White House's Proposed Medicaid Cuts Draw Quick Protests

White House's Proposed Medicaid Cuts Draw Quick Protests

By Kerry Young, CQ Roll Call, May 23, 2017

The Trump administration drew quick protests for proposing to slash Medicaid more deeply than a House-passed health care bill would do, causing even a top Senate Republican to balk. The White House plan appears to call for stripping more than $600 billion from Medicaid over a decade, in addition to a roughly $839 billion cut over 10 years from the House measure.

“I wouldn’t expect that to carry the day,” Senate Majority Whip John Cornyn of Texas, the chamber's second-ranked Republican, said Monday night about the White House's plan to deepen proposed Medicaid cuts, noting that Congress ultimately makes the decisions on federal spending.

The White House’s budget offers a somewhat confusing picture of its Medicaid plans. Policy experts say the Office of Management and Budget uses an inflated figure for expected Medicaid spending in its summary tables, which softens the picture of the cuts actually endorsed by President Donald Trump. The Trump administration's approach to Medicaid accounting is “disingenuous in many ways,” said Aviva Aron-Dine, a senior fellow at the liberal Center on Budget and Policy Priorities, who earlier worked at OMB.

"It's not a full accounting of their proposals by any measure,” she told CQ Roll Call on Tuesday, adding that the proposal calls for additional reductions in Medicaid growth on top of the health care bill's cuts to growth. 

The OMB budget says Medicaid outlays would drop by $627 billion in the decade ending in fiscal 2027, falling to $4.70 trillion. This appears to largely reflect a Trump administration plan to reduce the flow of federal dollars to state Medicaid funds beyond the reduction proposed in the House GOP bill (HR 1628). OMB then has a separate placeholder item in its budget for $1.25 trillion in expected savings from Republican revisions to the 2010 health care law (PL 111-148, PL 111-152).

OMB didn't respond to repeated emails from CQ Roll Call about the Medicaid figures in the summary tables.

The complexity of OMB's accounting was confusing even to senators. When John Thune, the no. 3 Senate Republican, was asked Tuesday about the impact of Medicaid cuts on top of the reduced Medicaid growth in the health care bill, he questioned whether the White House really intends to deepen the cuts beyond those in the health care bill. The South Dakotan said he thought the Trump proposal reflected the cut in Medicaid growth already in the House bill, but didn’t deepen them.

“That’s not what we are being told,” Thune said when asked about the White House bid to further lower the Medicaid spending below current law. “So we’ve got to figure that out. I thought it was about the same number overall.”

Advocacy groups and Democratic lawmakers said the Trump administration’s plans to make additional cuts would devastate a program that serves as the nation’s safety net.

“Further eroding the federal commitment to Medicaid funding will be an extra blow to states struggling to balance their own budgets while maintaining essential health care services for pregnant woman, children, the elderly and disabled,” said Steven Houser, president of the American Heart Association, in a statement.

Senate Minority Leader Charles E. Schumer, D-N.Y., pointed out that Medicaid also serves middle-class people indirectly, as it allows many elderly people to enter nursing homes. The program also covers services that keep many elderly people living in their own homes. Without this assistance, middle-aged people may need to cover these expenses for their parents, Schumer said. The Democrat also noted that Medicaid is helping states respond to the national opioid crisis, easing somewhat the shortage of services for coping with addiction.

"I’ve had fathers cry in my arms because their sons were waiting on line for treatment and died of an overdose. What a burden a parent has to live with,” Schumer said in emphasizing Medicaid’s role in responding to the crisis. “We should cut that and cut it to give more tax breaks to the rich. It’s an America turned upside down in this budget.”