President Donald Trump’s new budget proposal calls for stripping $610 billion from the Medicaid program over the next 10 years – providing an executive-branch rubber stamp of key provisions in Obamacare repeal legislation being championed by Republicans in the House of Representatives.
That legislation, the American Health Care Act, narrowly passed the House and is under consideration in the Senate. It would cut Medicaid funding by $839 billion through 2026, mainly by changing the program’s funding formula and repealing the Affordable Care Act’s Medicaid expansion.
“This budget sort of sits on top of what is done in the AHCA, which is to cut Medicaid by a large amount, cut the Affordable Care Act subsidies by another $300 billion and provide a big tax break for corporations and wealthy people,” said Judith Solomon, vice president for health policy at the liberal Center on Budget and Policy Priorities.
“It’s taking from the poor to confer benefits on the rich. . . . So it’s Robin Hood in reverse,” Solomon said.
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Presidents’ budgets generally are considered dead on arrival as Congress works to enact its own priorities in the spending process. But they can be a window into an administration’s thinking, in this case how Trump is aligning himself with Republican efforts on Capitol Hill to overhaul health care.
Overall, Trump’s budget calls for $54 billion in cuts to non-defense programs in 2018 to pay for a $54 billion hike in defense spending. “We are going to do more with less, and make the government lean and accountable to the people,” Trump’s budget document reads.
The president’s budget also seeks greater flexibility for states to revise their Medicaid programs by adding work requirements for Medicaid recipients. It’s part of a continued effort by the Trump administration to trigger a conservative overhaul of Medicaid, the state/federal health care plan for the poor and people with disabilities.
Trump’s budget also would cut $5.8 billion over ten years from the Children’s Health Insurance Program, which helps cover children whose parents earn too much to qualify for Medicaid but not enough to afford private coverage.
Since half of Medicaid beneficiaries are children, any cuts to the CHIP program – which covers more than 5.6 million youngsters – would “really put children’s health coverage squarely in the bull’s-eye,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
“To hear that on top of the massive cuts to Medicaid, there could be significant CHIP cuts on top of that, is shocking to me. And shortsighted. And very harmful,” Alker said. “What this budget says to me is that children and families are not a priority.”
Social Security Disability Insurance and the Supplemental Nutrition Assistance Program, commonly known as food stamps, are other safety-net programs would face similar benefit restrictions and tighter rules under the Trump budget.
In a telephone briefing with reporters Monday morning, White House budget director Mick Mulvaney didn’t mention Medicaid or other social insurance programs that Trump might target for funding cuts.
Mulvaney did, however, say, “We are not going to measure success by how much money we spend” but rather by how many people are helped. He added that he isn’t comfortable telling a taxpayer it’s worth spending money “on a long list of social programs.”
The White House will brief reporters later today on the budget.
An estimated 5 million people would lose Medicaid coverage in 2018 under the House health care legislation, according to the last analysis of the bill by the Congressional Budget Office. That number would grow to 14 million people by 2026, fueling a 17 percent reduction in Medicaid enrollment.
The CBO is expected to issue a new analysis of the GOP bill Wednesday.
While the legislation also would allow states to implement work requirements for Medicaid recipients, the Trump administration could do the same thing by granting states a federal waiver of Medicaid rules.
Six states – Arkansas, Indiana, Iowa, Michigan, Montana and New Hampshire _ operate their Medicaid expansion programs through federal waivers, a system that allows them more flexibility to create policies designed to promote financial responsibility among enrollees.
Kentucky also wants one to impose a host of conservative policy changes, including work requirements for people using the program. Arizona’s waiver request seeks many of the same changes, plus a five-year lifetime limit on program benefits.
If Health and Human Services Secretary Tom Price grants the requests as expected, the measures would mark the first time in the history of the program that benefits would be capped and Medicaid eligibility would be tied to work requirements.
Solomon expects Price to grant the Kentucky and Arizona waiver requests. But they’ll likely be challenged in court, she said, because neither request meets a basic requirement of waiver experiments and demonstrations: to further the objectives of the Medicaid program, such as improving coverage, health outcomes and access to providers.
“My opinion, and that of many others, is that a work requirement (and lifetime benefit limit) that will cause people to lose coverage is not something that is consistent with the goals of the Medicaid program, which is essentially to provide health care,” Solomon said.
Gutting Medicaid’s finances would make it hard for hospitals that serve a disproportionate share of Medicaid patients, said Beth Feldpush, senior vice president for policy and advocacy at America’s Essential Hospitals.
She said their member facilities, mainly urban hospitals that serve low-income patients, would likely have to cut staff and services if they ended up treating higher rates of uninsured people who had lost their Medicaid coverage.