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America First Audit

He said it in public. These are the documents on what happened next. Browse all records.

Why these cases

Trump sold “America First.” This record traces how public money, power, and risk moved toward family businesses, donors, favored firms, and foreign governments: and what workers, ranchers, retirees, patients, veterans, and small investors were left to absorb.

Said vs. done

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Case 231 of 254

The Rural Medicaid Squeeze

Actions
documentedPresident Trump signed Public Law 119-21, which enacted Medicaid eligibility, work-requirement, and financing changes.U.S. Government Publishing OfficeRead record · 1 source
Outcomes
reportedKFF allocated CBO's estimates geographically and projected $137 billion in reduced federal Medicaid spending in rural areas over ten years.KFFRead record · 1 source
People and impacts
Who gained
  • State Medicaid agencies
  • Rural health providers
Who paid or was affected
  • State Medicaid agencies
  • Rural Medicaid enrollees
  • Rural health providers
  • Federal Medicaid program

Amounts and affected parties

  1. lossProjected reduction in federal Medicaid spending in rural areasestimated $137 billion reduction
    Loss or cost borne by
    Rural Medicaid enrollees
    projected · 2025-07-24 · projected · central scenarioRead source record
    Calculation detailsPopulation Federal Medicaid program; State Medicaid agencies; Rural Medicaid enrollees; Rural health providersPeriod 2025-01-01 to 2034-12-31Projection horizon 2034-12-31Basis KFF applied rural enrollment and spending distributions to CBO's enacted-law estimates.Limits Rounded geographic allocation. State responses and future federal implementation can change incidence; this is not an observed cut or provider loss.
  2. commitmentRural Health Transformation Program authorization$50 billion authorized
    Committed by / source
    Federal Medicaid program
    Committed toward / intended recipient
    Rural health providers
    committed · 2025-07-25 · observedRead source record
    Calculation detailsPopulation Federal Medicaid program; State Medicaid agencies; Rural Medicaid enrollees; Rural health providersPeriod 2026-01-01 to 2030-12-31Basis Face amount enacted and described by the White House.Limits Authorization is not the same as obligations or measured benefit; allocation differs from Medicaid formulas.
Promise and assessment
The promise
documentedThe White House said President Trump would not cut Social Security, Medicare, or Medicaid benefits.The White HouseRead record · 1 source

Promise contradicted

The enacted law contradicts the unqualified promise not to cut Medicaid benefits, although its rural effect is a modeled allocation and the law also creates a time-limited rural health fund.

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