He promised not to cut Medicaid. But we know what his promises are worth.

When he was still running in the Republican presidential primary a year and a half ago, then-candidate Donald Trump promised that he would not cut Medicaid, the premiere health insurance program for low-income Americans.

“Every other Republican is going to cut, and even if they wouldn’t, they don’t know what to do because they don’t know where the money is,” Trump told The Daily Signal at the time. “I do.”

In the week before he assumed the presidency, Trump went a step forward and promised that his Obamacare replacement plan would provide “insurance for everybody.” He did not, of course, describe the mechanism that would provide this insurance. But he did make it clear that no one should expect to lose their coverage as a result of his administration.

Even then, we knew what a promise from Donald Trump is worth. Which is why it should come as no surprise that the Trump administration is now planning to strip health coverage from millions of low-income households.

White House counselor Kellyanne Conway confirmed on Sunday that Trump’s proposed Obamacare replacement would convert Medicaid into a block grant program. This would take its administration out of the hands of the federal government and put states in charge, with potentially disastrous consequences.

Further details are, presumably, forthcoming. But in the meantime, there’s plenty of research out there on prior Medicaid block grant proposals. When the Center on Budget and Policy Priorities analyzed a 2014 block grant plan crafted by House Speaker Paul Ryan (R-WI) (then the chair of the House Budget Committee), it found that would result in a 26 percent cut to Medicaid and the Children’s Health Insurance Program by 2024. It’s difficult to figure out exactly how many people would lose coverage as a result, but here’s a rough guess from the CBPP report:

The Urban Institute similarly estimated that the 2012 block grant proposal would lead states to drop between 14.3 million and 20.5 million people from Medicaid by the tenth year. (That would be in addition to the 13 million people who would lose their new coverage or no longer gain coverage in the future due to repeal of the Medicaid expansion, with the number rising as high as 17 million if all states take up the expansion.)

At a minimum, block granting Medicaid will cost millions of vulnerable Americans their health insurance. Some of those people will die preventable deaths as a result.

The Trump administration is just a few days old. It has a nearly empty cabinet and a scant policy agenda. Its health care plan is mostly a giant blank. But President Trump, through one of his top surrogates, has made one thing clear: His promise to defend the coverage that low-income Americans currently have was a bald-faced lie.

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