It's becoming a regular theme with the rump Putin administration in the White House. When it can't get what it wants out of Congress, it just ignores it and rules by fiat. That's what the Trump team is contemplating for wall funding; for what it is planning to do with food stamps; and now, for slashing Medicaid.
While it’s in court fighting one set of Medicaid waivers it’s allowed (letting states impose work requirements on Medicaid enrollees), it is preparing to trigger even more lawsuits by creating waivers to give states the option of getting their federal Medicaid funding in a block grant. So instead of an open-ended fund that responds to the needs of the states as they arise, states could choose to get a chunk of predetermined funding that they would have more "flexibility" in choosing how to divvy up among children, the disabled, the elderly, and the working poor. Guess who gets kicked off first.
It's unclear how many states really want this and would take the administration up on it. Playing political games with Medicaid expansion was easy for Republican-led states, because it was all about providing coverage to a new population, not taking it away from any group of already vulnerable people. Also, they need the money. Healthcare costs continue to rise for everyone, and state budgets aren't immune. Making the hard decisions about who to ration care to—children, the disabled, the elderly—isn't something most governors would want to do. At least not now that Scott Walker and Sam Brownback aren't in the picture any more.
There will be massive fights over this one, starting with congressional Democrats. Sen. Bob Casey of Pennsylvania responded immediately on Twitter: "Hell no. If the Administration tries to decimate Medicaid through executive action after its scheme was rejected by Congress and the American people, I will fight it with everything I have." He continued, "That fight will be through legislation, in the courts, holding up Administration nominees, literally every means that a U.S. Senator has."
That should be a fight that every member of Congress is willing to take on, because it's a fight about their constitutional role to write the laws that the administration then must follow. With the House in Democratic control now, that fight isn't in question. But with Trump right-hand man Mitch McConnell still leading the Senate, don't expect an official peep out of that chamber.