Trump budget calls for cutting Medicaid, ACA by about $1 trillion

President Trump’s proposed budget includes about $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, analysts said.

The budget released Monday includes $844 billion over 10 years in cuts from the “President’s health reform vision,” a stand-in for the repeal and replacement of ObamaCare. There are also more than $150 billion in additional cuts from implementing Medicaid work requirements and other changes to the program, which would result in some people losing coverage if they did not meet the requirements. 

The cuts drew swift condemnation from Democrats, who pointed out that Trump himself promised not to cut Medicaid, the health insurance program for the poor, during his 2016 campaign.

“I’m not going to cut Medicare or Medicaid,” Trump said in 2015, adding, “Every other Republican is going to cut it.”

“Americans’ quality, affordable health care will never be safe with President Trump,” Speaker Nancy Pelosi (D-Calif.) said in a statement on the budget proposal. 

A senior administration official defended the Medicaid cuts, arguing reforms will help preserve the program for people who need it most. “The Budget protects and preserves Medicaid by putting it on a sustainable path, so it can continue to provide vital services to those who need it the most, including children, the disabled, elderly and pregnant women,” the official said. 

In contrast to previous years, the budget does not spell out how Trump proposes to repeal and replace ObamaCare. Instead, the budget gives a savings number of $844 billion that could come from any number of possible changes to Medicaid or the health law’s exchanges and subsidies. 

One policy that is specified is that the budget calls for ending the additional federal funding that helped states expand Medicaid to cover more people under the Affordable Care Act, with officials arguing states can step up their spending if they want to expand the program. 

Elsewhere in the budget tables, the document puts total Medicaid cuts at about $920 billion over 10 years. 

In terms of practical impact, presidential budgets are often dead on arrival in Congress, and there is no chance these health care changes will pass while Democrats control the House. 

“President Trump’s budget is not going to be passed this year,” Larry Levitt, a health policy expert at the Kaiser Family Foundation tweeted. “But, it signals that he would look to dramatically scale back the Affordable Care Act and Medicaid if he’s reelected and Republicans control Congress.”

The budget also calls for about $600 billion in savings from Medicare, according to Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget. 

Despite Democratic attacks on Trump on Monday for cutting Medicare, most of those savings come from cuts to Medicare payments to doctors and hospitals that would actually lead to reduced costs for seniors, Goldwein said. Administration officials stressed there are no cuts to Medicare benefits.