Two months into Donald Trump’s second term, his Republican attack dogs, including Elon Musk and his minions at DOGE, are still busy chewing into many parts of the federal government. But the Trump Administration continues to promise that it will protect three major entitlement programs that together account for nearly half of all federal spending. “The Trump administration will not cut Social Security, Medicare, or Medicaid,” the White House wrote in a statement a couple of weeks ago. “President Trump himself has said it (over and over and over again).”
Of course, Trump says many things that bear little relation to reality. During last year’s Presidential campaign, he insisted that he had nothing to do with Project 2025—the Heritage Foundation’s nine-hundred-page blueprint to reshape the federal government, which describes Medicare and Medicaid as the “principal drivers of our $31 trillion national debt.” Lo and behold, one of the authors of that report, Russell Vought, is now the director of the Office of Management and Budget, where, according to his White House bio, he is “responsible for overseeing the implementation of the President’s policy, management and regulatory agendas across the Executive Branch.”
The alliance of radical conservative activists like Vought, who have long had entitlements in their sight, with Ayn Randian tech bros like Elon Musk, who enthuse about “efficiencies,” is perhaps the distinguishing feature of Trump 2.0. Project 2025 contains a number of proposals to reform Medicare and Medicaid, but it largely stays away from Social Security, which for years has been considered the third rail of American politics. Musk has shown fewer reservations. In an interview with the podcaster Joe Rogan, he described Social Security as “the biggest Ponzi scheme of all time.” In online posts and an appearance on Fox Business, he also claimed that there were more than twenty million people aged a hundred or older in the Social Security database, and he suggested that this could be evidence of pervasive fraud. (Trump repeated these allegations in a speech to Congress.)
It seems clear that Musk, Trump, and other Republicans have decided that the “waste, fraud, and abuse” narrative provides them with a more effective means of mobilizing support for cuts to entitlements than the traditional arguments about rising deficits and debt. After Musk and Trump made their claims about dead Social Security recipients, the acting head of the Social Security Administration, Leland Dudek, had to issue a press release explaining that the data they cited came from people with Social Security numbers who “do not have a date of death associated with their record” but who “may not be receiving benefits.” In other words, Musk and Trump were spreading disinformation.
Dudek was promoted when his predecessor resigned, in mid-February, following clashes with DOGE staffers who were attempting to access information about Social Security recipients. Although Dudek has corrected some of Musk’s misstatements, he has also embraced the DOGE cost-cutting agenda. Since he took over, the Social Security Administration has announced plans to reduce its workforce by about twelve per cent. It is shuttering dozens of local field offices, even as it is changing its rules so that Social Security claimants who aren’t able to confirm their identities online are obliged to appear in person. (Until now, people could confirm their identities over the phone.)
With new developments practically every day, it’s hard to keep up with everything relating to entitlement programs. The key thing to remember is that there are two distinct but related stories unfolding. One is the ongoing campaign by Musk and DOGE to chip away at the Social Security Administration and other government departments. The other story, which has received much less media coverage, is playing out on Capitol Hill, where Republicans are looking for spending cuts to finance an extension of the feed-the-rich tax cuts they passed during the first Trump Administration. All the indications are that they are preparing to target entitlement programs that serve the poor, particularly Medicaid and food assistance.
The two stories intersect because any permanent savings that Musk and his colleagues would make could be applied to future budgets. Also, if DOGE did uncover genuine fraud and waste on a large scale, Republicans on Capitol Hill could conceivably exploit this to build public support for their own cuts. So far, however, the DOGE investigators have come up largely empty-handed, while the sight of the world’s richest man leading an assault on programs that serve some of the poorest and most vulnerable Americans has alarmed even some elected Republicans. “It doesn’t help the President,” Senator Lisa Murkowski, of Alaska, said last week, referring to Musk’s role. She also registered concerns about the closure of Social Security field offices and the elimination of employees who answer call lines, warning, “I can tell you it’s not going to go over well.”
Meanwhile, economists and other number crunchers are analyzing the budget resolution that House Republicans passed late last month, which Trump endorsed, saying it “implements my FULL America First Agenda.” To make space for four and a half trillion dollars in tax cuts over ten years, the resolution instructs various House committees to find nearly two trillion dollars in cuts to programs that come under their purview. This figure includes eight hundred and eighty billion dollars from the Energy and Commerce Committee, which oversees Medicare and Medicaid, and two hundred and thirty billion dollars from the Agriculture Committee, which manages the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program. Another five hundred billion dollars in cuts were left unspecified.
Some Republicans have denied that they are singling out Medicaid and SNAP for big cuts, but simple arithmetic undermines this claim. According to the nonpartisan Congressional Budget Office, Medicare and Medicaid make up more than ninety-seven per cent of the spending that the Energy and Commerce Committee oversees. Cutting Medicare, which is partly funded by payroll contributions from working Americans, is politically contentious. But, “if you don’t touch Medicare, the math doesn’t work without deep cuts to Medicaid,” the Democrats on the House Budget Committee noted. In theory, the Agriculture Committee has a bit more leeway to cut other programs aside from SNAP, but, in practice, the food-assistance program appears to be its main mark.
Medicaid, which was created in 1965 alongside Medicare, is administered by the states, but the federal government bears about seventy per cent of its cost. Once a relatively small program for the aged and impoverished, it is now a pivotal component of the nation’s over-all safety net. Under the Affordable Care Act of 2010, it was expanded to make it accessible to Americans of all ages with income of up to a hundred and thirty-eight per cent of the poverty line. By October of last year, enrollment in Medicaid had risen to about 72.1 million, which means that about one in five Americans depend on the program.
At the local level, nineteen states with Republican governors have chosen to participate in the Medicaid expansion. It’s a great deal for the states: in this case, the federal government picks up ninety per cent of the cost. At the national level, however, the G.O.P. has remained committed to chopping back the program. In Project 2025 and other venues, Republican policy analysts and legislators have suggested multiple ways to do this, including imposing strict work requirements on enrollees, capping spending on a per-capita basis, and pushing more of the costs onto the states. Republicans have claimed that reforms of this kind wouldn’t prevent eligible enrollees from receiving the health care they require. But this argument doesn’t stand up to inspection.
