Popular vote loser Donald Trump swore in the campaign that he wouldn't cut critical social insurance programs—Medicare, Social Security, and Medicaid. But Trump says a lot of things, not a lot of which can be believed. When it comes to Medicaid, look to his actions, and what Republicans are already doing with his support with Obamacare repeal.

First, Congressional Republicans currently plan to repeal Medicaid expansion as part of their ACA repeal efforts. In 2015, Medicaid expansion was responsible for covering nearly 11 million newly eligible enrollees. However, although they can repeal expansion through reconciliation with only 51 votes, rolling back this successful program might not be as easy as they expect. […]

Second, the Congressional majority hopes to realize its longtime dream of changing Medicaid’s financing structure to a block grant. Instead of the current system of the federal government matching a certain share of state Medicaid payments, under this approach states would receive capped payments. Since the size of the block grants would grow more slowly than health cost inflation, this would increasingly shift costs onto state budgets over the years, especially during recessions. […]

Third, key members of the incoming administration hope to aggressively transform Medicaid’s benefits, eligibility, and cost-sharing through administrative actions and waivers – undermining the program without needing Congress’s help. Over the past few years, we’ve seen a limited preview of this in some states that have used waivers from the federal government to take more conservative approaches to expanding Medicaid, often focused around increased cost-sharing and health savings accounts. For example, Indiana requires Medicaid expansion enrollees to pay premiums to receive the full benefits plan; those below the poverty level who don’t pay are shifted to a more limited plan, while those above the poverty level who don’t pay are dropped from coverage and banned from re-enrolling for six months. […]

The success of these three major threats to Medicaid is not inevitable. But the first step to resisting them is recognizing that the Congressional Republican agenda for health care goes much further than repealing the ACA: President-elect Trump is entering office armed with the power to fundamentally undermine and weaken America’s health care safety net.