Trump Goes to Medicare, Medicaid and ACA

President Trump released his vision for the 2019 budget today, and as you might expect, it proposes several significant cuts to domestic programs while increasing military spending and committing $ 18 billion to build the wall over the next two fiscal years, then adding 984 billion. dollars to the federal deficit. year.

There are many things to take, but one part that stuck to me in the proposal, entitled Effective, Effective, Accountable: The American Budget, is a call for cuts in Medicare, Medicaid, and the Affordable Care Act. He also proposes to cut the Supplemental Nutritional Assistance Program by $ 214 billion over 10 years.

During the election, Trump repeatedly stated that he would not touch the three major government- funded programs, tweeted and said this many times in his speeches. And for good reason: Medicare is popular, and as medical costs continue to rise, they will only rise. In fact, Medicare for All, the leftist’s dream, is gaining popularity in its own right.

At this point, it’s hard to wonder what Trump is doing or saying. But his new budget calls for a sharp cut in Medicare spending – $ 554 billion over 10 years – in part to offset the $ 1.4 trillion tax cuts he and the GOP split mostly to corporations and the wealthy this year. The proposal says this will be done “without compromising beneficiary access to care or changing covered items and services,” but instead by eliminating federal waste and changing the so-called “donut” in prescription drug plans. “Far fewer people will get to a disastrous phase where they pay 5 percent of the cost of drugs and Medicare will hook 80 percent,” The Washington Post reported .

It is true that this budget plan has little chance of being implemented (Congress will make final spending decisions, in part based on last week’s budget outline and signed by Trump), and that the president has proposed similar cuts in last year’s budget. but he makes clear the president’s priorities, which, if it weren’t obvious already, were not about helping struggling Americans.

The budget provides for a “Market Grant for Health Care” that will be used to pay for programs “in addition to the traditional Medicaid program, a change that will reduce Medicaid spending by about $ 250 billion over 10 years,” according to WaPoreports, and again calls for cancellation and the replacement for ACA, which expanded health insurance coverage to an additional 20 million Americans , about 14.5 million of whom received coverage through the Medicaid extension or the Child Health Insurance Program.

The budget bases this on an alleged non-compliance with the law: “In 2018, approximately 30 percent of those enrolled had a choice with just one insurance company. The exchanges have not done enough to attract healthier people and families who want affordable options that meet their needs. ”

There is a lot to be said for the ACA fix, but the use of higher premiums and fewer options as an excuse to repeal the law is questionable. The Trump administration has done everything it can to thwart the implementation and effectiveness of the ACA, including launching negative ads about it, slashing advertising costs for open recruitment, and pushing for cancellation in 2017, leaving millions unsure if they would receive medical service. in the new year. Insurers , the Congressional Budget Office and independent analysts said the administration’s uncertainty around the law was to blame for the jump in prices and weaker competition.

So it’s no surprise that premiums have gone up (although the budget, oddly enough, doesn’t explain that subsidies, which about 85 percent of Obamacare members are eligible for, offset this increase). Surprisingly, it never got worse.

Here’s the budget in full .

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