While insisting repeatedly that he “won’t harm Medicare or Social Security or touch Medicaid,” President Trump’s draconian and chaotic program eliminations, personnel firings and policy reversals reveal quite the opposite: a full assault on Medicare and its beneficiaries is well underway.

The thrust of the administration’s campaign is obscured by ceaseless denials about the nature and severity of their actions, ongoing assurances of how much they “love our seniors” and misleading claims that their extreme policies are merely overdue reforms designed to fight “bloat, inefficiency and fraud.”

Below are three examples of interrelated programs that are targeted for severe personnel and service cuts, each essential for Medicare’s continued viability.

• Social Security. SSA serves as the gateway to Medicare. The agency makes Medicare’s initial eligibility and enrollment decisions, determines late penalties, assesses premium amounts and hears appeals and grievances.

Following Trump’s assurances about Medicaid, DOGE announced personnel layoffs totaling 7,000, claiming the agency was “bloated.” According to the Medicare Rights Center, however, SSA has been underfunded and understaffed for many years, and presently its staffing level is at a 25-year low, hardly a sign of bloat.

DOGE’s actions succeeded mostly in delaying people’s access to Medicare benefits and services, especially older, poorer and rural beneficiaries and those with disabilities with less proximity to SSA resources, affordable transportation and accessible technology.

• Medicaid: According to the MRC, cutting Medicaid is equivalent to cutting Medicare, citing the 68 million Medicare enrollees, 20% of whom need Medicaid to access and afford essential health and long-term care. Moreover, 30% of all Medicaid spending directly supports Medicare recipients.

Medicaid helps Medicare beneficiaries pay their monthly premiums and out-of-pocket costs. Additionally, the program serves as primary payer for long-term care, providing services in settings ranging from homes and daycare/respite centers to assisted living and nursing facilities. Finally, Medicaid covers services that Medicare does not, including dental, hearing and vision care.

Medicare and Medicaid (aka MaineCare) are especially important in Maine where, according to KFF (formerly the Kaiser Family Fund), in 2024 twenty-six percent of the state’s residents were considered low-income. Twenty-one percent of Mainers were enrolled in Medicaid, 20% of whom were Medicare recipients.

These programs are also critical revenue sources for the state’s community hospitals and long-term care facilities. If Medicaid is cut, already underfinanced hospitals and nursing facilities will have to reduce staff and services, or close completely. Rural residents and communities, already in serious fiscal and employment jeopardy, will be further stressed.

• Administration for Community Living (ACL). Morningstar revealed in March that ACL, a tiny program within the Department of Health and Human Services, would be disbanded, and “critical” programs retained only through the current fiscal year.

ACL oversees prominent community support programs such as Meals on Wheels that provided more than 261 million meals to older and disabled Americans nationwide. ACL’s in-home respite assistance was provided to 15 million family caregivers caring for aging family members or those with dementia.

Med Page Today reports that another ACL casualty is its State Health Information Program. According to the Street, this is Medicare’s navigation program that exists in every U.S. state and territory. It includes 12,500 trained volunteers and agency staff who provide independent, unbiased assistance to Medicare applicants and beneficiaries struggling to negotiate its complicated rules and understand its dizzying array of health and drug plans.

Trump’s assaults on our national health care for older Americans and those with disabilities presents us with the daunting challenge of actively opposing an administration whose calling card is intimidation.

Writing in the New York Times, political scientists Levitsky, Way and Ziblatt point out that since the Trump administration has weaponized government agencies against its critics, the risk and fear of speaking out have risen and silence and compliance have become attractive options for many Americans.

Locally, this newspaper, on April 29, reported on the plight on some Maine nonprofit agencies facing present and future federal funding cancellations and an uncertain future. Agency responses varied, but fear and confusion were palpable.

According to Levitsky, et al., productive opposition is provided when individuals and organizations remain vocal and form collectives and work collaboratively to present a wider array of voices. Locally, Gov. Janet Mills’ public outspokenness and the recent collective action of the New England states show exemplary leadership. Remaining on the sidelines is not an option.