President Donald Trump’s fiscal year 2019 budget proposal is nothing more than a messaging document, providing a blueprint for the administration’s strategy but wielding no power beyond the paper it’s printed on. But health and human rights advocates say its message is clear: Some programs are as expendable to the administration as the women and vulnerable populations they are meant to help.

Trump’s 160-page budget and its supplemental materials zero in on undermining familiar GOP targets, including the Affordable Care Act (ACA), Medicaid, Planned Parenthood, and true evidence-based family planning. Together and separately, such programs fulfill life-saving and life-sustaining needs, especially for people living at the margins and intersections of race, gender, sexuality, income, ability level, and immigration status. 

While the U.S. Congress rarely enacts presidents’ yearly budget submissions as written, this budget highlights Trump’s targeting of decades-old safety nets that have long been the focus of congressional Republicans’ ire. The budget proposal envisions billions of dollars in cuts to Medicare, Medicaid, and Social Security, violating Trump’s campaign promises to protect them.

“Budgets reflect priorities,” NARAL Pro-Choice America national communications director Kaylie Hanson Long said in a statement. “And this budget makes clear that Donald Trump’s is to keep punishing women.”

Long ticked through several items—defunding Planned Parenthood, which disproportionately hurts the poor and rural; preserving the discriminatory Hyde Amendment, which prevents people with low incomes from accessing abortion care; and delivering the final blow to imperiled teen pregnancy prevention programs at the Department of Health and Human Service—NARAL said were on the administration’s wish list as evidence.

Another proposal includes restructuring Medicaid into block grants in what could be a severe blow to the nation’s safety net of family planning providers, along with flat-funding the stagnated Title X family planning program that ensures access to contraception and cancer screenings for the 4 million diverse, low-income patients that such providers serve.

This potential damage to domestic reproductive health could be replicated on the global stage. The budget halves international family planning aid, according to analysis from the Kaiser Family Foundation. It claims “an emphasis on evidence-based methods,” while only name-checking fertility awareness over far more effective forms of birth control. This language comes just a week after the administration ignored the evidence on the negative effects of its anti-choice global gag rule, which reproductive health advocates say could result in at least 6.5 million unintended pregnancies, 21 million unsafe abortions, and 21,700 maternal deaths around the world.

“This budget confirms that Trump and his cronies in his White House of ill-repute are hell-bent on substituting religious dogma for evidence and that the gratuitous cruelty of their first year can be expected in the second as well,” Brian Dixon, senior vice president for the Population Connection Action Fund, said in a statement.

David Stacy, government affairs director for the Human Rights Campaign (HRC), an LGBTQ rights advocacy group, doubled down on the idea that the budget reflects the administration’s values. He pointed to Trump and virulently anti-LGBTQ Vice President Mike Pence in criticizing the administration’s plans to cut domestic and global HIV/AIDS programs and essentially fold the U.S. Department of Justice’s (DOJ) Community Relations Service, the law enforcement agency’s self-described “‘peacemaker’ for community conflicts and tensions arising from differences of race, color, national origin, gender, gender identity, sexual orientation, religion and disability.”

“The Trump-Pence budget released today shows a callous disregard for critical programs that impact LGBTQ Americans,” Stacy said in a statement upon Monday’s budget drop. “The elimination or slashing of programs related to the Affordable Care Act, HIV/AIDS, and international humanitarian projects are a direct threat to the safety and well-being of LGBTQ people here and around the world.”

The budget outlines plans to unravel the ACA, or Obamacare—despite congressional Republicans’ repeated failed attempts to repeal it—by pushing another repeal and replace bill. Obamacare “made health care coverage a reality for many LGBTQ individuals and their families for the first time,” HRC stresses on its website. The health-care law includes nondiscrimination protections for HIV status and transgender patients, the latter of whom are under attack by Trump’s explicitly anti-trans DOJ and his new health-care discrimination wing.

Repealing Obamacare would further jeopardize recent health insurance gains for more than 5 million women of color, according to National Women’s Law Center (NWLC) data from 2017. “Make no mistake: the steep cuts proposed in the president’s budget will expand inequality and deepen poverty,” NWLC Vice President for Policy and Strategy Anna Chu said in a statement.

Chu stressed that Trump’s “token additions,” including an “inadequate paid parental leave proposal,” wouldn’t be enough to “salvage a cruel plan that completely ignores what women and their families want and need.”

Another such token addition is $485 million “to prevent and respond to violence against women and related victims” at a time when Trump, himself accused of sexual misconduct by at least 22 women, hasn’t backed down from defending two alleged domestic abusers who recently resigned from his staff. The provision in the administration’s 1306-page budget appendix siphons that money from the federal Crime Victim’s Fund, which flows, in part, to “direct services to crime victims including information and referral services, crisis counseling, temporary housing, criminal justice advocacy support, and other assistance needs,” according to a nonpartisan Congressional Research Service report.

Sen. Patty Murray (D-WA), a frequent critic of the administration’s policies to undercut reproductive rights and transgender student protections, criticized the proposal.

“Days after dismissing survivors of sexual assault and domestic violence who bravely come forward, the President proposed a budget that pretends to boost funding for domestic violence prevention and response but really takes from funding that is meant to go directly to survivors,” Murray said in a statement.

Murray’s critique reinforced what seemed to be the advocacy community’s chief complaint about the budget: that it represented the misplaced values of the Trump administration.

“Budgets are moral documents. Dismantling services that keep millions of Americans healthy reveals this administration’s shameful priorities,” Dr. Willie Parker, an abortion provider and board chair of Physicians for Reproductive Health, said in a statement.

“By asking Congress to once more attempt to repeal the Affordable Care Act, to allow states to add work requirements for Medicaid, and to defund Planned Parenthood, the President’s budget is another way his administration continues to target the well-being of women and families, low-income patients, communities of color, and LGBTQ communities.”