President Trump has put Medicaid on the chopping block. Despite the White House’s promises that it would not make any cuts to the program, which provides one in five people nationwide with health care coverage, cuts would be all but certain if Trump’s budget agenda were to be implemented. If millions of people lost their access to Medicaid, the consequences would not be limited to just their health care—as our communities grow less healthy, they also become less safe.

The GOP-controlled House of Representatives, with President Trump’s support, passed a budget resolution at the end of last month that calls for a $2 trillion cut to mandatory spending over 10 years. Republican representatives, led by Speaker Mike Johnson, are now working to make $880 billion of those cuts in the section of the budget that funds Medicaid. An analysis by the Congressional Budget Office found that number impossible to reach without cuts to the program.

While most attention has reasonably gone to the immediate effects of health care cuts, the well-studied, direct link between Medicaid and public safety is cause for alarm, too. Although crime has been on the decline nationwide, Trump campaigned heavily on it, saying that “American cities, suburbs and towns are totally under siege” and that he would “make our towns and cities safe again.” But his actions in office threaten to undermine our safety by cutting Medicaid.

More than 83 million people currently get their health care coverage via Medicaid. It’s jointly funded by state and federal dollars and enjoys enormous popularity with the public. Research has shown time and again that Medicaid expansion is linked to drops in crime. States that expanded Medicaid as part of the Affordable Care Act (ACA) rollout, saw violent crime decrease by more than five percent. Other studies have found the impact of Medicaid expansion on crime to be even greater. Medicaid expansions also reduce the number of people released from prison who are reincarcerated within a year of their release by 11 percent.

On the other hand, when people lose health care coverage offered through Medicaid, crime rates climb. In 2005, Tennessee dropped nearly 200,000 people from TennCare, its Medicaid offering. By 2007, the median Tennessee county saw crime rise by about seven percent during a period when crime rates nationwide were holding steady or falling. That natural experiment offers insight into what would happen if Trump’s tax plan slashes Medicaid benefits across the country.

It makes sense that crime goes down when people have health insurance; access to health care has been repeatedly linked to public safety. If we are serious about improving public safety, research suggests that we should be investing in health care and social supports. Medicaid has been proven to deliver exactly that kind of baseline security for people. Studies show that it reduces crime by reducing economic desperation and increasing access to the mental health and substance abuse treatment programs that meet the needs of people who, all too often, end up incarcerated. More than 70 percent of incarcerated people have at least one diagnosed mental health condition or substance use disorder.

Rather than cutting health care programs, we should invest even more in them. One study found that increasing funding for substance abuse treatment—the sort that Medicaid covers—by $1.6 billion would save up to $5.1 billion in avoided crime. Another study found that Medicaid expansion dramatically reduced arrests, suggesting that broadening access to insurance coverage could further reduce police contact.

This is not the first time Trump has attempted to gut Medicaid. During his first administration, Trump hoped to repeal the ACA. However, those efforts were met with opposition from across the political spectrum, from grassroots organizers to Republican governors who did not want to lose critical funding for their states’ Medicaid programs.

Yet, that defeat has seemingly not deterred Trump from again trying to dismantle the social safety net. On the campaign trail in 2024, he proposed cuts to programs designed to help working-class Americans. And the latest plans to cut Medicaid bear a striking similarity to the bills meant to replace the ACA in 2017.

If crime rises in the wake of cuts to Medicaid, Trump’s response will be predictable: more police and prisons, not more health care. In his first congressional address, Trump called for a new crime bill that would include increasingly tough punishments and expand protections for police officers, echoing his campaign promises to “stop out-of-control crime.” His administration is already cutting other federally funded programs proven to reduce crime, like community violence intervention and alternatives to incarceration; cuts to Medicaid would only worsen the problem.

If Trump and House Republicans are serious about building safety, they should jump at the chance to expand a popular policy that delivers health care coverage while reducing crime. By putting Medicaid on the chopping block, Trump, Johnson, and House Republicans are jeopardizing public safety and playing politics with people’s ability to get essential care.