Earlier this week, the Trump Administration released its proposed budget for fiscal year 2019. This is the president’s first full budget proposal since taking office and it outlines the administration’s vision for the future. Although the budget proposal is non-binding and many elements need congressional approval for enactment, the administration can implement some of these policies on its own, through regulations, executive orders, and guidance. This is an eye-opening and chilling road map for where the administration wants to take health care for families and children.
As expressed through this budget, President Trump’s vision is one of deep cuts to health care programs, soaring out-of-pocket costs for individuals and families, and diminished access to needed services.
The budget proposes these damaging cuts:
- cuts to health coverage from repeal of the Affordable Care Act (ACA) total $675 billion over the next decade
- Medicaid cuts total an astounding $1.4 trillion over 10 years
- cuts to the U.S. Department of Health and Human Services by over 20 percent, which would have significantly hamper HHS’s ability to administer key health and human services programs
The president also targets Medicare, family planning, and numerous other health programs for large proposed cuts.
Deep Cuts to the Health Safety Net and Another Go at ACA Repeal
The president proposes to repeal the Affordable Care Act with legislation similar to the Graham-Cassidy-Heller-Johnson proposal, which failed to get enough support in Congress last year and was wildly unpopular with the public.
Graham-Cassidy would eliminate the significant gains made by the ACA. It would roll back the ACA’s Medicaid expansion, which has expanded coverage to 15 million people. It would terminate premium tax credits that help many working-class families afford marketplace coverage, replacing these credits them with a block grant to states that shrinks health care funding by hundreds of billions of dollars. The traditional Medicaid program would be slashed and Medicaid spending would be capped under an inadequate growth rate, shifting costs to states and forcing them to make impossible decisions, choosing which residents lose benefits or health insurance altogether. More about how Graham-Cassidy would damage America’s health care.
But the White House proposed budget goes even further than Graham-Cassidy in cutting the Medicaid program, ratcheting down caps to the program more severely. While the CBO projected Graham-Cassidy would cut Medicaid by $1 trillion over 10 years, the White House budget would result in total Medicaid cuts of an astounding $1.4 trillion over 10 years. These cuts would compound every year—meaning they would be deeper in year 10 than in year 1, and even more profound after that.
Additionally, the president proposes further weakens the ACA’s popular consumer protections under the guise of providing further flexibility to states. President Trump’s vision for health care would return us to the days when people with preexisting conditions could be denied essential benefits or charged so much that coverage would be out of reach.
Creating New Barriers Between Families and Needed Health Care
President Trump’s health care vision is to erect further barriers to care through work requirements and other changes to Medicaid eligibility. The budget documents spells out what has already become clear through recent Medicaid waiver approvals: The Trump Administration is prioritizing policies that are punitive and endanger access to care through Medicaid for vulnerable populations.
New paperwork barriers to Medicaid coverage in the budget include not only the new requirements to document employment that we saw in the failed “Repeal and Replace” legislation of last year, but new requirements to document immigration status before receiving coverage and to allow states to require documentation of assets as part of Medicaid eligibility determinations. These new hurdles would undo an important aspect of the ACA, making Medicaid applications a largely online, electronic process.
Insufficient Proposals to Combat Rising Prescription Drug Costs and the Opioid Epidemic
While President Trump describes some proposals to combat rising prescription costs, they do not do enough to meaningfully address the sky-high and ever increasing prices pharmaceutical corporations set for prescription drugs.
Likewise, though there is new funding proposed to address the opioid epidemic, the budget’s severe cuts to Medicaid make the new funding a drop in the bucket. By eliminating health coverage for upwards of 20 million adults, the administration would endanger the ability of millions to get treated.
This budget makes the administration’s vision for health care clear. By slashing Medicaid and the health care safety net and eroding consumer protections, the administration is endangering high-quality affordable health coverage for families and children across America.