’s argument is they cut taxes for rich people and they did it by taking money out of your pocket, I think Ossoff’s going to win every day and twice on Sunday.
Sargent: Well, Democrats have a very good argument. Now they just have to make it. Michael Linden, fascinating stuff, man. Thanks so much for coming on.
Linden: Thank you.