For all that President Trump loves to portray himself as a protector of Americans' healthcare -- witness his fatuous new claim to have "saved Pre-Existing Conditions in your Healthcare," when he's actually undermined those safeguards -- perhaps the most consistent administration healthcare policy has been an attack on Medicaid.
The new year brings the opening of a new front in this war on the government program specifically aimed at bringing coverage to low-income households. The White House says it's planning to tighten eligibility rules for Medicaid.
That's a process experts say is likely to raise administrative costs for states, reducing the funds available for medical treatment, and throw potentially millions of people off the program even though they are eligible.
It's happening, furthermore, despite the absence of credible evidence that eligibility rules have been abused.
"We haven't seen any compelling data that there's widespread eligibility fraud," says Joan Alker, a leading Medicaid advocate as executive director of the Center for Children and Families at Georgetown University.
The administration's push for tighter eligibility oversight, however, has states nervous that they're about to be saddled with onerous new bureaucratic responsibilities.
State Medicaid officials acknowledge that in a program covering more than 71 million people nationwide, some enrollees may not meet all the economic and categorical qualifications.
But "we don't see the-sky-is-falling type of stuff," says Matt Salo, executive director of the National Assn. of Medicaid Directors. His members' concern, he says, is that the administration will propose "a laser-guided mousetrap for a mouse."
We've reported before on the hostility shown by the Trump administration -- and political conservatives generally -- for Medicaid.
Based in part on animus shown by conservatives to any program specifically devoted to lower-income residents, it increased sharply after the Affordable Care Act allowed states to expand Medicaid eligibility beyond the traditional population of low-income families with children to include low-income childless adults.