Trump Adviser David Sacks Admits Tax Bill Makes Huge Cuts to Medicaid

President Donald Trump and Republican leaders keep pretending they aren’t cutting Medicaid with their new tax bill, which will further enrich the wealthy and pay for it in part by significantly slashing Medicaid, the government health insurance program for low-income and disabled Americans. 

Trump, who has repeatedly promised to protect Medicaid, and House Speaker Mike Johnson (R-La.) have both claimed that Republicans are simply targeting “waste, fraud, and abuse” in their tax bill, which passed the House last week.

David Sacks, who is serving as Trump’s “AI and crypto czar,” put the Medicaid situation more plainly Saturday on his All In podcast: “This bill cuts $880 billion from Medicaid over a decade.”

Like Trump’s 2017 tax law, the GOP’s reconciliation legislation is expected to disproportionately benefit the wealthy. This year’s bill will even reduce the after-tax income of households earning less than $51,000 per year. 

It is also expected to force at least 10 million Americans off Medicaid, according to the nonpartisan Congressional Budget Office. This carnage will primarily be achieved by imposing work requirements — a demand that any able-bodied Medicaid recipients work at least 80 hours a month. 

Such requirements, which have previously failed at the state level, would come in addition to the program’s existing income caps. Taken together, this means that Medicaid recipients will be expected to work low-paying jobs and deal with burdensome paperwork demands if they want to maintain their insurance coverage. Many eligible recipients will likely lose coverage due to the added bureaucracy. 

The president and Republican leaders have nonetheless tried to argue they are not actually cutting Medicaid, and that their changes won’t actually harm their constituents who deserve access to the program. 

Trump said last week that his tax bill simply targets “waste, fraud and abuse for Medicaid,” and he promised that his working-class supporters “won’t lose health insurance” as a result of the legislation. (Some of his supporters will certainly lose health insurance.)

“We have not cut Medicaid,” Johnson falsely insisted in a Face the Nation interview on Sunday. He added that Republicans are simply “working on fraud, waste and abuse.” 

A memo last week from the National Republican Congressional Committee, which elects GOP lawmakers, declared that “Republicans Are Strengthening Medicaid.” It urged Republicans to go on offense, and depict their changes as efforts to protect the program and “ensure Medicaid serves those who need it.”

Sacks, a venture capital executive and Trump special government employee, skipped some of this pretense in the All In podcast, as he admitted the Republican tax bill “cuts $880 billion from Medicaid.” He noted that the cuts are “politically tough and controversial.”

In the podcast discussion, Sacks was defending against the argument that the Trump tax legislation should do more to reduce spending. He said he wished the bill cut spending more, but he argued the Medicaid cuts are already “relatively tough things to do politically,” and that Republicans can’t cut more and expect to pass the bill. 

Even as Sacks acknowledged a basic truth that Republicans have denied — the Trump tax bill cuts Medicaid — he tried to spin the work requirements as a positive thing, as Republican leaders are doing now. 

“It imposes work requirements for able-bodied adults,” he said. “This is similar to what Bill Clinton did back in 1996 with welfare reform, basically saying that you can’t be a layabout and get welfare.”

Of course, many people on Medicaid are technically considered able-bodied, even if they are functionally disabled and cannot work, because they have not been approved for disability, which is an onerous process. These people will lose coverage — and they won’t be able to replace it: The tax bill, as written, says that people who lose Medicaid coverage due to work requirements cannot sign up for alternate coverage on state marketplaces.

Johnson, the Republican speaker, has claimed that Republicans are simply trying to remove “29-year-old males sitting on their couches playing video games.” On Sunday, he said that “when you make young men work, it’s good for them.” He framed this as “moral.”

It feels wrong hearing Republicans describe the poor people whose insurance they’re terminating as lazy couch-surfers — and hearing Sacks, who’s worth at least hundreds of millions of dollars, describe them as “layabouts” feels even worse.

At least he admitted what his boss, Donald Trump, won’t: Republicans are about to make huge cuts to Medicaid. And they’re doing so to help fund more big tax cuts for the super rich.