Trump’s new law strips coverage, jacks up costs, and risks 200,000 deaths

As lawmakers drafted what is poised to become the landmark legislative achievement of his second term, President Donald Trump told Republicans in Congress in May, “Don’t fuck around with Medicaid.” 

On Wednesday, as he met with holdouts on the “Big Beautiful Bill” to try to get it over the finish line, Trump told members of Congress if they want to win future elections, they should avoid touching Medicaid, Medicare, and Social Security. He’s not wrong: 82 percent of voters say cutting Medicaid is unacceptable, including 71 percent of Trump’s voters. And 56 percent of voters say protecting these vital programs should be the Trump administration’s top priority. 

It seems that someone may want to tell the president that the bill he signed into law Friday following a marathon of all-nighters in Congress last week does, indeed, fuck with Medicaid — in a big way. 

Voters elected Trump in November in hopes he would fulfill his promise to “end inflation and make America affordable again.” That promise hasn’t materialized; in fact, groceries, housing, and electricity bills are all getting more expensive. And with the stroke of his signature Friday, Trump has broken his promise on health care, too.

Trump’s budget law will strip Medicaid coverage from as many as 15 million people, primarily by imposing work requirements on all supposedly “able-bodied” adults under the age of 65 — making them jump through needless hurdles to access life-saving care. Without Medicaid, these Americans would be forced to go without insulin, dialysis, and cancer screenings — or God forbid, cancer treatments. 

State lawmakers will be forced to find billions of dollars in their already squeezed budgets to cover the Medicaid expenses the feds have pushed onto their balance sheets. More than 300 rural hospitals and nearly 600 nursing homes are at risk of shutting down. And for those who try to buy individual health coverage through state marketplaces when they get kicked off Medicaid, their price tag will be double what it is now. 

Republicans falsely claim their bill doesn’t cut Medicaid, but that is precisely the point of their policies. Republican House Majority Leader Steve Scalise’s nose must have been growing when he said last week that these provisions will make sure “the truly disabled and needy will be able to get better access to Medicaid.” According to the GOP, “better access” apparently means hiking health care costs for the poorest Americans and implementing a maze of red tape.

Unfortunately for the Republicans trying to pull a fast one on the American people, we already know exactly what happens when Medicaid recipients are forced to deal with onerous requirements to access benefits they’re entitled to. And that’s because they’ve run this play before. 

During Trump’s first term, he enabled states to pilot work requirements for their Medicaid programs. New Hampshire, for example, attempted to implement work requirements for Medicaid beneficiaries in 2019 by requiring them to submit proof that they worked, volunteered, or were in school for at least 100 hours per month. In the first month of the new policy, more than two-thirds of Medicaid recipients were unable to comply with requirements — not because they didn’t meet them but because the administrative burden was so high. The online form didn’t even have an option for individuals to report their employment. Within weeks of the requirements going into effect and nearly 20,000 people at risk of losing coverage, the state halted implementation.  

In Arkansas, Medicaid recipients who were at or just above the poverty level ($28,000 for a family of 3) were required to report at least 80 work hours per month. For the first five months, recipients could only do so through an online portal — in a state where a quarter of households lacked high-speed internet. When the state added a phone option, callers waited on hold for up to an hour. In just seven months, one in four Medicaid recipients subject to the requirement lost their health coverage. 

Scalise claims the work requirements in the GOP bill mean the “35-year-old who’s sitting in his mom’s basement playing video games is gonna have to go get a job again.” Wrong again. In fact, the evidence shows that work requirements do nothing to increase employment. That’s because nearly two-thirds of working-age adults on Medicaid are employed, and most of the remaining third aren’t working because they’re students, caregivers, ill, or disabled. 

For the 31 million working-age adults on Medicaid, the Republican budget bill will mean they get confusing letters in the mail directing them to spend countless hours struggling to navigate glitchy government websites to update their address and submit their timesheets. (Of course, that’s for those who have stable mailing addresses and access to the internet.)

When the legislation temporarily stalled in Congress last week amid concerns about the devastating effects of these health care cuts, Vice President J.D. Vance posted on X that “the minutiae of the Medicaid policy … is immaterial.” 

That ‘immaterial minutiae,’ experts estimate, could cause as many as 200,000 preventable deaths when Americans can’t access the care or treatments they need, hospitals and nursing homes shut down, and insurance premiums become even more unaffordable. 

There’s nothing immaterial about the impact these cuts will have on Americans, and Vance’s change in tune is particularly interesting in light of the fact that he made the case for Trump in 2017 on the basis that Trump was more than just “a Republican focused entirely on cutting taxes for the wealthy,” adding that Trump hadn’t campaigned “saying ‘’I’m going to take away your Social Security and your Medicaid.’” 

Vance was half right. Trump isn’t focused entirely on cutting taxes for the wealthy. He’s also focused on gutting Medicaid and taking away health care from millions of Americans.