During the presidential campaign, Donald Trump issued regular promises to “take care” of ordinary Americans. He mentioned two groups in particular: the inner-city poor (who, for Trump, were a synecdoche for black Americans) and the rural and Rust Belt victims of the opioid crisis. “First, we have to support locally based and locally run clinics, and we gotta close up the border,” he said during a November 2015 stop in New Hampshire. “In the meantime, people are getting hooked, and we’re going to take care of those people.” Just before the election, he detailed his plans for dealing with addiction in America’s rural and post-industrial communities. “I want to dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment,” he said, in a speech that called for more federal resources to reduce and treat opioid addiction.
Trump was less specific when speaking about inner cities—which he routinely described as lawless “war zones” of poverty and crime—but there, too, he said he wanted to help. “The African-American community has been taken for granted for decades by the Democratic Party. It’s time to break with the failures of the past—I want to offer Americans a new future,” he said last year in remarks to supporters in Wisconsin.
Those were Trump’s promises, building blocks of his image during the campaign, that of a caring, competent businessman. Enough voters—or at least, enough white voters—bought that image to give him an Electoral College victory, and thus the White House. Now, less than two months into his presidency, Trump is betraying both promises (and both groups of voters) in dramatic form. That this isn’t a surprise—as a businessman, Trump was notorious for cheating partners and shortchanging customers—doesn’t make it any less shocking.
On opioid addiction, Trump has committed his administration to the exact opposite of what he’s promised. Medicaid, the joint state-federal health program for poor and low-income Americans, is an integral part of the fight against the still-rising opioid painkiller and heroin epidemic, which contributed to tens of thousands of overdose deaths in 2015. It covers more than 70 million people and is the largest source of funding for behavioral health treatment, like addiction recovery and substance abuse prevention. Indeed, the Affordable Care Act required Medicaid to start paying for all available addiction treatments, beginning in 2014. And in the 31 states that expanded the program under Obamacare, 1.2 million people have gained coverage for substance abuse treatment. (Overall, according to one analysis, the ACA expanded access to drug abuse treatment for 2.8 million Americans.) Medicaid is far from perfect—varying rules for covering opioid addiction medication, as well as tough eligibility requirements in some states, make it less effective in combating substance abuse than it might be—but it’s still a valuable tool. If Trump were serious about fighting opioid addiction, he would at least commit to strengthening the program.
Instead, he’s put his weight behind the American Health Care Act, the Republican-drafted alternative to the Affordable Care Act. “I think we’re going to have a tremendous success,” President Trump has said of this bill. “We’re going to do something that’s great and I’m proud to support the replacement plan released by the House of Representatives and encouraged by members of both parties.”
Not only would the bill phase out the Medicaid expansion, but it would eliminate a host of coverage requirements for insurers, including coverage for drug treatment. Millions of Americans would lose insurance altogether (to pay for lower taxes on high earners) while those still on Medicaid would lose access to help for addiction and substance abuse. And on top of those measures, the AHCA would base Medicaid payments on enrollment, rather than cover a percentage of expenses. In the long run, this would reduce federal Medicaid support and result in fewer beneficiaries and less coverage. For low-income individuals who buy subsidized insurance on the individual market, the AHCA would slash their tax credits. In one swift move, millions of Americans would lose meaningful access to health insurance, which is to say, millions who struggle with addiction will lose the help they need. And this is to say nothing of treatment facilities that rely on federal dollars to operate. Under this bill, they lose out too.
The picture for cities is as bleak. According to budget documents obtained by the Washington Post, the White House is mulling more than $6 billion in cuts to the Department of Housing and Urban Development. This would help pay for Trump’s promised increase of $54 billion for the Department of Defense. These cuts, which amount to 14 percent of HUD’s budget, would fall hardest on public housing residents as well as recipients of housing vouchers. They would slash $1.3 billion from funds for repairing public housing units, $300 million from rental assistance payments (including vouchers for homeless veterans), and $4 billion in community planning and development grants, eliminating programs to combat urban decline and poverty.
It’s difficult to overstate the harm of these cuts to HUD. Nationwide, the vacancy rate for low-cost units has fallen to single digits, and federal housing assistance has been stretched to a breaking point. “Three in four families who qualified for assistance received nothing,” wrote sociologist Matthew Desmond in his book Evicted: Poverty and Profit in the American City. Again, this is before Trump has done anything. Desmond also noted that in 2013 “between 50 and 70 percent of poor renting families spent half of their income on housing and between 25 and 50 percent spent at least 70 percent on it.” The cuts proposed by Trump would mean more housing instability and concentrated poverty, fewer opportunities for cities and localities to develop and provide affordable housing.
All of this suffering would be compounded by the rest of Trump’s agenda, from the “reverse Robin Hood” moves of the American Health Care Act to proposed cuts to food stamps and other assistance for the poor. The president’s promised aid isn’t coming. What is coming, however, is increased spending on law enforcement, new contracts with private prisons, and support for draconian policing strategies. Trump will “assist” the urban disadvantaged by criminalizing them even further.
From Trump University to his litany of failed projects and developments, Donald Trump is infamous for the bait and switch, selling fantasies of luxury, then ensnaring buyers in schemes of wealth extraction. As president, Trump is making this an ethos of government, promising to help the disadvantaged, and using that mandate to slash benefits and funnel tax dollars to the wealthy and connected. The Trump image always has been and continues to be a con, and we, the American public, have been had.