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Josh Hawley
Posted on: July 23, 2025 at 17:02:53 CT
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For months, no Republican in either the House or the Senate spoke out more forcefully, or more consistently, against cutting Medicaid than Josh Hawley. As President Donald Trump’s “big beautiful bill” was weaving its way through Congress, Hawley argued repeatedly that stripping health insurance from the poorest Americans would be “morally wrong and politically suicidal” for a party that, in the Trump era, has relied on millions of votes from people who receive government assistance.
Back home in Missouri, the senator was making the same case in private, according to several people I spoke with who met with him or his staff this year. His deep engagement on the issue impressed advocates representing Missouri’s hospitals, doctors, and rural health centers, all of whom were having trouble getting GOP lawmakers to take their concerns seriously. The changes, these advocates argued, could cost Missouri billions of dollars in federal funding, take away insurance from an estimated 170,000 residents, and force hospitals and rural health centers to close.
“I did believe that he was genuine,” Amy Blouin, the president of the Missouri Budget Project, a nonpartisan think tank, told me. “I do see him as a different type of Republican.”
Yet Hawley ultimately joined almost every other Republican in Congress and voted for the bill, which independent analysts project will cut nearly $1 trillion from Medicaid and leave 10 million Americans newly uninsured. With three Republicans opposing the legislation in the narrowly divided Senate, Hawley’s support proved decisive.
In a statement, Hawley said that the bill’s benefits—chiefly the extension of Trump’s first-term tax cuts—outweighed his concerns. “Gotta take the wins where you can,” the senator told a reporter. Then, last week, Hawley’s Medicaid journey took yet another turn when he introduced legislation that would prevent some of the deepest reductions from taking effect—essentially proposing to repeal a major provision of the legislation he had just voted to enact.
Hawley’s contortions on the bill were perhaps the starkest illustration of how a Republican Party, under pressure to deliver a quick win for the president, ended up slashing a core social-safety-net program much more deeply than many people expected—and more than some of its own members, including Trump himself at times, seemed to want. Republicans are only now beginning to assess the fallout from their enactment of such a far-reaching law. Polls have found that the bill is unpopular, and its Medicaid cuts especially so. But the law puts off its most painful provisions until after the 2026 midterm elections. Trump himself won’t face voters again, so lawmakers like Hawley will be left to deal with the bill’s political and real-world consequences.
Democrats have roundly mocked Hawley, painting him as one more weak-kneed Republican who talked a big populist game on Medicaid only to fold quickly under pressure from Trump. “It was a performance worthy of a gold medal in political pretzel gymnastics,” Russ Carnahan, a former Missouri representative in Congress who is now chair of the state Democratic Party, told me. Hawley’s effort to immediately restore the cuts, Carnahan said, was a cynical attempt to fool Missourians: “He turned his back on helping people when he had the chance.” A former three-term Republican senator from Missouri, John Danforth, was barely more sympathetic. Danforth was once a political mentor to Hawley but broke with him after he backed Trump’s attempt to overturn the 2020 presidential election. He told me that Hawley’s new legislative proposal is tantamount to a press release. “It has no real consequence,” Danforth said, dismissing the measure as “simply a way of saying ‘whoops.’”
Hawley’s office declined to make him available for an interview. Instead, a spokesperson pointed to victories that the senator had secured in the GOP bill, including additional relief for Missourians living with cancers linked to Manhattan Project work that took place in the state more than 80 years ago. This morning, at an event hosted by Axios, Hawley said he had drawn a “red line” on benefit cuts for individual Medicaid recipients, and that the bill did not contain any.
Hawley had seemed to be an unlikely savior for those looking for a Republican willing to thwart Trump’s agenda. Outside Missouri, he is best known as the senator who held up a fist of support for the Trump faithful gathered outside the Capitol on January 6, 2021, and then, hours later, was seen on video fleeing the mob. Unlike moderate Senators Susan Collins of Maine and Lisa Murkowski of Alaska, Hawley does not have an extensive record of breaking with Republicans on key votes. Nor does he have an imminent campaign to consider; Hawley won reelection last fall by nearly 14 points.
The Missourians I spoke with presume that Hawley’s populist rhetoric reflects his national ambitions. With an eye toward the 2028 presidential race, he might be trying to stay loyal to Trump—a requirement for political survival in today’s GOP—while separating himself from rivals whose emphasis on fiscal austerity alienates the president’s working-class supporters. Hawley cited Trump’s own past pledges to protect Medicaid in explaining his initial opposition to the cuts, and he was one of a few Senate Republicans who publicly welcomed the idea (which the party ultimately abandoned) of raising taxes on the rich in the GOP megabill.
The bill contains several major changes to Medicaid, and Hawley is trying to prevent only some of them. He continues to support, for example, the work requirements for nondisabled adults that could add administrative burdens to the program and result in millions of people losing insurance. The cuts that Hawley opposes would affect the amount of money that states such as Missouri could receive from the federal government for Medicaid. Hawley has taken credit for the fact that the enacted bill delays the start date of those provisions until at least 2028, and for securing a $50 billion rural health fund in the bill that could partially offset the loss of federal money for states. His new proposal would repeal the Medicaid funding changes altogether and double the rural fund.
Hawley’s attempt at a balancing act has found him few friends so far. Democrats are happy to use his critique of Medicaid cuts as campaign fodder for next year’s midterm elections—the Democratic Congressional Campaign Committee hailed him as its “newest surrogate”—while denouncing his vote for the bill. Republicans have mostly ignored him. None have signed on as co-sponsors of his new proposal. When I surveyed the seven other Republicans who represent Missouri in Congress on whether they share Hawley’s concerns about Medicaid or support his new legislation, none responded. (A spokesperson for Missouri’s GOP governor, Mike Kehoe, said that Hawley “is right to be concerned about the long-term sustainability of rural hospitals in Missouri and across the country.”)
Danforth told me he never thought Hawley’s vote on the GOP bill—which the former senator called “terrible”—was in doubt. “It would just be impossible to be a Republican in good standing in this era and vote against it,” Danforth said. “You’re going to be heckled. People are going to abuse you, and you’ll just never come up for air. So you must vote for the ‘big, beautiful bill,’ even though it means voting for elements that are against what you’ve been saying.”
Missouri’s Medicaid advocates haven’t given up on Hawley, however. In some respects, his lonely, politically awkward fight might be their best hope to stave off cuts that Heidi Lucas, the executive director of the Missouri Rural Health Association, described to me as “devastating.” “People are going to die because of these, especially when rural hospitals start closing,” Lucas said. “They were already running on very thin margins, and this is going to put them over the edge.” Lucas said the rural health fund, even if it gets doubled, is “a drop in the bucket” compared with the total loss of federal dollars. “We need stitches to fix the problem, and he’s doing it more like a Band-Aid,” she said of Hawley.
Still, Lucas offered Hawley some praise for introducing his bill. “Whatever we can do to mitigate the damage these cuts are going to have, we need to be supportive of,” she said. “So we’ll support Hawley pushing for these fixes in the hopes that in the long term, these will get into place, and then we can roll back some of the other provisions.” Maybe, Lucas allowed, “this ends up being a great thing.”
Hawley’s bill stands little chance of passing while Republicans control Congress. And Democrats aren’t interested in partnering with Hawley after he voted for the bill that contained the cuts in the first place. “It’s a cynical play, and people see that,” Representative Suzan DelBene of Washington State, the chair of the Democratic Congressional Campaign Committee, told me. “It’s not an honest attempt to address the issue, because this issue wouldn’t exist if he hadn’t voted for it.”
If Democrats can harness voter anger to recapture one or both chambers of Congress next year, Hawley could become more useful to them as a Republican willing to revisit the president’s signature bill. A political backlash to the bill could make Hawley’s critique look prescient. And Trump, who was never that excited about slashing Medicaid to begin with, could use a further delay or repeal of the cuts as a bargaining chip for other legislative priorities. “What we’ve just seen is these election cycles lead to policy decisions, and they do truly have consequences,” Jon Doolittle, the president of the Missouri Hospital Association, told me. “There is time for these laws to change before they take effect.”
Amy Blouin is hoping that’s true. I asked her whether she still thinks that Hawley was “genuine” in his opposition to Medicaid cuts. She said she does, but his vote for the president’s bill stung nonetheless. “I don’t know the right word to describe the feeling. It’s not necessarily betrayed,” Blouin said. She settled on “extremely disappointed.” Like others I spoke with, she had wondered whether Hawley could withstand the intense pressure all Republican lawmakers were facing to back Trump’s bill. A few of them did, most notably Senator Thom Tillis of North Carolina, who voted no, after criticizing the Medicaid cuts. “I was hoping,” Blouin told me with a rueful laugh, “that Senator Hawley would be a Tillis.”
Unlike Hawley, however, Tillis was not voting with his political future in mind: Shortly after declaring his opposition to the bill, he announced his retirement from the Senate.
Back home in Missouri, the senator was making the same case in private, according to several people I spoke with who met with him or his staff this year. His deep engagement on the issue impressed advocates representing Missouri’s hospitals, doctors, and rural health centers, all of whom were having trouble getting GOP lawmakers to take their concerns seriously. The changes, these advocates argued, could cost Missouri billions of dollars in federal funding, take away insurance from an estimated 170,000 residents, and force hospitals and rural health centers to close.
“I did believe that he was genuine,” Amy Blouin, the president of the Missouri Budget Project, a nonpartisan think tank, told me. “I do see him as a different type of Republican.”
Yet Hawley ultimately joined almost every other Republican in Congress and voted for the bill, which independent analysts project will cut nearly $1 trillion from Medicaid and leave 10 million Americans newly uninsured. With three Republicans opposing the legislation in the narrowly divided Senate, Hawley’s support proved decisive.
In a statement, Hawley said that the bill’s benefits—chiefly the extension of Trump’s first-term tax cuts—outweighed his concerns. “Gotta take the wins where you can,” the senator told a reporter. Then, last week, Hawley’s Medicaid journey took yet another turn when he introduced legislation that would prevent some of the deepest reductions from taking effect—essentially proposing to repeal a major provision of the legislation he had just voted to enact.
Hawley’s contortions on the bill were perhaps the starkest illustration of how a Republican Party, under pressure to deliver a quick win for the president, ended up slashing a core social-safety-net program much more deeply than many people expected—and more than some of its own members, including Trump himself at times, seemed to want. Republicans are only now beginning to assess the fallout from their enactment of such a far-reaching law. Polls have found that the bill is unpopular, and its Medicaid cuts especially so. But the law puts off its most painful provisions until after the 2026 midterm elections. Trump himself won’t face voters again, so lawmakers like Hawley will be left to deal with the bill’s political and real-world consequences.
Democrats have roundly mocked Hawley, painting him as one more weak-kneed Republican who talked a big populist game on Medicaid only to fold quickly under pressure from Trump. “It was a performance worthy of a gold medal in political pretzel gymnastics,” Russ Carnahan, a former Missouri representative in Congress who is now chair of the state Democratic Party, told me. Hawley’s effort to immediately restore the cuts, Carnahan said, was a cynical attempt to fool Missourians: “He turned his back on helping people when he had the chance.” A former three-term Republican senator from Missouri, John Danforth, was barely more sympathetic. Danforth was once a political mentor to Hawley but broke with him after he backed Trump’s attempt to overturn the 2020 presidential election. He told me that Hawley’s new legislative proposal is tantamount to a press release. “It has no real consequence,” Danforth said, dismissing the measure as “simply a way of saying ‘whoops.’”
Hawley’s office declined to make him available for an interview. Instead, a spokesperson pointed to victories that the senator had secured in the GOP bill, including additional relief for Missourians living with cancers linked to Manhattan Project work that took place in the state more than 80 years ago. This morning, at an event hosted by Axios, Hawley said he had drawn a “red line” on benefit cuts for individual Medicaid recipients, and that the bill did not contain any.
Hawley had seemed to be an unlikely savior for those looking for a Republican willing to thwart Trump’s agenda. Outside Missouri, he is best known as the senator who held up a fist of support for the Trump faithful gathered outside the Capitol on January 6, 2021, and then, hours later, was seen on video fleeing the mob. Unlike moderate Senators Susan Collins of Maine and Lisa Murkowski of Alaska, Hawley does not have an extensive record of breaking with Republicans on key votes. Nor does he have an imminent campaign to consider; Hawley won reelection last fall by nearly 14 points.
The Missourians I spoke with presume that Hawley’s populist rhetoric reflects his national ambitions. With an eye toward the 2028 presidential race, he might be trying to stay loyal to Trump—a requirement for political survival in today’s GOP—while separating himself from rivals whose emphasis on fiscal austerity alienates the president’s working-class supporters. Hawley cited Trump’s own past pledges to protect Medicaid in explaining his initial opposition to the cuts, and he was one of a few Senate Republicans who publicly welcomed the idea (which the party ultimately abandoned) of raising taxes on the rich in the GOP megabill.
The bill contains several major changes to Medicaid, and Hawley is trying to prevent only some of them. He continues to support, for example, the work requirements for nondisabled adults that could add administrative burdens to the program and result in millions of people losing insurance. The cuts that Hawley opposes would affect the amount of money that states such as Missouri could receive from the federal government for Medicaid. Hawley has taken credit for the fact that the enacted bill delays the start date of those provisions until at least 2028, and for securing a $50 billion rural health fund in the bill that could partially offset the loss of federal money for states. His new proposal would repeal the Medicaid funding changes altogether and double the rural fund.
Hawley’s attempt at a balancing act has found him few friends so far. Democrats are happy to use his critique of Medicaid cuts as campaign fodder for next year’s midterm elections—the Democratic Congressional Campaign Committee hailed him as its “newest surrogate”—while denouncing his vote for the bill. Republicans have mostly ignored him. None have signed on as co-sponsors of his new proposal. When I surveyed the seven other Republicans who represent Missouri in Congress on whether they share Hawley’s concerns about Medicaid or support his new legislation, none responded. (A spokesperson for Missouri’s GOP governor, Mike Kehoe, said that Hawley “is right to be concerned about the long-term sustainability of rural hospitals in Missouri and across the country.”)
Danforth told me he never thought Hawley’s vote on the GOP bill—which the former senator called “terrible”—was in doubt. “It would just be impossible to be a Republican in good standing in this era and vote against it,” Danforth said. “You’re going to be heckled. People are going to abuse you, and you’ll just never come up for air. So you must vote for the ‘big, beautiful bill,’ even though it means voting for elements that are against what you’ve been saying.”
Missouri’s Medicaid advocates haven’t given up on Hawley, however. In some respects, his lonely, politically awkward fight might be their best hope to stave off cuts that Heidi Lucas, the executive director of the Missouri Rural Health Association, described to me as “devastating.” “People are going to die because of these, especially when rural hospitals start closing,” Lucas said. “They were already running on very thin margins, and this is going to put them over the edge.” Lucas said the rural health fund, even if it gets doubled, is “a drop in the bucket” compared with the total loss of federal dollars. “We need stitches to fix the problem, and he’s doing it more like a Band-Aid,” she said of Hawley.
Still, Lucas offered Hawley some praise for introducing his bill. “Whatever we can do to mitigate the damage these cuts are going to have, we need to be supportive of,” she said. “So we’ll support Hawley pushing for these fixes in the hopes that in the long term, these will get into place, and then we can roll back some of the other provisions.” Maybe, Lucas allowed, “this ends up being a great thing.”
Hawley’s bill stands little chance of passing while Republicans control Congress. And Democrats aren’t interested in partnering with Hawley after he voted for the bill that contained the cuts in the first place. “It’s a cynical play, and people see that,” Representative Suzan DelBene of Washington State, the chair of the Democratic Congressional Campaign Committee, told me. “It’s not an honest attempt to address the issue, because this issue wouldn’t exist if he hadn’t voted for it.”
If Democrats can harness voter anger to recapture one or both chambers of Congress next year, Hawley could become more useful to them as a Republican willing to revisit the president’s signature bill. A political backlash to the bill could make Hawley’s critique look prescient. And Trump, who was never that excited about slashing Medicaid to begin with, could use a further delay or repeal of the cuts as a bargaining chip for other legislative priorities. “What we’ve just seen is these election cycles lead to policy decisions, and they do truly have consequences,” Jon Doolittle, the president of the Missouri Hospital Association, told me. “There is time for these laws to change before they take effect.”
Amy Blouin is hoping that’s true. I asked her whether she still thinks that Hawley was “genuine” in his opposition to Medicaid cuts. She said she does, but his vote for the president’s bill stung nonetheless. “I don’t know the right word to describe the feeling. It’s not necessarily betrayed,” Blouin said. She settled on “extremely disappointed.” Like others I spoke with, she had wondered whether Hawley could withstand the intense pressure all Republican lawmakers were facing to back Trump’s bill. A few of them did, most notably Senator Thom Tillis of North Carolina, who voted no, after criticizing the Medicaid cuts. “I was hoping,” Blouin told me with a rueful laugh, “that Senator Hawley would be a Tillis.”
Unlike Hawley, however, Tillis was not voting with his political future in mind: Shortly after declaring his opposition to the bill, he announced his retirement from the Senate.
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Josh Hawley - Ace UNC - 7/23 17:02:53
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