Mailbag: Medicaid And The Democrats' Working Class Problem

John Fetterman ... Citizens United ... Budget Reconciliation

Thanks again for your questions, readers. Have a question for next Thursday’s mailbag? Leave it in the comments below.

Kishor Haulenbeek: Any thoughts about what's going on with John Fetterman?

adambulldog: And: do you think Fetterman should resign?

Mcmcleod: Or is there a way to make him resign if he is unfit to serve but refuses to do so.

Three in one! The Fetterman profile that inspired these questions is unnerving to read. And quickly after it ran, the Associated Press reported that he had a mental-health episode during a meeting with a Pennsylvania teachers union.

Before long, Fetterman began repeating himself, shouting and questioning why “everybody is mad at me,” “why does everyone hate me, what did I ever do” and slamming his hands on a desk, according to one person who was briefed on what occurred.

So that’s the backdrop. To the questions, I think a couple overlapping things are going on with him. First, he’s physically and mentally impaired. The stroke he suffered just before the 2022 election seems to have been the trigger, a severe depressive episode followed, and now it seems he likely isn’t following his recovery protocols.

Second, he’s adopted, or at least chosen to foreground, political positions and tactics that are deeply at odds with the pitch he made to Pennsylvania Democrats to win the Senate nomination. This started before the 2024 presidential election, but Trump’s victory really seems to have triggered a crisis in his own mind about what he thinks and whether the politics that won him his seat are still viable.

That’s the answer to question one. The answer to question two is: yes, I think he should resign, but more-or-less only because the reporting suggests he needs full-time help, and the job may be killing him. Some of the things he’s said, particularly as to the value of Palestinian and Iranian life, are abhorrent. But that’s not the basis of my view that he should resign, except insofar as his impairments have actually affected his political and ideological judgment. He’s an elected senator, and if he were otherwise well, I’d be inclined to just let the voters sort things out.

And it may well come down to voters (or to Fetterman’s own determination about seeking re-election) because to answer the third question, there’s no real way to make him resign. There is no recall process for senators. There is an impeachment-like process internal to the Senate called expulsion, and I suppose it’s possible that he could deteriorate in such a way that a requisite two-thirds of sitting senators would vote to expel him.

But for now, Republicans are pretending to have Fetterman’s back against Democrats and the press. They would ideally like him to switch parties and become a Republican. Failing that, they’d like him to stick around and create various kinds of problems for Democrats. The last thing they want is for Fetterman to resign, and Josh Shapiro to appoint a mainline interim replacement. So we’re stuck in this mess indefinitely.

David Perrett: I was reading about the new Tax Bill in the New Republic and they said, "Donald Trump received 56 percent of the working-class vote in 2024, according to exit polls, up from 51 percent in 2020 and 49 percent in 2016. The bond between the president and these voters is sadomasochistic". What is your thoughts about his voters and if all those cuts to Medicaid with change their minds.

Stipulating to those numbers (I wouldn’t draw from exit polls, personally), I’d say a few things.

First, these are three elections, among three different electorates over eight years. And while I don’t want to overstate the degree of churn—most working class 2016 Trump voters probably voted for him again in 2020 and most of them again in 2024—it’s a mistake to assume that his working-class supporters started as a fixed group of people that’s only grown from there. Plenty of the people in the first batch have died since 2016 or climbed into the middle class or decided they don’t like Trump. Some of the 2024 voters are first-time voters. Etc., etc.

But the trend appears to be real. And so the question I’ll try to answer is really more like “why is this trend happening,” rather than “what’s with these voters?”

My strong hunch is that Trump’s polling among working-class voters will dip as he and Republicans in Congress take aim at Medicaid. And if they actually cut Medicaid the political consequences will depend on the severity and timing of the cuts. But Republicans tried to cut Medicaid in 2017, too. It coincided with a dip in Trump’s approval rating, and a year and half later, for many, many reasons, congressional Republicans got wiped out in the midterms. But by 2020 it had all blown over—and even in the midst of a bungled pandemic that had left hundreds of thousands of Americans dead, Trump increased his overall share of the two-party vote and improved his performance among working-class voters in particular.

Then he did it again, aided by the false perception that he was a better steward of the economy than Joe Biden was.

Add it all up and I think it’s pretty clear that “win the working class by focusing on kitchen-table issues” is mostly just a forlorn fantasy. Working class voters have class interests, but they aren’t defined exclusively by the desire to make more money and lead more stable financial lives. They are largely low-education voters, and low-education voters are flocking to the right basically everywhere. And while I’m sure bigotries and chauvinism and the weakening of the patriarchy have a lot to do with that, I think plenty of it has to do with affect. Trump sounds like an a.m. talk radio guy, an insult comic, a blustery right-wing podcaster. They look at Republican elites and surrogates and they don’t see the dark money donors or judges or corporate elites; they see twangy, gun-toting F-150 owners who don’t have the time or patience for teachers’ pets or other persnickety people who harp on about rules and decorum and so on. In the meantime, Democrats since the Obama years have leaned hard into just those niches. And so they’ve come to seem more culturally alien to the working class of all races, even as their agenda has grown more working-class friendly. Not to settle into cliche, but who would you rather grab a drink with, your former high school bully or your high school teacher? Or principal? Or your boss? Not everyone will pick the former bully, but a lot of people will!

Trump is term-limited out, and extremely old, and is doing a terrible job overseeing the economy, so this dynamic could change, and change quickly. But as Democrats go recruiting for 2026 and look ahead to 2028, I feel pretty strongly that they’d be better off mining diamond-in-the-rough leaders who reflect the cultures of their communities rather than over-polished valedictorian types who are good at aping issue polls.

Kage: So this big bad bill doesn't need 60 from the Senate?

The short answer is no.

The longer answer gets a bit technical. The budget-reconciliation process is exempt from the filibuster, but there are limitations. Medicaid spending cuts are allowed under reconciliation rules. Tax cuts are also allowed, so long as they’re either paid for or temporary, and don’t alter the finances of Social Security. That’s the bulk of the GOP bill.

By contrast, the reconciliation process, under Senate rules, isn’t meant to exempt non-budgetary items, like regulatory reforms, from the filibuster. So if the House sends the Senate a reconciliation bill filled with various corporate giveaways that don’t alter tax-and-spending levels, Democrats can challenge those provisions, and they can only stay in the bill with 60 votes—the same as the filibuster threshold.

In theory, the majority party can decide to ignore these rules. But that would be tantamount to abolishing the filibuster, which is why they’ve proven so sticky.

Richard Keppler: Trump is waging a lawless assault on the constitution and the rule of law itself, helped by an enabling ruling from the Supreme Court. (Decisions Trump doesn't like from the court wind up as TP in the Trump Tower men's room). The only branch that could seriously end this is the Congress. Can we expect anything at all on that front from them in before the midterms?

Probably not. I can imagine modest rebukes, but nothing that would satisfy people who actually care about the rule of law. So I can imagine Republicans prevailing on Trump to reconsider accepting the plan from Qatar, say. And I can imagine them trying to bring Trump’s illegal impoundments in line with the law in some partial swap, where they rescind some appropriated funds, and he agrees to resume spending unrescinded funds. I can even imagine them rescinding some of his tariff authority, if he keeps abusing it recklessly and causing serious economic damage. But the real remedy for a president who ignores or pretends to comply with court orders is impeachment. Trump is highly erratic, which means I’d put the odds of that at greater than zero. But not much higher.

Ethan Stein: Trump has given his imperial order for drug companies to reduce prices. Is this something that Democrats should try to find common ground with? Shouldn't we be loudly giving him some sort of props for this? Is it hypocritical and cynical for us not to?

I don’t think so. I think it’d be fine for Democrats to offer to work constructively on a lawful prescription-drug overhaul. But the law doesn’t become optional just because breaking it in certain ways is popular. I wouldn’t advise Democrats to make this the centerpiece of their rule-of-law appeal. But I also wouldn’t advise them to side with Trump over whichever drug companies ultimately sue him over this. The last thing Democrats want is for the public to give him credit for “prescription drug price cuts” that are actually just vaporware.

wyatt: Brian...can Citizens United be overturned by Legislation (Dem Trifecta with getting rid of the filibuster)...or must it include a SCourt Decision?

Practically speaking, to truly overturn Citizens United, you’d need to expand the Supreme Court (or quickly reshape it by luck in attrition) and trust new justices to develop healthy jurisprudence around money in politics.

So for instance: Democrats in Congress responded to the Citizens United decision many years ago by trying to pass the DISCLOSE Act, which accepted the reality of Citizens United but sought to offset the consequences by requiring more transparency: If, say, a Wall Street-funded independent expenditure group propped up a candidate with massive ad spending, his opponent could at least respond by naming and shaming contributors, alleging corruption, etc. Republicans filibustered the DISCLOSE Act to death, but even if it had passed, the same Supreme Court would likely have struck it down as unconstitutional, too.

It’s also important to remember that the term Citizens United has, in many tellings, become a stand in for the many ways the Supreme Court has allowed powerful interests to flood elections and politics with money, often anonymously. But SCOTUS did that over a number of decisions. Citizens United itself specifically nuked a prohibition on unlimited giving by corporations and unions, which was a big deal, but isn’t the beginning and the end of the problem.

So Congress could try to overturn Citizens United, or at least pass legislation to work around it, but any new campaign finance law would run into a whole body of rotten jurisprudence. The only solution to that problem is new jurisprudence, which probably entails court expansion.

Sarah Birnbaum: How can I keep from wanting to chew my own head off from despair and ennui given the 2026 senate map?

1. Wait to see who Dems recruit in reach states.

2. Study Dem over-performance in special elections, which is growing.

3. Recall that Dems won a Senate seat in Alabama a few years ago because of the kind of human scum Republicans frequently nominate in the Trump years.

Trevor Austin: I think you already covered on Politix that a president can’t use the tariff authority to smuggle in a VAT. But is there room to make that a legislative initiative that’s in the agenda? You call it a Trade Balance Tax. A flat rate on the value of imports, with rebates on components that are subsequently re-exported. Use the revenue for offsetting cuts to income taxes. You get to tell voters you’re cutting their taxes and making China pay for it, and you get the machinery in place where companies are tracking and rebating the taxes for their expenses. So a VAT just becomes “national sales tax, but you can deduct your inputs they way you already do for imports.” You front-load the administrative burden and get it over the hump by tying it to protectionism.

I admire the creativity, and agree about the politics of the sales pitch. But unlike Trump-style tariffs, which amount to an abuse of existing authority, this would definitely require new law, and new implementation and enforcement tools. And I think it’d get pretty messy. We’d see an old-fashioned industry campaign against the legislation on paperwork grounds. If it somehow passed, I think it’d be pretty hard to police fraud on the export side. Probably works better on paper than in practice. But I think it’d be a fun thing for Dems to toy with as a campaign proposal.

Spartan@NationalZero.com: Proposal: Members of Congress should be paid substantially more, even a tenfold increase of the current $174,000/year but ONLY IF it's paired with the most draconian, colonoscopy-level scrutiny of their finances on par with that of CIA officers or sequestered jurors, bans on holding a stake in so much as a friggin tractor dealership in rural Indiana let alone stocks, prohibiting having extramarital affairs or any other sorts of potentially compromising personal conduct susceptible to blackmail, and that pay be subject to serious docking if they fail to collectively meet certain productivity benchmarks like letting the government shut down, etc.

Had this idea for a while, but was spurred to revisit it by Mike Johnson complaining that members don't make enough. I think making it more than worth their while financially is a fair trade for turning Congress itself into a totalitarian police state of personal scrutiny overseen by, say, a hardass independent counsel's office and the DC district courts.

Needs more details, I'm sure, but might such a trade be a viable starting point?

This is a great idea and doesn’t really need more details. Good government types have wanted to give members of Congress a substantial raise for some time, in part because underpayment creates an incentive to corruption. Adding an anti-corruption “stick” to a pay increase package would be good for mass politics (paying politicians more money isn’t popular on its own) but the internal politics of this are kinda perverse. Members want a raise, but don’t want to vote for one for themselves, and many also don’t really want to comply with stricter disclosure and anti-trading rules. Probably the best way to go about this is for Congress to enact a package like this that takes effect in six years. It’s unconstitutional for sitting a sitting Congress to vote itself a raise, so typically we look to the next Congress. But by year six, every incumbent will have either retired, died, or faced voters at least once. So they can say, credibly, they’re voting to make serving in Congress a more equitable, fair calling for future members and candidates.