What did Donald Trump do today?

He used illegal Medicaid cuts to punish his political opponents in two blue states.

The Trump administration announced today that it was "pausing" Medicaid disbursements to Minnesota and California, over supposed fraud. The governors of each of those states are both political rivals to Trump: Gavin Newsom of California is a likely Democratic presidential candidate in 2028, and Minnesota's Tim Walz was the Democratic vice-presidential nominee in 2024.

Trump has made this threat before: in February, he said he'd withhold $259 million from Minnesota. He never carried it out, though. Courts have stopped Trump from politically motivated interference with healthcare programs before. In spite of the attention that Trump's HHS officials—former lawyer Robert F. Kennedy Jr. and daytime talk show host Mehmet Oz—tried to bring to the move today, it's not clear that any money has been withheld yet.

There is Medicare fraud in Minnesota and California—and in every other state, and probably almost every individual county. Committing fraud against the government for these kinds of programs is easy, but getting away with it is more difficult—as Trump, whose business was convicted of defrauding the State of New York, is well aware. (That is not to be confused with Trump's criminal conviction on 34 felony charges, which dealt with different matters.) Even if he didn't have personal experience with it, Trump has pardoned many wealthy and politically connected Medicare and Medicaid fraudsters, who collectively stole billions of dollars.

Regardless, Trump has no authority to withhold Medicaid funding for any state, or impose conditions on its release outside of what the law permits. Doing so violates Congress's constitutionally granted control over appropriation, as well as the 1974 Impoundment Control Act.

Trump has made little secret of his intention to punish states that don't support him politically at the federal level—even though, to use California as an example, that means punishing millions of people who voted for him. He's also effectively stopped approving disaster relief for blue states in his second term.

 

Why does this matter?

• Cutting off basic government services to punish areas the leader thinks aren't sufficiently loyal to him is what dictators do. 

• It's beyond evil to punish poor children by withholding medical care to score political points against Americans who politically oppose you. 

• Presidents who care about fraud generally commit less of it.

What did Donald Trump do today?

He once again threatened to withhold medical care from poor children to punish the Americans he thinks are his enemies.

The day after Trump gave a long speech that left him visibly exhausted, the White House kept him out of public sight today. But the administration did send JD Vance and Mehmet Oz out to reiterate a threat Trump made last night. The two held a press event today promising to withhold $259 million in Medicaid funds to the state of Minnesota. That state's governor, Tim Walz, was Vance's opponent in the 2024 vice-presidential race. 

Minnesota is also home to the largest Somali-American communities in the nation, a group Trump has compared to animals and falsely accused of disloyalty. It's not clear how much of Trump's loathing of Americans of Somali descent comes from his personal racist beliefs and how much of it is political opportunism in the belief that other Americans can be convinced that those racist beliefs are true. Racist broadsides against immigrants were a major theme of his campaign and a sort of acid test for then-candidate Vance, who was given the job of spreading false rumors that Haitian-American immigrants in Ohio were stealing and eating household pets.

The link to Minnesota and Medicaid has its roots in a fraud investigation launched by the Walz administration before the election. Some of the targets were Somali-Americans, although most were not. That ultimately led to Walz suspending one grant program that had been a particular target for fraud, although legitimate claims were filled through other programs.

Medicaid, which is the federal government's main provider of health insurance for children and poor families, has no such alternative at the state level, meaning that Trump's threatened cuts will directly impact the ability of Minnesotans who have not committed fraud to receive necessary health care. 

There's no way to be sure whether Vance and Oz's delivery of Trump's threat will amount to anything in practice. He's made precisely this same threat before, to no real effect, because courts immediately put a stop to it. As a general rule, Trump has no legal power to punish Americans, especially Americans who are not themselves guilty of any crimes, by arbitrarily denying them government services—and certainly not as a means of political revenge against a state that doesn't vote for him.

Oz, who is Trump's Medicaid administrator, said that people who commit fraud against the program are "self-serving scoundrels." That's hard to disagree with. Among the people who have commited fraud against Medicaid and Medicare who have received pardons or commutations from Trump are:

• Paul Walczak of Florida, who stole employee Medicare payments and used them to buy a yacht, and whose mother later gave Trump's PAC $1 million 

• Joseph Schwartz of New Jersey, who committed fraud against Medicaid as the CEO of a chain of for-profit nursing homes, who paid lobbyists with Trump's ear $1.1 million to get the pardon 

• Lawrence S. Duran and Judith Negron of Florida, who defrauded Medicare of $200 million, and who had earned the longest sentences for health care fraud ever handed down in the United States 

• Rickey Ivan Kanter, who defrauded Medicare through his orthopedic shoe business 

• Paul Behrens, Thaddeus Bereday, Todd S. Farha, William Kale, and Peter Clay of Florida, all executives in a health insurance company that defrauded Medicare 

• Robert Corkern of Mississippi, a hospital management company owner who bribed a public official to overpay for his services, driving up public reimbursement costs 

• William "Ed" Henry, a former Republican member of the Alabama state legislature, who stole government property as part of a Medicare fraud scheme 

• Ted Suhl of Arkansas, who ran a faith-based behavioral therapy clinic, and defrauded Medicaid 

• Philip Esformes of Florida, whose chain of nursing homes billed Medicare $1.3 billion for care it never provided to patients, and who went on to commit other crimes after Trump's clemency 

• Saloman E. Melgen of Florida, an opthalmologist who bilked Medicare for $73 million by performing unnecessary (and sometimes painful and dangerous) eye surgeries 

 

Why does this matter?

• It's beyond evil to punish poor children by withholding medical care to score political points against Americans who politically oppose you. 

• Under no circumstances does a president who pardons $1.6 billion in medical fraud, mostly from his own home state, care about medical fraud.

What did Donald Trump do today?

He tried and failed to quietly fire his CDC Director for not going along with his administration's attack on the COVID-19 vaccine.

For a man whose game show catchphrase was "you're fired," Trump is quite squeamish about actually firing people, and has gone to extraordinary lengths to avoid having to do it himself. He prefers to act through intermediaries or via social media—even when the person in question works in the same building as him. In his second term, at least where his inner circle is concerned, he's all but abandoned the concept, preferring instead to "promote" staff who offend or underperform in some way to diplomatic jobs.

With regular federal employees—the ones with no personal connection to Trump—it's a different story. Trump has fired hundreds of thousands of workers, including many he had no legal right to fire, forcing them to take legal action just to be temporarily reinstated. The full scope of Trump's decimation of the federal workforce is becoming clear: just shy of 200,000 government employees have lost their jobs, with another 100,000 expected this year. 

The damage done by those firings is far greater than the immediate loss of the workers' livelihoods. The job market itself has virtually shut down over the last few months, and unemployed former government workers are now competing with new entrants to what's left of the private sector market. Meanwhile, federal agencies are unable to staff critical positions because skilled workers are resigning too, either out of fear for the uncertainty of working under Trump or disgust at his treatment of workers.

All of these tendencies were on display today, as Trump unofficially and indirectly fired the head of the CDC, Dr. Susan Monarez—the person he'd appointed to the role just weeks ago. But while the firing was announced on the CDC's own social media site, as of late this evening, it had not actually been done, apparently in the hope that Monarez would resign of her own accord. 

Through her attorneys, Monarez posted this response to Trump's attempts to get her to fall on her sword:

Throughout the day, both CDC and White House spokespeople insisted that Monarez had been fired, but Trump himself must order it done, and whether through inability or unwillingness, he had not yet made any such order as of midnight Thursday.

Meanwhile, three other senior CDC officials resigned in protest tonight. Like Monarez, they cited the dangerous and anti-scientific orders from HHS Secretary Robert F. Kennedy Jr., who today announced restrictions on who would be eligible to receive this winter's updated COVID-19 vaccine. Kennedy, a former talk show host and lawyer with no experience in health care, is a vaccine conspiracy theorist. The officials who resigned cited Kennedy's censorship of medical research to fit his personal political agenda, his purging of scientists who wouldn't promise to issue the findings he wanted, and the Trump administration's belief in the discredited science of eugenics.

Under today's orders, which appear to have set off the firings and resignations, Americans will no longer be able to simply choose to receive a vaccine at a convenient location like a pharmacy. Instead, they s will have to schedule a visit with their doctor first. This will add expense and inconvenience even for those whose access to health care won't be affected by Medicaid cuts in Trump's budget bill. 

Studies vary, but the COVID-19 vaccine is generally credited with saving 20,000,000 lives worldwide in its first year of availability alone.  

Full text of the resignation letters

Why does this matter?

• Americans' health and safety literally depends on letting competent public health officials do their jobs.  

What did Donald Trump do today?

He lied about his budget bill.

Trump signed his budget bill into law today as part of a White House Independence Day ceremony. According to nonpartisan experts including the Congressional Budget Office, the bill is expected to add $3 or $4 trillion to the national debt, cause 17 million Americans to lose their health coverage, and make permanent Trump's 2017 tax cuts that exclusively benefit the very wealthiest Americans while cutting services for everyone else. It will also massively expand the size of ICE, ballooning its budget overnight into something bigger than the entire military spending of some of the world's largest nations.

None of these things are popular. In fact, Trump's budget bill is the second most unpopular piece of legislation in the last 35 years, topped only by his failed attempt to repeal the Affordable Care Act in 2017.

Republicans in both chambers—including some who voted for the bill—warned their colleagues that the clear public opposition to the bill was political suicide for the midterm elections. That may explain why Trump said this today:

It's the most popular bill ever signed in the history of our country. Whether you're military or anybody else, this is the most—single most popular bill ever signed.

As is often the case with these kinds of bizarre denials of reality from Trump, it's not clear whether he's deliberately lying or has no idea what he's talking about. He appeared genuinely confused earlier this week about whether the bill had anything to do with Medicaid. (It cuts Medicaid by one trillion dollars, almost precisely the amount needed to offset the tax breaks for the ultra-wealthy.)

Trump also repeated a lie about Social Security, claiming that his bill ended taxation of its benefits. In fact, it has no effect at all. Most seniors don't pay income tax as it is, but those who do will still see that income taxed. The Trump Administration sent an e-mail overnight repeating this lie directly from the Trump-appointed head of the Social Security Administration, praising Trump by name for fulfilling his "promise."

Trump did campaign on that still-unfulfilled promise to end taxation of Social Security benefits, something that would have been far more popular than most of the actual provisions in the bill and faced little opposition in Congress—if he had bothered to put it in.

Why does this matter?

• Reality doesn't change just because Donald Trump tells it to. 

• Presidents who pass genuinely popular legislation don't have to demand that people pretend it was popular. 

• If Trump wasn't lying, then he's incapable of understanding that he's being systematically lied to, and is unfit for office on those grounds.

What did Donald Trump do today?

He missed a trillion-dollar cut in his own budget bill and had to be told what was in it.

Trump's budget bill is up for debate in the House, where its immediate future is uncertain. Mostly a vehicle for making Trump's 2017 tax cuts permanent at any cost, it contains any number of provisions that are likely to be disastrous both for Republicans seeking re-election and Americans as a whole. Among the most potentially devastating is a trillion-dollar cut to Medicaid, which more than 71 million Americans use quite literally from cradle to grave: it pays for 41.5% of hospital births, and it covers hospice care for the terminally ill. 

Many Americans who rely on Medicaid don't even know that they do, because it is rebranded in the states: BadgerCare in Wisconsin, STAR+PLUS in Texas, Medical Assistance in Pennsylvania, and so forth. Today, it seemed that Trump wasn't exactly clear on what Medicaid was either, as he had to be told by Congressional Republicans that his bill does indeed severely impact it. As a report in NOTUS on Trump's meeting with wavering House members today put it:

But Trump still doesn’t seem to have a firm grasp about what his signature legislative achievement does. According to three sources with direct knowledge of the comments, the president told Republicans at this meeting that there are three things Congress shouldn’t touch if they want to win elections: Medicaid, Medicare and Social Security.

“But we’re touching Medicaid in this bill,” one member responded to Trump, according to the three sources.

In other words: Trump went to reassure House members that they could vote for his bill because it wouldn't touch the politically dangerous subject of Medicaid, and had to be informed by his own party's Congressional delegation that his bill grabs it with both hands.

This is not the first time that Trump has made this claim; it's a standard talking point for him and one his staff obediently repeated when asked for comment today. For the most part, the media has treated it as a standard Trump obfuscation, noting its falsehood without directly calling Trump a liar.

Today's report was the first strong indication that Trump may have genuinely believed what was on his cue cards, or at least thought there was some truth to it, and that he somehow missed the trillion-dollar cut to Americans' health care budget with his name on it.

Why does this matter?

• A president who can't keep track of a TRILLION dollars in urgently-needed health care spending isn't fit for office. 

• Neither is one who can't be bothered about it. 

• Neither is one who knew but forgot. 

• Neither is one who just lies about it.

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.

What did Donald Trump do today?

He proposed to cut Medicare, Medicaid, and Social Security.

Trump's official 2020 budget proposal, released today, calls for $845 billion in cuts to Medicare. Trump is also proposing $241 billion in cuts to Medicaid, and $26 billion from Social Security.

There's nothing inherently wrong with proposing such cuts, which have no chance of becoming law, regardless of which party controls Congress. But Trump distinguished himself from other Republicans during the primary by accusing them of wanting to cut those programs, while swearing that he himself never would. 

For example, in a May 2015 interview with a conservative website, Trump said, "I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid."

A few days later, he gave a speech in which he made the same claim—and then quoted himself in a tweet.

He said the same thing in his formal campaign announcement the following month: "Save Medicare, Medicaid and Social Security without cuts. Have to do it."

In 2017, the Washington Post put together a video compilation that captured some, but not all, of Trump's subsequent promises to leave those entitlement programs untouched.

Trump subsequently accused Hillary Clinton of attending a "secret Wall Street meeting" where she "admitted that she wants to cut Medicare and Social Security." (This was a lie.) He also said that Democrats running in the 2018 midterm elections "want to destroy Medicare."

Why does this matter?

• People who heard Trump promise not to cut Medicare, Medicaid, and Social Security may have thought he wouldn't try to cut Medicare, Medicaid, and Social Security.

• Accusing other people of wanting to do the things you are doing doesn't change the fact that you are doing them.

What did Donald Trump do today?

He tweeted this graph, attributed to the Congressional Budget office, with the comment "Democrats purposely misstated Medicaid under new Senate bill - actually goes up."

 

source: Twitter, @realdonaldtrump

In fact, Trump is purposely misstating Medicaid under the new Senate bill, which would bring it down from current allocations, by hundreds of billions of dollars.

 

source: CBO report on the BHCA, p. 13

Among the CBO's actual findings on the bill's effects on Medicaid spending:

• "The largest savings would come from reductions in outlays for Medicaid— spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law" (p. 4)

• "In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance." (p. 4)

• "[T]he amount of federal revenues collected and the amount of spending on Medicaid would almost surely both be lower than under current law." (p. 9)

• "The largest effects on spending under this bill would be for Medicaid. Overall, including all provisions affecting Medicaid, CBO estimates that spending for the program would be reduced by $160 billion in 2026 compared with projections under current law." (p. 12)

• "The total deficit reduction that would result from the insurance coverage provisions includes ... a reduction of $772 billion in federal outlays for Medicaid." (p. 13)

Trump reacted angrily this morning to the suggestion in several newspaper reports yesterday that he was, in his words, "not totally engaged in healthcare." 

Why is this a problem?

• It's really, really important that a president can be trusted not to lie about easily checked facts.

• Accusing others of your own flaws is called projection, and it is not a sign of good mental health.

What did Donald Trump do today?

He claimed the Senate version of his Obamacare repeal bill would not affect anyone currently on Medicaid, which is false.

At today's untelevised briefing, press secretary Sean Spicer said that Trump was "committed to making sure that no one who currently is in the Medicaid program is affected in any way, which is reflected in the Senate bill, and he's pleased with that."

Trump is "committed" to keeping Medicaid unchanged in more ways than one: as a candidate, he claimed he was the only Republican who would "save Medicare, Medicaid and Social Security without cuts," and contrasted his supposed hands-off approach with Hillary Clinton, who he said would "knock the hell out of" Medicaid and other entitlement programs--and that Clinton's promises to the contrary were lies.

The Senate bill drastically reduces funding for Medicaid, and would absolutely affect current enrollees, not least by kicking many of them out of the program by 2023 and forcing states to drop even more for lack of funding. 

So what?

• When candidate Trump told voters he wasn't going to cut Medicaid, they may have thought that meant he wasn't going to cut Medicaid.

• Presidents are entitled to whatever policy views they like, but they're not entitled to lie about them.

What did Donald Trump do today?

He explained that his promise not to cut Social Security and Medicaid did not mean he wouldn't cut Social Security and Medicaid.

Trump released another budget plan today, consistent in its overall extreme austerity (except for defense spending) with the previous attempt that went ignored by Congress. In his inaugural campaign speech in 2015, Trump promised to "save Medicare, Medicaid and Social Security without cuts." But his current proposal would slash the Social Security Disability Insurance program by 28%. About 10,000,000 Americans currently receive disability assistance through the program. Asked to explain this discrepancy, Budget Director Mick Mulvaney claimed that the Social Security Disability Insurance program was not really a part of Social Security.

It really is.

Candidate Trump also promised not to cut Medicaid, but his budget today calls for $600 billion in cuts to the program (on top of an estimated $839 billion in cuts built into his health care bill). Roughly one-quarter of Americans are enrolled in Medicaid and would be affected by those cuts. Mulvaney explained that Trump's promise not to cut Medicaid had been "overridden" by his promise to repeal the Affordable Care Act.

So what?

• Voters who heard Trump promise not to cut Social Security and Medicaid may have believed that he was not planning to cut Social Security and Medicaid.

• Breaking a promise you didn't intend to keep isn't excused by making a conflicting promise you can't keep.

What did Donald Trump do today?

He clarified through a spokesperson that "insurance is not really the end goal" of his proposed Affordable Care Act replacement.

Trump has promised that his Obamacare replacement would be "insurance for everybody." But this morning, Mick Mulvaney, director of Trump's Office of Management and Budget, told MSNBC that the ACA is

a great way to get insurance and a lousy way to actually be able to go to the doctor. So we’re choosing instead to look at what we think is more important to ordinary people: Can they afford to go to the doctor? And we are convinced it will be possible for more people to get better care at the doctor under this this plan than it was under Obamacare.

Trump has hired the services of a personal physician for much of his life, but for most Americans, health care without health insurance is a mathematical impossibility, and has made medical bills the leading cause of bankruptcy. Little if anything in Trump's proposed plan would bring down the dollar cost of medical care for those forced to pay for it without good insurance.

Why should this bother me?

• Unless a president wants to create a single-payer health care system (like Medicare or a Canadian-style national health service), health insurance is absolutely essential to the "end goal" of health care.

• Voters may have thought that when candidate Trump promised "insurance for everybody," he meant insurance for everybody.

What did Donald Trump do today?

He began backing off a plan for universal health care almost as soon as it was made public.

In an interview with the Washington Post conducted Saturday and published late Sunday, Trump spoke in general terms of a plan that would guarantee "insurance for everybody." Taken at face value, this would be a universal national healthcare plan to replace private insurance, which would involve a much bigger role for government than the Affordable Care Act that Trump campaigned against. 

However, any such plan conflicts with both Trump's campaign promises to end Obamacare and with Congressional Republicans' preparation to move the government out of health entitlement programs. Today, Trump's spokesman Sean Spicer began walking back the "insurance for everybody" language in favor of a plan where market forces would make insurance affordable, and Trump would personally negotiate deals with drug companies.

Why is that a bad thing?

• If a president has a "plan" on Saturday night, it should still exist on Monday morning.

• Conservatives who voted for Trump may have believed him when he said he thought government-run health care was a bad thing.

• It's bad if a president thinks the job involves haggling over line items with medical supply contractors.

What did Donald Trump do today?

He changed his policy stance on Medicare and Medicaid to align with the privatization plans currently being promoted by Paul Ryan.

Trump had campaigned on a promise to keep these programs in their current form, something he claimed no other Republican would do.

Why should anyone care about this?

• It is bad to break campaign promises.

• It is especially bad to break campaign promises on issues that many voters feel very strongly about.

• When a presidential candidate runs against his own party on an issue, and then changes his position to align with his party seven days after being elected, voters may feel he has lied to them.