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Last week, at a private Easter lunch, Donald Trump was caught on a hot mic saying that with the country at war, the federal government should offload Medicaid, Medicare, and child care expenditures onto the states. “We have 50 states. We have all these other people. We’re fighting wars,” the MAGA leader said. “It’s not possible for us to take care of day care, Medicaid, Medicare, all these things.”

Offloading vast medical expenses onto the states, the president acknowledged, would pressure states to raise their taxes, but that’s simply the price of doing war for Trump. For someone who campaigned on a cast-iron promise to strengthen Medicare and not start “new wars,” it was a stark U-turn that may put the health care access of tens of millions of Americans at risk.

Faced with a public relations debacle, the White House spin doctors immediately went into damage control, implausibly claiming that Trump was only talking about tackling “fraud” within these systems. Yet their efforts were undermined by the budget proposal that Trump released just days later, which reiterated the commitment to massively jack up military spending, including a nearly 50 percent year-on-year increase in the Pentagon’s budget at the expense of pretty much every part of the existing safety net. Trump is now urging the GOP to pass it in the next two months by budget reconciliation. Should Republican leaders decide to go down this route, they could bypass the Democrats and, despite the deep unpopularity of cuts to health care spending, implement an assault on the country’s health care services without going through the normal process of negotiations and compromise.

Trump’s budget — which comes on top of the trillion dollar-cuts to health care spending over the next decade thanks to his “big, beautiful bill” — includes a 12.5 percent (or $5 billion) cut to Health and Human Services; huge cuts to the Agency for Healthcare Research and Quality; a gutting of health care services aimed at the LGBTQ community; large reductions in spending on behavioral health services; and a........

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