Trump tax cuts: The impact on Medicaid and the welfare state’s future

Four years ago, America was on the cusp of the largest expansion of its welfare state since the 1960s.

Under Joe Biden in 2021, House Democrats passed legislation that would have established a monthly child allowance for most families, an expansion of Medicaid’s elder care services, federal child care subsidies, universal prekindergarten, and a paid family leave program, among other new social benefits.

But that bill failed — and then, so did Biden’s presidency.

Now, Republicans are on the brink of enacting the largest cut to public health insurance in American history. And the outlook for future expansions of the safety net looks dimmer than at any time in recent memory.

There are two primary reasons why progressives’ prospects for growing the welfare state have darkened.

First (and most straightforwardly), the Democrats are not well-positioned to win full control of the federal government anytime soon. To win a Senate majority in 2026, the party would need to win multiple states that Trump carried by double digits last year. And the 2028 map isn’t that much better. The basic problem is that Democrats have built a coalition that’s heavily concentrated on the coasts and thus, systematically underrepresented in the Senate. To win the robust congressional majorities typically necessary for enacting large social programs, Democrats would likely need to transform their party’s brand.

Second, although Democrats developed grander ambitions for social spending over the past decade, they simultaneously grew more averse to raising taxes on anyone but the super-rich. In the 2010s, when inflation and interest rates were persistently low, the party could paper over this tension with deficit spending. But Biden-era inflation revealed the limits of this strategy.

And if Congress passes President Donald Trump’s tax cut plan, then interest rates and inflationary risk are likely to remain elevated for years, while the cost of servicing America’s debts will soar. Add to this the impending exhaustion of Social Security’s trust fund, and space for new welfare programs is likely to be scant, unless Democrats find a way to enact broad-based tax increases.

Liberals could respond to all this by paring back their ambitions for the welfare state, while seeking to advance progressive goals through regulatory policy. It is perhaps not a coincidence that the two most prominent policy movements in Democratic circles today — the anti-monopoly and “abundance” crusades — are both principally concerned with reforms that require no new tax revenue (antitrust enforcement in the former case, zoning liberalization in the latter).

But expanding America’s safety net remains a moral imperative. In the long-term, Democrats must therefore strive to build the electoral power and political will necessary for raising taxes on the middle-class (or at least, on its upper reaches).

Democrats like social welfare programs. But they like low taxes on the upper middle-class even more.

Over the course of the 2010s, the Democratic leadership’s appetite for new social spending grew. Bernie Sanders’s insurgent campaigns in 2016 and 2020 put Medicare-for-All at the center of the party’s discourse, and moved its consensus on the welfare state sharply leftward. In the latter primary, even the Democrats’ most moderate contender — Joe Biden — vowed to establish a public option for health insurance and tuition-free community colleges, among other social programs.

Biden’s agenda only grew more ambitious upon taking office. No president since Lyndon B. Johnson had proposed a more sweeping expansion of social welfare than the Build Back Better Act.

And yet, while Democrats’ aspirations for social spending had become historically bold, the party’s position on taxes had grown exceptionally timid. In 2016, Hillary Clinton had promised not to raise taxes on any American family earning less than $250,000. Four years later, Biden vowed to spare all households earning less than $400,000 – despite the fact that tax rates on upper middle-class families had fallen during Trump’s first term.

Meanwhile, the Democrats’ congressional leadership was actually pushing to cut taxes on rich blue state homeowners by increasing the state and local income tax deduction.

In other words: In 2021, Democrats were promising to establish an unprecedentedly large welfare state, while keeping taxes on 98 percent of households historically low.

Officially, the party believed that it could square this circle by soaking the super-rich. After all, America’s highest-earning 1 percent had commandeered more than 20 percent of the nation’s annual income. The government could therefore extract a lot of revenue by merely shaking down the upper class.

In reality, though, Biden’s vision was also premised on the assumption that America could deficit-finance new spending with little risk of sparking inflation or high interest rates.

The Build Back Better Act did not actually raise taxes on the rich by enough to offset its social spending. Instead, Democrats leaned on budget gimmicks to “pay for” its agenda: Although the party intended the law’s new programs to be permanent, it scheduled many of them to expire after just a few years, so as to make the policies look cheaper over a decade-long budget window. Absent these arbitrary expiration dates, the bill would have added $2.8 trillion to the deficit over a decade. Even as written, the law would have increased deficits by $749 billion in its first five years.

More fundamentally, Biden’s basic fiscal objective — to establish wide-ranging social benefits through taxes on the super rich alone — only made sense in a world of low inflation.

Western Europe’s robust welfare states are all funded through broad-based taxation. This is partly because administering a large safety net requires managing economic demand. When the government expands its provision of elder care, social housing, child care, and pre-K, it increases overall demand for workers and resources in the economy. And if the supply of labor and materials doesn’t rise in line with this new demand, then inflation can ensue.

Taxes effectively “pay for” new spending by freeing up such resources. When households see their post-tax income decline, they’re often forced to make fewer discretionary purchases. Raise taxes on an upper middle-class family and it might need to postpone its dreams of a lake house. That in turn frees up labor for public programs: The fewer construction workers needed to build vacation homes, the more that will be available to build affordable housing.

But soaking the extremely rich does less to dampen demand than taxing the upper middle-class does. Even if you increase Elon Musk’s tax rate by 50 percent, he won’t actually need to reduce his consumption at all — the billionaire will still have more money than he can spend in a lifetime.

The same general principle applies to multimillionaires, albeit to a lesser extent: Raise their taxes, and they’re liable to save less money, but won’t necessarily consume fewer resources. And if they do not curb their consumption in response to a tax hike, then that tax hike will not actually free up resources.

In 2021, Democrats felt no obligation to sweat these details. For nearly a decade after the Great Recession, economic demand had been too low. Workers and materials had stood idle on the economy’s sidelines, as there wasn’t enough spending to catalyze their employment. In that context, unfunded welfare benefits can boost growth without generating inflation.

But as Democrats moved Build Back Better through Congress, the macroeconomic terrain shifted beneath their feet. Biden likely would have struggled to get his social agenda through the Senate (where Democrats held only 50 votes) even in the absence of 2022’s inflation. But that surge in prices all but guaranteed the legislation’s defeat: Suddenly, it became clear that the government could not increase economic demand without pushing up inflation and interest rates. America had returned to a world of fiscal constraints.

Unfortunately, those constraints could prove lasting, especially if Donald Trump’s tax agenda makes it into law.

Building a comprehensive welfare state is about to get harder

The most lamentable aspect of Trump’s “Big Beautiful Bill” are its cuts to healthcare and food assistance for the poor. Yet even as it takes health insurance from 10 million Americans and reduces food assistance to low-income families by about $100 a month, the legislation would add $2.4 trillion to the debt over the coming decade, according to the Congressional Budget Office.

Yet the actual cost of the GOP’s fiscal vision is even larger. To reduce their bill’s price tag, Republicans’ set some of their tax cuts to arbitrarily expire. Were these tax cuts made permanent, the bill would add roughly $5 trillion to the deficit over the next 10 years.

This is likely to render the US economy more vulnerable to inflation and high interest rates in the future.

Thus, the next Democratic government probably won’t have much freedom to deficit spend without increasing Americans’ borrowing costs or bills. Meanwhile, if that administration holds power after 2032, it will also need to find a ton of new revenue, just to maintain America’s existing welfare state.

Social Security currently pays out more in benefits than it takes in through payroll taxes. For now, the program’s dedicated trust fund fills in the gap. But in 2033, that fund will likely be exhausted, according to government projections. At that point, the government will need to find upward of $414.5 billion in new revenue, each year, to maintain existing Social Security benefits without increasing the deficit.

Given Democrats’ current stance on taxes, the imperative to keep Social Security funded would likely crowd out the rest of the party’s social welfare agenda. Indeed, merely sustaining Americans’ existing retirement benefits would almost certainly require raising taxes on households earning less than $400,000. Maintaining such benefits while also creating new welfare programs — in a context of structurally high deficits and interest rates — would plausibly entail large, broad-based tax increases, the likes of which today’s Democrats scarcely dare to contemplate.

Granted, the robots could solve all this

To be sure, it is possible that technological progress could render this entire analysis obsolete. Some analysts expect artificial intelligence to radically increase productivity over the next decade, while devaluing white-collar labor. This could slow the pace of wage and price growth, while turbo-charging income inequality.

In a world where robots can instantly perform work that presently requires millions of humans, America could plausibly finance a vast social welfare state solely through taxes on capital.

But until AI actually yields a discernible leap in productivity, I don’t think it is safe to take an impending robo-utopia as a given.

Democrats eventually need to sell Americans on higher taxes

Democrats probably can’t escape the tension between their commitments on taxation and social spending. But they can seek to mitigate it in a few different ways.

One is to scale down the party’s ambitions for the welfare state, while seeking to advance progressive economic goals through other means.

Such a retreat would be understandable. The party’s fear of raising taxes is not baseless. In a 2021 Gallup poll, only 19 percent of Americans said they would like to have more government services in exchange for higher taxes, while 50 percent said they’d prefer lower taxes in exchange for fewer services.

Meanwhile, Democrats have grown increasingly reliant on the support of upper middle-class voters. In 2024, the highest-earning 5 percent of white voters were more than 10 percentage points more Democratic than America as a whole. The lowest earning two-thirds of whites, by contrast, were more Republican than the nation writ large.

In this political environment, calling for large middle-class tax hikes could well ensure perpetual Republican rule.

In the short term then, Democrats might therefore be wise to narrow their agenda for social welfare, focusing on modest programs that can be funded exclusively with taxes on the rich.

At the same time, the party could seek to better working people’s lot through regulatory policy. You don’t need to raise middle-class taxes to expand collective bargaining rights, guarantee worker representation on corporate boards, or raise the minimum wage. And the same can be said of relaxing regulatory barriers to housing construction and energy infrastructure. (Of course, achieving any of these goals federally would require Democrats to win a robust Senate majority — one sufficiently large and progressive enough to abolish the legislative filibuster, which currently establishes a 60-vote threshold for enacting new, non-budgetary legislation.)

In the long run though, Democrats must not forfeit the pursuit of a comprehensive welfare state. America lets more of its children suffer poverty — and more of its adults go without health insurance — than similarly rich countries. These deprivations are largely attributable to our nation’s comparatively threadbare safety net. And they can only be fully eliminated through redistributive policy. A higher minimum wage will not ensure that children with unemployed parents never go hungry, or that every worker with cancer can afford treatment.

Furthermore, as technological progress threatens to rapidly disemploy large segments of the public, robust unemployment insurance is as important as ever. And as the population ages, increasing investment in eldercare will be increasingly imperative.

Democrats should seek to make incremental progress on all these fronts as soon as possible. Even if the party is only willing to tax the rich, it can still finance targeted anti-poverty spending. But absent an AI-induced productivity revolution, building a holistic welfare state will require persuading the middle-class to accept higher taxes.

How this can be done is not clear. But part of the solution is surely to demonstrate that Democratic governments can spend taxpayer funds efficiently and effectively. So long as blue areas struggle to build a single public toilet for less than $1.7 million — or a high-speed rail line in less than 17 years — it will be hard to persuade ordinary Americans to forfeit a larger chunk of their paychecks to Uncle Sam.

All this said, Democrats have plenty of time to debate the future of fiscal policy. In the immediate term, the party’s task is plain: to do everything in its power to prevent Trump’s cuts to Medicaid and food assistance from becoming law.

The path to a comprehensive welfare state won’t be easy to traverse. Better then not to begin the journey toward it by taking several steps backward.