Republicans are prioritizing work requirements, Medicaid reforms, and a focus on responsibility, understanding the high political stakes involved.
What to Know:
- Karl Rove says the bill will have a major impact on the 2026 midterm elections.
- The bill adds a new 80-hour-per-month work requirement for certain Medicaid recipients.
- Medicaid eligibility will now be verified twice a year instead of annually.
- Sen. Thom Tillis announced he will not run for reelection after opposing the Medicaid provisions in the bill.
- Rove encouraged Republicans to stay active and campaign on the legislation’s policies.
Expected to reshape how millions of Americans access public health benefits, major Medicaid reforms are included in the “big, beautiful bill.” This sweeping federal spending package was recently passed by Congress and is backed by Republican leadership. Karl Rove believes the new federal spending package offers Republicans a strong platform for the 2026 midterm elections.
Karl Rove; image from X
The longtime GOP strategist praised the bill during an appearance on Fox News, pointing to its reforms to Medicaid as both substantive policy and strategic political opportunity. These reforms include adding work requirements for some recipients and increasing the frequency of eligibility checks, changes that are expected to affect millions.
Medicaid Reforms at the Center
The legislation includes an 80-hour-per-month work requirement for certain able-bodied adults who receive Medicaid. Rove framed this as a return to the original purpose of the program, which was designed to serve poor seniors, children in low-income families, and individuals with disabilities. The bill also changes the Medicaid eligibility system, shifting reviews from once a year to every six months.
Image generated by DALL-E
These changes are expected to reduce enrollment and increase the oversight of existing cases. Supporters say the new rules aim to encourage work and ensure that only qualified recipients stay enrolled. Critics, however, argue that the new requirements could result in the loss of coverage for eligible individuals due to administrative burdens or missed deadlines.
Tillis Declines Reelection After Breaking with Party
Senator Thom Tillis of North Carolina, a Republican, voted against the bill’s Medicaid provisions as reported by Politico, and later announced he would not seek reelection. He had urged lawmakers to remove the work requirement language before final passage.
Senator Thom Tillis official photo; via Wikimedia
His retirement is one of the first political consequences linked to the bill and highlights potential divides within the Republican Party about how to approach future entitlement reform.
Rove’s Strategic Message
Rove described the legislation as a chance for Republicans to reinforce messages about work, responsibility, and the intended purpose of safety net programs. In his Fox News appearance, he referenced a study suggesting that among able-bodied Medicaid recipients who are not working, common activities included watching television and playing online games.
Image generated by DALL-E
While Rove did not name the source, similar data has been presented by the American Enterprise Institute, which analyzed national time-use surveys and found that non-working adults on Medicaid spend significant time on passive leisure activities.
Screenshot from AEI
Critics contend that survey data alone doesn't fully account for significant factors such as caregiving responsibilities, health problems, and employment hurdles, which are crucial for a complete understanding of how beneficiaries utilize their time.
Rove Urges GOP to Stay on Offense
In his remarks, Karl Rove underscored that passing the “big, beautiful bill” was only the first step in a much larger political strategy. He warned Republicans against becoming complacent after achieving a legislative win and instead called for ongoing engagement with voters.
“There’s always a tendency to say, ‘We got the bill passed, oh, let’s all take the time off.’ Uh-uh,” Rove said during his appearance on America’s Newsroom.
He went on to frame the bill not just as a legislative achievement but as a launching pad for continued advocacy.
“That’s the requirement that you then go to work.”
The message was clear: Republican lawmakers and candidates should treat the legislation as a foundation for voter outreach, campaign messaging, and policy defense in the lead-up to the 2026 midterms. According to Rove, resting on the success of passing the bill would be a missed opportunity.He recommended the party use the bill to highlight responsibility, program integrity, and fiscal discipline, believing these themes would appeal to a wide range of voters.
Wrap Up
This call to action suggests that Republican leadership views the bill not as the end of a policy debate but as the beginning of a broader campaign to reframe how entitlement programs are discussed and defended in national politics.
Karl Rove’s comments suggest that Republicans are preparing to campaign on the contents of the “big, beautiful bill,” particularly its changes to Medicaid. With work requirements, new eligibility standards, and early signs of political realignment within the party, the legislation is expected to be a central issue in the 2026 midterms. Whether it becomes a point of strength or division may depend on how its real-world effects are felt by voters in the coming months.
