Centrist Republicans are said to be worried that the reconciliation bill’s proposed cuts to Medicaid spending will leave them vulnerable to Democratic attacks. They are right to be concerned, but they can rest more easily if only they realize that they, not the Democrats, hold the moral high ground on this issue.

That conclusion might strike some readers as strange. It’s well established that swing voters do not like to see people lose their health insurance, even if doing so would save taxpayers money.

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This basic moral fact is at the heart of traditionally successful Democratic messaging on Republican healthcare policy.

The 2012 attack on former Rep. Paul Ryan’s (R-WI) proposed change to Medicare is a case in point. Ryan wanted to transform Medicare from a fee-for-service program to one that provided a set subsidy for each senior citizen to buy their own health insurance. 

Democrats seized on the uncertainty that the proposal inherently created. Would the amount be enough to get everyone the healthcare they need in retirement? Ryan could never effectively answer that challenge. His claim that the free market would provide cost-effective policies struck many seniors as fanciful and uncertain. Better the fee-for-service bird-in-hand than the premium support two birds in the bush.

That basic moral dilemma is what made the famous “pushing grandma over the cliff” ad impactful. The fact that grandma might lose her healthcare, or see her coverage diminished, through no fault of her own, was viewed by many voters outside the GOP base as immoral and unfair.

The same moral dynamic was at play in the 2018 midterms. The Republican plan to repeal and replace Obamacare threatened to remove one of that scheme’s popular provisions, the requirement that insurance plans cover all applicants for the same price regardless of their pre-existing medical conditions.

One can argue that sicker people should have to pay more for their coverage under a free market system. One can also argue that insurers should not be forced to cover treatment for conditions that did not arise while the applicant was contracted to the insurer.

But those market-based arguments strike most voters as immoral. Americans largely believe that health insurance should cover people for whatever illness they have, regardless of when or how they acquired them. They prefer, in this case, security over liberty.

Democrats based their 2018 midterm campaign on this theme, picking up 41 House seats. 

Centrists are afraid the Medicaid spending cuts will trigger a similar outcome, but that’s comparing apples to oranges.

The bulk of the spending cuts in the reconciliation bill come from a provision that requires able-bodied adult Medicaid recipients under 65 to work, take classes, or do community service for at least 20 hours a week. Recipients with dependent young children, among others, are exempt from this mandate.

This provision is popular with voters of all stripes. According to a February poll, 62% of voters, including a majority of independents, back the bill’s work effort requirements.

It’s easy to understand why. People believe that government benefits should go hand in hand with effort to help oneself and contribute to society. The work effort requirements do just that.

The cuts in spending flowing from this proposal are the result of estimates that many people will not comply. In this case, it’s easy for threatened members to argue that that’s their own fault – people lose Medicaid coverage only if they can’t even make the effort to try to contribute to their own well-being.

That’s a very different moral case than the one underlying the typical Democratic healthcare attack. 

Other proposed Medicaid spending changes rest on similarly sound moral ground. A provision that penalizes states that spend their own money on providing health insurance to illegal aliens is an example.

Trump voters don’t think illegal aliens should be in the country at all, much less get taxpayer-subsidized health insurance. The bill’s provisions might lead some states to withdraw or limit coverage for those people, but voters open to backing Republicans won’t see that as unfair.

These avenues of response will require members to get out of their comfort zone a bit. They will have to explain what’s really in the bill and spend money to air television ads doing so. It’s understandable they would prefer not to have to do this at all — that’s an easier course to take.

But they also know that Republican voters are tired of spending money for benefits for scroungers and illegals. Many members from safe districts know this, so they are pushing so hard to ensure these provisions are in the final bill.

THE LAST-MINUTE CHANGES MADE TO THE TAX BILL TO WIN OVER HOLDOUT REPUBLICANS

The fact is that both sides rest on sound political ground. The GOP base wants spending cuts and the way the bill does it is morally acceptable to swing voters. 

Centrists should rest assured that if they stand up to fight this point in their re-elections, they are very likely to win the battle with the public. 

Henry Olsen is a senior fellow at the Ethics and Public Policy Center and a veteran political analyst. He hosts Beyond the Polls, a podcast about American elections and campaigns.