More than 200,000 Medicaid recipients live in Rep. Darrell Issa’s 48th Congressional District.
Some of them, maybe a lot, likely would lose coverage under the domestic policy bill pushed by President Donald Trump and approved by House Republicans early Thursday morning.
The exact impact on health care for low-income people remains unclear because the “savings” would come through complex changes adding work requirements and additional eligibility checks, creating more hoops for people to go through to obtain or retain coverage.
In other words, instead of straightforward cuts, the bill would deny people Medicaid by burying them in paperwork. Many would not be able to comply. The bill also does away with tax credits that help people afford health care coverage.
Nearly 9 million people would lose Medicaid coverage over the next decade if the Senate approves the measure, according to estimates by the Congressional Budget Office.
Some Republicans argued for even deeper Medicaid cuts because the bill would deepen the federal deficit. Other GOP , particularly those in swing districts, expressed concern about any Medicaid reductions.
As the bill was being negotiated earlier this week, Issa did not answer questions from The San Diego Union-Tribune emailed to his staff about the Medicaid provisions, or if he wanted to see them changed.
“Rep. Issa s the excellent work that’s been done so far by his GOP colleagues – especially the Judiciary Committee that he helps lead as Senior Member ,” Issa spokesperson Jonathan Wilcox said in an email. “Providing unprecedented border infrastructure, immigration enforcement, and new facilities to deal with both apprehensions and deportations while at the same time delivering net government savings — that’s real leadership.”
Issa suggested two weeks ago that he was on board with the Medicaid cuts, taking the Republican view that they are aimed at waste and fraud. Ironically, he gave an odd compliment to Bill Clinton, saying the action would roll back Medicaid to the way it was under the former Democratic president, according to The Washington Post.
“The wrongful inclusion of significant numbers of people, including undocumented people, including people who are not entitled and including able-bodied men who aren’t looking for jobs — those are not cuts to Medicaid, those are a return to the sanity of Bill Clinton,” Issa said.
Undocumented immigrants aren’t allowed to enroll in Medicaid, and there are no reliable estimates of fraud in the program, according to the Post. However, the bill also makes deep cuts to states that provide health care to undocumented immigrants even if, like California, they use their own money in a separate program.
The other four of the San Diego County congressional delegation — Democrats Sara Jacobs, Mike Levin, Scott Peters and Juan Vargas — voted against the bill. They have repeatedly hammered on several of the provisions as potentially having disastrous effects on millions of people in order to partially offset the bill’s tax cuts weighted toward the wealthy.
Democratic organizations already have been spending millions of dollars on ads attacking Republicans who are vulnerable in next year’s elections. Recently, GOP-d groups launched a multimillion-dollar counter-campaign.
The bill was ed by a one-vote margin on a largely party-line vote, meaning each vote for the measure, including Issa’s, was needed to put it over the top.
Issa was also mum on another key point of dispute in the bill — whether to increase the amount of state and local taxes people can write off on their federal returns.
Seven years ago, Issa broke with GOP leadership and voted with a dozen other Republicans against lowering the so-called SALT deductions to their current level. Representatives of high-tax states such as California, New York and New Jersey said their constituents bear a heavy burden under the reduction. Many made the same argument in recent weeks, though not Issa, at least not to the Union-Tribune.
Despite opposition from Issa and others, Republicans approved a $10,000 limit on the amount of SALT deductions in 2017. The current bill initially proposed raising that to $30,000, but a compromise was reached to set the cap at $40,000 with a higher cap on annual income when it comes to eligibility.
Beyond the impact on the health and finances of millions of Americans, the bill has become a central focus in the fight for control of the House in next year’s elections — particularly the Medicaid and tax cut provisions.
There’s a bit of déjà vu here, as health care and tax cuts were topline issues in the 2018 elections that saw Democrats briefly retake the House majority from Republicans. Issa was in the middle of it all. This time around, however, there’s a big difference.
Back then, Issa represented a North County-centric district that had morphed from solid red to toss-up purple over the years. He barely won re-election in 2016 and faced an even tougher challenge seeking a ninth term two years later, in part because Trump was president and unpopular in the district.
In that atmosphere, Issa held the line against the SALT limit. But it was his vote on the Affordable Care Act that became a defining issue of the campaign — and drove him from it. Levin eventually was elected.
Republicans once again had sought to scuttle the increasingly popular health care program often called “Obamacare.” Trump was adamantly opposed to the ACA and the GOP came up with a fig-leaf alternative.
After days of drama with seemingly no votes to spare, Issa became the focus of national attention. Asked about his position, he told a reporter from The Hill it was “none of your business.”
Ultimately, he cast a pivotal vote to repeal and replace Obamacare, a controversial move exacerbated when he later ed a White House celebration with Trump and other GOP House .
That further energized opposition at home and there were regular protests outside his district office, largely about his health care vote (which went for naught as Obamacare was sustained in the Senate).
Issa’s prospects looked so dim that he decided not to run for re-election in 2018.
Regular protests against Issa are occurring again, largely focusing on the Trump agenda, particularly Medicaid cuts. But they’re in his new district, the heavily Republican, East County-based 48th, where Issa officially moved and then won in 2020.
Issa would seem to be a safe bet next year to win the district, which at this stage is not considered competitive by either party.
Nevertheless, the larger battle for the House in 2026 could hinge on how Issa and fellow Republicans voted on the Trump domestic policy bill.
