Medicare and Medicaid Administrator Mehmet Oz, speaks before US Vice President JD Vance delivers remarks on the administration's work to combat fraud in Milwaukee, Wisconsin, on July 8, 2026. Photo by Mark Schiefelbein / POOL / AFP via Getty Images

A few 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.

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 new rule means even if you have pancreatic cancer, HIV, or Parkinson’s, you will have to meet work requirements to maintain eligibility, or prove you are too sick to comply. Your doctor’s opinion won’t matter. It will be up to the bureaucrats.

Essentially, this amounts to navigating a process fashioned explicitly to kick people off the program. That means filling out forms and filing papers and hoping someone sitting at a desk determines you comply with a definition critics say is vaguely written and open to interpretation.

This is all part of a scheme hatched during the passage of the massively destructive Big Beautiful Bill last year. Trump and his MAGA cohorts wanted to give a trillion-dollar tax break to the top one percent. But the cuts were projected to add trillions to an already historically high federal debt.

So, to conjure a so-called “pay for,” Republicans turned to Medicaid, the critical program that provides healthcare to the poorest Americans.

Simply slashing funding was politically unpalatable, even for the party best known for trying to dismantle Obamacare multiple times without providing a viable alternative. So Republicans came up with a workaround: make it more difficult to qualify.

In practice, that translated into the aforementioned new work requirements.

The medical frailty rule shows, in part, how this overarching plan will lead to fewer beneficiaries: create a complicated bureaucracy difficult to navigate, then cut people who can’t comply.

The nonpartisan Congressional Budget Office projects the additional work rules will lead to 11.8 million people dropping Medicaid over the next decade — 7 million of whom they project will not find insurance elsewhere.