Critics of President Donald Trump's new budget are accusing him of breaking a key campaign promise ahead of his 2020 re-election bid.
His fiscal 2020 proposal unveiled Monday calls for reductions in funding for Medicare and Medicaid relative to current law. Over a decade, the plan would shave an estimated $800 billion or more off Medicare, which covers older Americans, according to the Kaiser Family Foundation and various reports. It would also cut spending on Medicaid, the federal-state program that insures low-income Americans, by more than $200 billion while setting up block grants to states.
Congress ultimately decides what money to spend, and Trump's proposal is not likely to get through Capitol Hill. Still, a budget represents a president's priorities even if it may not ultimately impact Americans' lives.
For Trump — who during his 2016 presidential bid promised not to cut the popular Medicare, Medicaid and Social Security programs — the proposal opens another vulnerability as he tries to hold on to the White House. In 2015, he declared that he "was the first and only" possible GOP presidential candidate to "state there will be no cuts to Social Security, Medicare & Medicaid."
Multiple candidates for the Democratic presidential nomination seized on suggested cuts to the social safety net, arguing they would hurt seniors and the most vulnerable Americans. They will likely keep the president's health care policies top of mind through the November 2020 election, after Republican efforts to repeal the Affordable Care Act helped Democrats flip control of the House in last year's midterms.
Democratic presidential hopeful Sen. Kamala Harris of California called the proposed funding reductions "yet another piece of evidence for why we need a new president." Sen. Bernie Sanders, a Vermont independent running for president as a Democrat, framed the floated health-care changes as a "massive transfer of wealth" from the working class to the richest Americans.
Another presidential hopeful, Sen. Amy Klobuchar, D-Minn., pointed to proposed Medicare spending reductions as she contended that "we need a smart budget, not one based on empty campaign promises."
The proposed Medicare changes aim to address waste and abuse in the system — efforts that both major parties have supported in the past. It is "hard to predict how these proposals would affect patient care if they became law," said Tricia Neuman, director of the Kaiser Family Foundation's Program on Medicare Policy.
However, she expects hospitals and health providers to say the budget will harm seniors. AARP — a special interest group dedicated to older Americans — said it is "concerned about proposed cuts to programs important to seniors" in Trump's budget despite his efforts to address drug prices.
The White House has denied that Trump wants to gut Medicare — a widely popular program.
On Monday, acting Office of Management and Budget Director Russ Vought said the president is "not cutting Medicare in this budget" but rather "putting forward reforms that are cutting drug prices." Medicare spending would still rise "every year by healthy margins" and no "structural changes" would take place, he said.
While spending would still rise under Trump's plan, it would not climb as much as it would under current law. His proposal fits within a broader Republican push to reform the massive federal safety net programs Medicare and Social Security, which are projected to come under an increasing strain in the coming years from the aging U.S. population. During last year's midterms, Democrats frequently warned about potential GOP efforts to trim the programs in order to make up for revenue shortfalls created by corporate and individual tax cuts passed in 2017.
Medicare — which covers roughly 60 million people over age 65 — accounted for about 15 percent of the federal budget in 2017, according to the Kaiser Family Foundation. It is set to make up about 18 percent of federal outlays in 2028.
Trump's budget proposal comes as Democrats widely call for an expansion of government health options. Candidates for the 2020 Democratic nomination have pushed for a move to universal coverage, whether by giving Americans a choice to opt into Medicare or Medicaid or by setting up a single-payer system.
Sen. Brian Schatz, D-Hawaii, summed up Democrats' argument: "One party wants to expand Medicare and Medicaid and the other wants to cut them."
It is unclear how the Medicare cost cuts proposed by Trump would directly affect patients. The money would largely come from payments to hospitals and other health providers, according to Kaiser's Neuman.
Efforts to control Medicare costs are not new. The Affordable Care Act — better known as Obamacare — cut $716 billion from the program. Those savings came largely from reducing payments to Medicare Advantage plans, which private companies offer, Neuman said.
Past plans floated in Congress offer a better understanding of how Trump's wider health-care proposals would affect Americans. His proposal to undo Obamacare's Medicaid expansion and set up block grants to states echoes a bill put forth by GOP Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina in 2017.
During the GOP's rush to dismantle Obamacare in 2017, the Congressional Budget Office did not have the time to do a full accounting of the plan's effects. Still, the nonpartisan group estimated it would reduce deficits by $133 billion. The CBO added that "the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions" compared with current law.
Criticizing another party's plans to potentially damage Americans' health coverage has long been seen as a politically potent attack. Democrats put Republican attempts to repeal Obamacare — and potentially get rid of the law's protections for people with pre-existing medical conditions — front and center during last year's elections.
Trump will now have to defend against attacks on his plan to cut Medicare costs. Not long ago, he was on the sidelines during the 2012 presidential criticizing President Barack Obama for trimming Medicare spending.
"There's only one person who has defunded Medicare. His name is @BarackObama," Trump tweeted in August 2012.