What did Donald Trump do today?

He told Republicans not to "fuck around" with Medicaid, by which he means more than he's already trying to.

Trump is facing a familiar problem from his first term this week: a fight with his own party over the federal budget. With a razor-thin majority in the House and a number of Republican senators who are not politically dependent on him, Trump's budget asks are facing skepticism and scorn from all sides—and that's just inside the GOP. Democrats are rallying around opposing cuts to Medicaid, which provides health care and support for the most vulnerable Americans. 

Medicaid, like Social Security and other so-called "entitlement" programs, has long been in Trump's crosshairs, but the fact that Americans overwhelmingly oppose cuts to them has made them a non-starter even when Trump's party has controlled both houses of Congress.

Today, in a meeting on Capitol Hill with Republican party leaders, Trump made the usual demands for loyalty to him and threats for those who opposed his "big, beautiful bill," whether out of principle or political calculation. But he also tried to retreat to a more politically mainstream position on Medicaid, warning House Republicans not to "fuck around" with the popular program.

The problem there is that Trump's own budget proposal "fucks around" with Medicaid to the tune of almost a trillion dollars: $880 billion, by one estimate. This would kick 10.3 million Americans out of coverage—by definition, Americans who could not afford critical health care or disability support by other means. 

About 80 million Americans receive health care services through Medicaid. Even those who didn't lose care entirely would be affected by Trump's proposed cuts. So would people who are not on the Medicaid rolls themselves, but who provide home care themselves for elderly or disabled relatives and receive reimbursement, which is almost always much cheaper and effective than forcing patients into group care facilities. (Group care facilities will also be affected by Trump's proposed cuts.)

The few Republicans in Congress who want to "fuck around" with Medicaid even more are mostly doing so by proposing work requirements. By definition, most of the people who need Medicaid assistance are already unemployed and/or too sick or disabled to work, and most of the proposed "requirements" take that into account—so this is generally seen as an attempt to deny qualifying Americans through bureaucratic delays.

But it's not clear why Trump is telling those Congressional Republicans not to "fuck around" with Medicaid that way, since he's in favor of putting those barriers in place too, and said so as recently as yesterday.

Why does this matter?

• Presidents who don't want to fuck around with Medicaid should start by not fucking around with Medicaid.
  

• It is not Congressional Republicans' fault that Trump's own ideas are toxic with American voters.