Trump and Medicaid: Understanding the future of low-income health insurance

The Trump administration’s approach to federal aid has sparked intense debate, particularly concerning Medicaid, the largest public health insurance program in the United States. Recent policy shifts have raised questions about the program’s stability and the potential impact on millions of low-income Americans who rely on it for essential health care services.


When the White House Budget Office issued a memo instructing federal agencies to pause spending on financial assistance programs pending an internal review, concerns mounted over Medicaid’s future. The online Medicaid reimbursement portal, used by states to process payments, was reportedly inaccessible following the announcement, despite reassurances from the Office of Management and Budget that Medicaid would not be affected.

Following swift legal challenges from 22 state attorneys general and a temporary federal injunction, the administration rescinded the funding freeze. The reversal alleviated immediate concerns, but broader questions about Medicaid’s role under Trump’s leadership remain.


Medicaid, established in 1965 as part of President Lyndon B. Johnson’s amendments to Social Security, was designed to provide health insurance to individuals and families who could not afford private coverage. Today, it is a nearly $900 billion program funded jointly by federal and state governments, with over 79 million Americans enrolled as of October 2024.

The program covers a wide range of beneficiaries, including newborns, children, low-income individuals and families, people with disabilities, and nursing home residents. According to Joan Alker, executive director of Georgetown University’s Center for Children and Families, Medicaid serves as “the backbone of many aspects of our health care system.”

Despite the program’s essential role, Medicaid has often been at the center of political battles over government spending and health care reform.


Medicaid eligibility is based on income, family size, disability status, and age, with variations across states. Under the Affordable Care Act (ACA), Medicaid expanded to include adults earning up to 138% of the federal poverty level, which equates to roughly $20,783 for an individual in 2024.

Medicaid enrollment has surged in recent years, rising 20% since October 2023 and 66% since October 2022. The growing enrollment underscores the program’s importance as a safety net for millions of Americans, though experts caution that fluctuations in policy could create instability.



During Trump’s first administration, Medicaid faced significant threats, including attempts to repeal the ACA and implement deep funding cuts. One of the most notable moments came in 2017 when Senator John McCain cast a decisive vote against the “skinny repeal” of the ACA, preventing sweeping changes to Medicaid.

Trump’s American Health Care Act (AHCA) sought to alter Medicaid eligibility, reduce federal funding, and weaken protections for individuals with pre-existing conditions. While the AHCA ultimately failed, other policies under Trump’s administration, such as the repeal of the ACA’s individual mandate, contributed to an increase in uninsured Americans. By the end of 2019, 13.7% of adults were without health insurance, the highest level since early 2014, according to Gallup.

As Trump returned to the campaign trail for the 2024 election, Medicaid remained largely absent from his policy discussions. While he occasionally mentioned potential changes to Medicare and Social Security, he did not lay out a detailed Medicaid strategy. In a March 2024 post on Truth Social, he stated he was “not running to terminate” the ACA but aimed to make health care “better” and “less expensive.” However, he provided little detail on how he intended to achieve these goals.

Health care experts and advocacy groups remain concerned that another push to cut Medicaid funding could emerge. “Medicaid will be turning 60 this year, so we are very concerned that that proposal may arise again,” Alker warned, emphasizing that reducing federal funding could place an unsustainable burden on states.

With an aging population and an increasing need for long-term care, Medicaid’s future remains a crucial issue. As policymakers and the public debate the best path forward, the program’s role as a lifeline for millions of Americans continues to be a pressing national concern.