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Afew weeks ago, we argued the Trump administration was seeking to invent new ways to punish Americans. The idea was that the authoritarian impulses of the MAGA-run government will need to dial up the cruelty in order to sow chaos and pave the way for a broader assault on democracy.

Well, this week a rule was issued by Medicare and Medicaid services that shows just how proficient the Trump administration is at inflicting pain. And the consequences for poor, seriously ill Americans could be devastating.

Before we explain the rule, it’s worth contemplating the often destructive role healthcare — both the lack of it and exorbitant costs associated with it — play in the lives of working-class Americans.

Poll after poll shows that working people rank anxiety over healthcare costs at the top of the list of high-priority concerns. Unpaid medical bills are the most likely cause of personal bankruptcy in the US. Unlike any other wealthy nation on earth, when Americans lose their jobs, they often lose access to a doctor as well.

The US healthcare system is already inherently extractive — making it even more prohibitively expensive means more people will suffer with diseases that can be cured and die from afflictions that would otherwise be treatable. All of this makes the working class vulnerable and likewise incapable of asserting their right to be healthy.

Trump Is Making America Uninsured Again

And that’s where the new rule comes in.

The government agency that administers Medicaid has created a new criterion, ‘medically frail,’ which must be met to qualify for the program without working — even if you only have weeks to live. It didn’t exist prior to the passage of the Big Beautiful Bill.

Before that landmark legislation was signed into law, Medicaid was primarily a means-tested program, accessible to those with low enough incomes to qualify. But the........

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