Donald Trump has always had trouble keeping a story straight. But even by his own standards, the president’s flip-flop last week on Medicaid cuts was executed with dizzying speed. That pirouette should worry not only the millions of Americans on Medicaid, but those drawing Medicare and even Social Security benefits as well.
On Tuesday, Trump and unofficial co-president Elon Musk sat for an interview with Fox News host Sean Hannity. “Social Security won’t be touched, other than this fraud or something we’re going to find,” Trump said. “It’s going to be strengthened but won’t be touched. Medicare, Medicaid, none of that stuff is going to be touched.”
The president’s words seemed unambiguous and reflected three facts: The health care programs insure nearly 40% of Americans, more than 70 million Americans receive Social Security benefits, and all three programs are remarkably popular.
Despite the president’s promise the night before on Fox, the House GOP budget leaves Medicaid anything but “untouched.”
On his Truth Social platform the next morning, however, Trump posted an endorsement of the House GOP’s budget plan. “The House Resolution implements my FULL America First Agenda,” Trump wrote with his trademark restraint. “It will, without question, MAKE AMERICA GREAT AGAIN!”
That endorsement created a contradiction that, according to Politico, “sent aides scrambling to figure out what Trump meant.” Despite the president’s promise the night before on Fox, the House GOP budget leaves Medicaid anything but “untouched.”
The “full America First agenda” that Trump is so jazzed about will cost around $4.8 trillion, a combination of lower revenue and spending cuts. The vast majority of that — $4.5 trillion — comes as tax cuts, mostly an extension of the 2017 tax cuts that overwhelmingly benefited wealthy Americans. To make that cost more palatable to the far right’s deficit hawks, the budget asks approximately half a dozen House committees to find $2 trillion in spending cuts. The largest reductions — $880 billion — will come via the Energy and Commerce Committee, with most or all of that figure likely to come from Medicaid.
There’s no easy way for Trump to reconcile his words with his favored budget. The White House insists that Trump is merely talking about “waste, fraud and abuse” in Medicare, but hasn’t provided evidence that any of those three are widespread, let alone in quantities sufficient to reach the $880 billion target. In fact, as a group of House GOP moderates warned Speaker Mike Johnson in a letter last week, “For many families across the country, Medicaid is their only access to healthcare. Slashing Medicaid would have serious consequences.”
But it’s not just the 79 million Americans on Medicaid who should be worried. Despite what Trump claimed, the House budget is not his “full agenda.” Many of Trump’s most expensive campaign promises, including the elimination of taxes on tips, overtime and Social Security payments, aren’t included. In addition, Republicans from high-tax states have vowed to eliminate or at least significantly lift the cap on deducting state and local taxes.
There are already indications that Medicare could be vulnerable.
Passing everything on this list would require trillions more in spending cuts — well beyond the even deeper Medicaid cuts envisioned by the most conservative Republicans. If Trump only needed 12 hours to go all-in on slashing Medicaid to fund giveaways to the wealthy, why should anyone expect other entitlements to be off the table?
There are already indications that Medicare could be vulnerable. Medicare’s pandemic-era expansion of telehealth services is set to expire in April, after a two-year extension was a casualty of Republicans blowing up the last round of congressional budget negotiations in December. And the same day that Trump backed the House budget, White House spokesperson Kush Desai issued a statement saying that “the Trump administration is committed to protecting Medicare and Medicaid while slashing the waste, fraud, and abuse within those programs.” Only after news outlets noted Medicare’s inclusion did Desai issue an updated statement without any mention of the program. A day later, Senate Republicans dispelled any doubts that Congress would support Medicare cuts should Trump request them. As the Senate GOP moved forward with a vote on its own budget resolution, Democratic Sen. Jack Reed offered an amendment barring Medicare and Medicaid cuts. Every Democrat voted for the amendment; all but two Republicans voted against it. That leaves Social Security, traditionally the most protected program in American politics. But in the Fox News interview, it was Social Security, not Medicare or Medicaid, that Trump noted may be probed for “fraud or something we’re going to find.” Trump, Musk and the latter’s so-called Department of Government Efficiency have already pushed claims of rampant fraud that have fallen apart under the slightest scrutiny. Both men have claimed, for example, that “millions and millions” of dead people receive Social Security — a claim that Trump’s new commissioner of the Social Security Administration has debunked. The president may persist with this fraud about “fraud” because, as with the GOP budget, the math isn’t kind to Trump. As I wrote in October, “the Congressional Budget Office projects that the [Social Security] trust fund will run out before 2035. At that point, benefits will immediately shrink by more than 20%, around $400 per month per recipient on average.” But the policies that Trump trumpeted during the campaign will accelerate that timeline: Mass deportations mean fewer workers paying payroll taxes; additional tax cuts reduce revenues; and new tariffs are likely to boost inflation and, consequently, Social Security’s cost-of-living increases. Taking all of Trump’s proposals together, the Committee for a Responsible Federal Budget projects that Social Security’s trust fund would run out by 2031. The easy solution here would be to raise taxes on the wealthiest Americans, either by ending their portion of the 2017 tax cuts or lifting the cap on payroll taxes. Both are nonstarters for Republicans. So how will the ruling party deal with Social Security’s looming cliff? It’s not clear. But when Trump promises that Social Security will not be cut, remember that he and his allies are already laying the groundwork to turn “no cuts” into “big cuts” overnight.
James Downie is an opinion editor for MS NOW Daily. 
