Credit: Amy Swan

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In January 2018, the Centers for Medicare & Medicaid Services announced that it would support states that wanted to add work requirements to Medicaid. Six months later, Arkansas became the first state to put that guidance into practice.

The results were disastrous. More than 18,000 people lost health coverage. It turns out, however, that most of those people had met the requirement or qualified for an exemption. So why did they lose their health care? The new regulations required recipients to log their hours online—something that was almost impossible for those who had no internet access or who tried accessing the website during its nightly shutdowns. Meanwhile, administrative mistakes meant lost coverage for thousands.

A district court halted Arkansas’s work requirements, concluding that states cannot “refashion the program Congress designed in any way they choose.” The rule has since bounced around in the court system, as more states have attempted to add work requirements, and more judges have struck them down. The Trump administration will likely take their case to the Supreme Court, and there is no telling how the Court might rule on it.

Medicaid work requirements are just a glimpse into the Trump administration’s unified, coherent, and intentional assault on the safety net. It has also targeted food stamps, public housing, health care, and immigrant services with changes that would make benefits harder to access. These attacks ignore the broad public support of government programs, and reams of social-science research, putting millions of Americans at risk.

But unlike the GOP playbook of yore, where changes or cuts to safety net programs played out through the legislative process, Trump’s approach takes place almost exclusively behind the scenes—through executive actions and administrative rule making, and in the federal courts. While some of the administration’s proposals have proceeded, the courts have, until now, served as an important bulwark against these initiatives. If Trump wins a second term, that’s likely to change.

Republican efforts to cut safety net programs are not new. When Ronald Reagan came to power in the early 1980s, he launched an aggressive campaign against the welfare state, arguing that Lyndon Johnson’s Great Society project was “the central political error of our time.” The Reagan administration reduced funding for a range of safety net programs and restructured them to shift authority to the states.

Republicans accomplished much of their agenda in that era by working with moderate and conservative Democrats. But that bipartisanship—as well as public support for many antipoverty policies—limited their efforts to dismantle the programs.

Trump differs from his conservative predecessors in that he has made no such effort to work with Democrats. His first attempt to repeal the Affordable Care Act was profoundly unpopular, with support for the effort polling in the teens and 20s, the lowest ratings for any major piece of legislation in at least a generation. Republicans nonetheless tried to ram through several bills, which generated widespread protest and outrage, and eventually failed. Congressional efforts to cut the Supplemental Nutrition Assistance Program (SNAP), otherwise known as food stamps, were also unsuccessful.

Past Republican presidents tried to cut social programs through legislation. Trump’s approach is taking place almost exclusively behind the scenes.

And so, the Trump administration has shifted its attention away from Congress and to the rule-making process. Last year, in the span of nine months, the Agriculture Department proposed a bevy of changes to SNAP. For example, they proposed tightening work requirements and raising the income and asset limits that determine eligibility. Court decisions have stopped work requirements for now, and the asset rule has yet to go into effect. But if it does, about three million people will lose benefits.

Other agencies have been busy changing rules, too. Under dispute in the courts now is a proposal from the Health and Human Services Department that would allow health care providers to withhold medical services, medications, and information if they have moral or religious objections.

The Department of Housing and Urban Development proposed a rule forbidding people who qualify for public housing from living with an undocumented family member. For some, loss of housing or family separation would become the only options.

In many instances the courts have blocked these changes. But there are ominous signs on the horizon—specifically from the Supreme Court. In January, it overturned a lower court’s injunction and allowed the Department of Homeland Security’s “public charge” rule to move forward. The rule allows the federal government to deny green cards to immigrants who use Medicaid, food stamps, housing vouchers, or other forms of public assistance. In late February, the administration began implementing that change.

The lower courts’ resistance to the administration’s proposals has come to frustrate many prominent conservatives, including at least one on the Supreme Court. Justice Neil Gorsuch has criticized this “increasingly common” use of nationwide injunctions by district court judges to halt government policies, and has vigorously urged the Court to confront the issue.

If given four more years, Trump will continue to work with Republicans in the Senate to reshape the judicial system to accommodate conservatives’ decades-long goal of dismantling the welfare state. He has, at breakneck speed, already appointed more than a quarter of the active judges on the U.S. Court of Appeals. His judicial appointees are also comparatively younger than his predecessors’, extending their long-term power. Trump’s judicial legacy will entrench conservative governance for the foreseeable future.

IThe U.S. safety net is not easily understood. More than 80 interwoven and interdependent programs are spread across several departments and agencies. Nearly every program has different application procedures, eligibility criteria, and benefit levels. For millions of underemployed workers, children needing free lunch, families with exorbitant health care bills, people who cannot work because of a disability or chronic illness, and others, these programs may be the only reason they get by. But the vastness of the safety net makes it difficult to protect.

The programs do, however, have one unifying element: Nearly all of them use the federal poverty line to determine eligibility. Changing that line would hit all the programs at once, upending the lives of millions.

In 2019, the Trump administration proposed redefining the poverty line formula and changing how inflation is factored in. While it is not clear which inflation index the administration would use, it seems likely they would choose one that grows slowly. In other words, as the cost of living increases for everyone, the federal poverty line would stay comparatively low.

This change would ripple across the dozens of federal programs that use the poverty line in some way. More than 250,000 low-income seniors and people with disabilities would receive less help from Medicare, or lose it altogether; over 300,000 children would lose comprehensive health coverage, as would some pregnant women; at least 250,000 adults would lose health care coverage that they gained through the ACA’s Medicaid expansion; around 40,000 infants and young children would lose nutritional supplements; and more than 200,000 people, most of them in working households, would lose food stamps.

It is unclear whether the administration even has the authority to make this change on its own, but that has not stopped them before. For now, the rule is under review and hasn’t been finalized. If it is, it will almost certainly be challenged in court. But if that case comes before a judge who is sympathetic to the administration’s argument, millions of Americans could lose access to health care, food assistance, prescription drug benefits, heating assistance, or housing subsidies.

Government antipoverty programs work. Census data shows the massive economic impact these programs have on low-wage workers: In 2018, income from these programs kept more than 47 million people out of poverty. During economic downturns, they play a critical role in helping low-income families meet basic needs and act as a stimulus for the economy. Studies of the Great Recession suggest that the effects of unemployment spikes and poverty increases were buffered by safety net programs that acted as a counterforce. The changes proposed by the Trump administration will likely obliterate this cushion in the next recession.

Incomes are soaring and poverty is plummeting, Donald Trump said during the State of the Union address in February. “Our economy,” he said, “is the best it has ever been.” The facts reveal a different reality. A 2017 study showed that nearly 40 percent of Americans cannot pay for a $400 emergency expense. Income inequality is worsening, and the racial wealth gap is widening. Real wages have stagnated. Inflation and rising prices are creating new economic burdens for low-income families. A third of Americans struggle to afford food, shelter, or medical care. Social mobility has plummeted.

The 2021 budget proposal confirms Trump’s intent to cut social programs. Billions of dollars in spending on programs that provide economic stability and health care for families could be slashed. Student loan assistance, Medicaid, children’s health insurance, food stamps, housing assistance, disability insurance, heating assistance, and Medicare all face major reductions.

If Trump wins a second term, the emergence of a stingier, more punitive, and increasingly burdensome safety net would be a high priority for the administration. The federal court system—not Congress—would become the primary battlefield where social policy is contested. The judicial system, ripe with appointments of like-minded judges and perhaps another justice to the Supreme Court, would wage the administration’s war on the safety net. The damage to the policy infrastructure would not be easily undone. In the meantime, millions of already sidelined Americans would become hungrier, sicker, and more vulnerable, eradicating any shot at the American dream—or even just plain survival.

Ryan LaRochelle and Luisa S. Deprez

Follow Ryan LaRochelle and on Twitter @r_m_larochelle. Ryan LaRochelle is a Lecturer at the Cohen Institute for Leadership and Public Service at the University of Maine. Luisa S. Deprez is Professor Emerita of Sociology and Women & Gender Studies at the University of Southern Maine. They co-lead the Maine Scholars Strategy Network Working Group on Social Policy and the Safety Net.