The Trump administration has launched an unrelenting offensive against Medicare—a centerpiece of American social policy that once stood as a minimal, yet vital, bulwark against poverty, illness, and suffering in old age.
Over the last three months in particular the scale and intensity of the assault have plumbed new depths. Through a combination of executive orders, regulatory sabotage, and covert restructuring, the administration has moved aggressively to privatize and dismantle what remains of this already frayed public health program.
The groundwork for this onslaught was laid by the Democratic Party—most notably under the Obama and Biden administrations—which facilitated a gradual but decisive shift toward privatization through their expansion and promotion of Medicare Advantage (MA). The Democrats’ bipartisan complicity with the Republicans has been essential in converting Medicare from a guaranteed public benefit into a goldmine for private insurers, eager to profit from taxpayer funds while offering seniors narrower care options and fewer protections.
What Trump has done—openly and without apology—is push the program closer to the edge of total privatization. His administration’s decisions reflect a calculated strategy of the financial oligarchy to gut federal oversight, reward corporate interests, and leave millions of elderly and disabled Americans at the mercy of private profiteers.
Trump’s central mechanism of destruction is the Medicare Advantage (MA) program, a privatized alternative to traditional Medicare. MA plans already receive up to 20 percent more in federal payments per enrollee than traditional Medicare, a disparity driven by fraudulent practices such as “upcoding,” where insurers inflate patients’ diagnoses to garner larger reimbursements, and “favorable selection,” in which they cherry-pick healthier individuals while billing the government as if they were chronically ill.
Rather than curb these abuses, the Trump administration expanded them. In April, it approved a 5.06 percent increase in MA payments for 2026, further funneling public money into corporate hands. It also took steps to make MA the default enrollment for new beneficiaries—an outrageous move that undercuts informed consent and stacks the deck against public Medicare.
Moreover, the Trump administration aggressively marketed MA plans through official emails from the Centers for Medicare & Medicaid Services (CMS) that closely resembled advertisements. Insurance brokers were secretly incentivized with undisclosed bonuses to enroll seniors in MA plans, often without clear explanation of the consequences.
Many of these plans limit provider access, require prior authorization for treatment, and deny necessary services, disproportionately affecting those with complex health needs. This is not about “choice,” as the administration cynically claims. The inevitable effect will be to steer seniors into profit-making schemes masquerading as public policy.
Simultaneously, Trump is overseeing a decimation of the very federal agencies tasked with administering and protecting the integrity of Medicare. In March, the CMS, which is supposed to regulate MA plans and ensure quality of care, lost 300 staff members. Around the same time, key offices, like the Medicare-Medicaid Coordination Office and the Office of Minority Health, were gutted. In April, half of all regional offices within the Department of Health and Human Services (HHS) were closed.
The Social Security Administration (SSA) was similarly targeted, with 7,000 job cuts on the table in February and proposals in April to impose burdensome ID requirements that would impede access to benefits—particularly for the most vulnerable seniors. The Assistant Secretary for Planning and Evaluation (ASPE), a crucial advisory agency for health policy, saw 70 percent of its staff laid off in May. Even the Office of Inspector General—tasked with investigating fraud in Medicare—suffered leadership disruptions in January.
Oversight of the already corrupt MA system was crippled. Fraud detection was weakened. Public outreach vanished. And seniors were left to navigate a hostile system with fewer resources, less guidance, and growing dependence on for-profit actors.
In April, Trump also dismantled the Administration for Community Living (ACL), slashing 40 percent of its staff. Among the casualties were programs like the State Health Insurance Assistance Program (SHIP) and the Senior Medicare Patrol (SMP), which provide critical, unbiased counseling and fraud prevention. Their elimination not only leaves seniors vulnerable to misinformation and financial exploitation but also represents a conscious shift away from collective support in favor of individualized survival in a predatory marketplace.
While Medicare was being aggressively privatized, Trump’s parallel war on Medicaid struck a devastating second blow to millions of low-income seniors and people with disabilities who depend on both programs. Central to this assault was the One Big Beautiful Bill Act, passed by the House in May 2025, which proposed slashing up to $793 billion from Medicaid over ten years.
The bill imposed punitive work requirements, burdensome documentation mandates, and frequent eligibility reviews—all under the false banner of “reform.” In reality, these measures were calculated to obstruct access, overwhelm beneficiaries with red tape, and deter enrollment, effectively stripping vital healthcare from the most vulnerable sections of the population.
The consequences would be immediate and catastrophic. An estimated two million people, most of them dual-eligibles, stand to lose Medicaid access—cutting them off from assistance with Medicare premiums, co-pays, and essential services like long-term care. For these individuals, the combined impact of MA privatization and Medicaid retrenchment is catastrophic: more out-of-pocket costs, increased medical debt and worsening health outcomes.
Some of these attacks seek to reverse modest improvements made under Biden, such as streamlined Medicaid enrollment for dual-eligibles. Yet the fact that these improvements could be so easily dismantled underscores the Democratic Party’s failure to entrench them meaningfully in law or mobilize the public against privatization. Instead, both parties have treated healthcare as a bargaining chip, regardless of the tactical differences.
In an attempt to present himself as a populist reformer, Trump signed executive orders claiming to lower prescription drug prices—like the “Most-Favored-Nation” rule, which purports to match US drug costs to those in other countries. But these orders were performative, lacked congressional backing, and were quickly blocked by courts. They were little more than propaganda designed to distract from the administration’s real health policy agenda: slashing spending and placing more of the burden on individual patients.
The effects of Trump’s Medicare policies are being felt nationwide. Financially, overpayments to MA plans have already inflated Part B premiums by $13 billion annually. Proposed Medicaid cuts would eliminate assistance for millions of low-income beneficiaries. These financial burdens translate directly into skipped doctor visits, delayed care, untreated illnesses and premature death.
Medically, MA plans narrow provider networks and delay care with bureaucratic barriers like prior authorization. Seniors with chronic or serious conditions face increasing difficulty accessing specialists or continuing care with longtime providers. At the same time, public programs that help seniors understand their options have been dismantled, leaving them dependent on insurers that thrive on confusion and misinformation.
In the long term, the privatization agenda is unsustainable. The Medicare Trust Fund is expected to become insolvent by 2033, a crisis exacerbated by the hemorrhaging of public dollars into private MA plans. With enrollment in MA projected to reach 60 percent by the end of the decade, traditional Medicare risks becoming a neglected relic—underfunded, underutilized and available only to those unable to “opt into” private care.
This trajectory points to the emergence of a two-tiered healthcare system: a profitable, selectively accessible private system for those who can afford it, and a stripped-down, increasingly inadequate public option for everyone else. Such a future is not inevitable—but it is the logical outcome of bipartisan policy choices that treat healthcare as a corporate asset instead of a social right.
The Trump administration’s attack on Medicare is nothing short of an assault on the working class and elderly population of the United States. It is driven by the demands of Wall Street and the healthcare industry, which view Medicare as a lucrative source of revenue—not a lifeline for tens of millions. Meanwhile, unlimited funds are allocated for war and repression by a bipartisan alliance.
Trump did not act alone. His policies were made possible by decades of Democratic complicity. The Obama administration accelerated MA expansion, failed to crack down on fraud, and promoted “value-based care” models that blur the line between public and private systems. Biden’s administration, while reversing some of Trump’s first term moves, continued to promote privatized “innovation” over genuine public expansion.