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Ernst’s ‘we all are going to die’ quip underscores GOP’s Medicaid challenge

As Senate Republicans return to work on President Donald Trump’s priority legislative package, they face a messaging battle on Medicaid that is fraught with potential pitfalls.

They received a reminder of the perils Friday at an Iowa town hall, when Sen. Joni Ernst (R-Iowa) flippantly responded to an audience member who shouted out that people who lose coverage under the bill would die.

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“Well, we all are going to die,” Ernst said as the crowd groaned. “For heaven’s sakes, folks.”

On Saturday, as the remark was taking off on social media, Ernst released a follow-up video. Speaking from what appeared to be a cemetery, she apologized for assuming that everyone at her town hall knew “that, yes, we are all going to perish from this Earth.”

Ernst did hit some Republican talking points at her town hall. As they seek to shape how their bill is perceived, Trump and Republican lawmakers have said they are rooting out “waste, fraud and abuse” in Medicaid and shoring up the program for future generations. Republican strategists have urged their party to say they are “strengthening Medicaid” by eliminating fraud, preventing tax increases and making sure undocumented immigrants cannot benefit from the program.

But Ernst’s quip about mortality landed on the front page of the Des Moines Register and spread across the internet, not the party line about waste, fraud and undocumented immigrants. The imbroglio underscored the party’s messaging challenge as the bill moves through the Senate.

The Republican legislation, which narrowly passed the House last month, seeks to pay for some of Trump’s priorities by cutting more than $1 trillion from spending on social safety net programs over the next decade. The changes could lead to 8.7 million people losing Medicaid coverage and 7.6 million more uninsured people over 10 years, according to projections from the nonpartisan Congressional Budget Office.

Trump has painted himself as a fierce defender of Medicaid, even as GOP lawmakers stare down the prospect of significantly changing it. He promised during his 2024 campaign to protect entitlement programs and began his second term vowing to “love and cherish” the programs.

“Don’t f--- around with Medicaid” benefits, Trump told House Republicans last month shortly before they passed the bill.

The bill that House Republicans passed would increase the number of people without health insurance by restricting eligibility, narrowing the path for some Americans to get coverage and making it easier for some to lose it. The bill would also introduce new rules targeting Medicaid expansion and federally subsidized insurance marketplaces. Republicans say that will target fraud and abuse in the program.

But even House Republican leaders have at times struggled to send a clear message on the eligibility changes.

Rep. Lisa C. McClain (R-Michigan), chair of the House Republican Conference, defended Ernst on Monday when asked about her video in the cemetery, arguing that Democrats are fearmongering about the GOP’s Medicaid changes.

“I think she was trying to do a play on words, actually,” McClain said on CNN. “Listen, the fearmongering has got to stop, right? We are cutting - we are not cutting - Medicaid. We’re actually trying to shore Medicaid up so it’s there for the people that need it the most.”

But Rina Shah, a former GOP strategist and Capitol Hill aide, said people’s concerns about Medicaid are “well-founded” and Republicans should respond accordingly. They should not be defensive, she said, and should patiently explain how they can be “entrepreneurial” in fixing a program that many Republicans, at least, agree needs changes.

“All [Ernst] had to do was kind of walk back and say, ‘I just tried to inject a moment of levity, and I’m sorry,’” Shah said. “But the whole problem is she’s doing what we see from the Trump administration, which is prioritizing defiance over empathy.”

It’s not clear Ernst will face much blowback from voters in a state Trump won by 13 percentage points last year. But her handling of the situation prompted state Rep. J.D. Scholten (D) to announce plans to challenge her in next year’s Senate race. He told The Washington Post that he had already been thinking about running, but the controversy convinced him. Her comments, he said, were “horrific and tone deaf.”

Adding to the challenge, Republicans are not united on changing Medicaid. Cutting the program is “both morally wrong and politically suicidal,” Sen. Josh Hawley (R-Missouri) wrote in a New York Times op-ed last month titled “Don’t Cut Medicaid.”

Hawley spoke Monday with Trump about the bill, according to the senator, and said in a social media post afterward that Trump reiterated: “NO MEDICAID BENEFIT CUTS.”

Hawley said that he still has concerns from the House bill that he would want to work out in the Senate but that he supports the House’s inclusion of work requirements.

“The right message is we’re not going to cut Medicaid benefits,” Hawley said. “We’re going to do everything we can to help working people who cannot afford to get health care.”

Other Senate Republicans want the bill to do more to slash federal spending, including in ways that could further impact Medicaid. Among them is Sen. Rand Paul (Kentucky), who recently made an appearance in Ernst’s home state to make his case at a party fundraiser.

Some conservative groups - such as Advancing American Freedom, the group started by former vice president Mike Pence - are urging GOP lawmakers to get serious about overhauling Medicaid, even if doing so is politically painful.

“Republican Senators should stand firm on the House-passed Medicaid reforms that restore the program to its original intent, reduce waste, fraud, and abuse, and ensure fiscal sanity,” the group’s executive vice president, Paul Teller, said in a statement, adding that conservatives should be the “adults in the room” on the issue.

In-person town halls, such as the one Ernst held in Butler County, Iowa, have already become hot buttons for GOP lawmakers. The head of the House Republican campaign arm, Rep. Richard Hudson (North Carolina), advised members in March to hold virtual town halls rather than in-person events, as they were facing vocal opposition in the opening weeks of Trump’s second term.

McClain said Monday that town halls “have gotten a little bit out of control with fearmongering.”

Democrats see Ernst’s comments as validating their view that Republicans are struggling to defend the Medicaid provisions of the bill because they know they are unpopular. The Democratic Congressional Campaign Committee, which is focused on House races, moved quickly to capitalize on Ernst’s town hall, releasing a statement calling for three of Iowa’s Republican representatives to say whether they agreed with Ernst.

Senate Minority Leader Charles E. Schumer (D-New York) agreed with an MSNBC host’s tongue-in-cheek comment Monday that Ernst’s defense of the bill was “unorthodox.”

“Abe Lincoln said it right: Public sentiment is everything,” Schumer said. “And I guarantee you, Republican senators will be hearing the outrage from their constituencies.”

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Mariana Alfaro and Matthew Choi contributed to this report.