GOP senators bristle at Trump's Medicaid cuts

GOP senators bristle at Trump's Medicaid cuts
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GOP senators are balking at President Trump’s proposed steep cuts to the nation's healthcare system for the poor, worrying that it could leave millions without health plans.

Trump’s budget proposal would gut Medicaid by $627 billion over the next decade, on top of the $839 billion that would be cut under the House-passed ObamaCare repeal-and-replace bill. Combined, Trump and House Republicans have proposed slashing $1.4 trillion from Medicaid.

The budget also includes a $5.8 billion cut to the Children’s Health Insurance Program (CHIP), which helps families that make too much money to qualify for Medicaid.

Presidential budgets are largely wish lists of administrative priorities that Congress generally ignores. Former President Barack ObamaBarack Hussein ObamaBiden jokes about Obama memes: 'Barack did the first friendship bracelet, not me' Slain Saudi columnist upends 'Davos in the Desert' Sanders, Harris set to criss-cross Iowa MORE’s final budget never even got a vote.


But the proposals in Trump’s first such effort are already facing objections from Republican lawmakers, as well as Democrats, who are timid about signing off on such deep Medicaid cuts.

“It’s not going to survive the congressional process. No budget submitted by any president, whether Democrat or Republican, is enacted as proposed,” said Sen. Susan CollinsSusan Margaret CollinsManchin wrestles with progressive backlash in West Virginia Conservatives bankrolled and dominated Kavanaugh confirmation media campaign The Hill's Morning Report — Presented by the Coalition for Affordable Prescription Drugs — Health care a top policy message in fall campaigns MORE (Maine), one of the leading Republicans trying to protect the healthcare safety net.

“Obviously I’m concerned about the additional cuts proposed in Medicaid.”

The White House’s budget proposal is light on details. Most of the savings in the proposal hinge on allowing states to impose work requirements on Medicaid recipients and to operate their programs under a block grant or capped allotment system, all of which are included in the House-passed American Health Care Act (AHCA).

The proposal would also lower the growth of those federal payment caps to save more money, Trump’s budget director, Mick Mulvaney, said Monday. 

That policy is popular with Senate conservatives, who have discussed including it in their own version of ObamaCare repeal. 

But the chamber’s moderates have pushed back. Many are already uncomfortable about the AHCA’s Medicaid cuts, and on Tuesday some senators were widely dismissive of the budget proposal.

“I don’t think the president’s budget is going anywhere,” said Sen. Bill Cassidy (R-La.), adding that he thinks it contradicts Trump’s “insurance for everybody” promise.

“You don’t cut $800 billion over 10 years and keep your same level of coverage. I think that President Trump’s campaign contract with the voters should be fulfilled.”

It's possible the Senate will make changes to the Medicaid cuts approved in the House healthcare bill. Moderates have expressed concern that the House bill cuts off the expansion too soon and have pushed for a longer delay. Others have pushed to keep the expanded eligibility while imposing new limits on spending. 

Sen. Rob PortmanRobert (Rob) Jones PortmanOn The Money: Trump to seek new round of tax cuts after midterms | Mnuchin meets with Saudi crown prince | Trump threatens to cut foreign aid over caravan On The Money: Mnuchin to attend anti-terror meeting in Saudi Arabia | Treasury releases guidance on 'opportunity zone' program | Maxine Waters gets company in new GOP line of attack Election Countdown: O'Rourke brings in massive M haul | Deal on judges lets senators return to the trail | Hurricane puts Florida candidates in the spotlight | Adelson spending big to save GOP in midterms MORE (R-Ohio) said he’s concerned with how the Medicaid cuts would impact the opioid epidemic in his state and Ohioans who’ve gained coverage through the Medicaid expansion. 

If the budget includes the AHCA's Medicaid cuts, "I think it’s pulling the rug out from under people who are getting coverage,” Portman told reporters. 

Sen. Dean HellerDean Arthur HellerGOP-affiliated voters outperforming Democrats in key states’ early voting: report Democrats slide in battle for Senate Biden: American values being 'shredded' under Trump MORE (R-Nev.) said in a statement he was concerned about the proposal’s cuts to Medicaid and the danger it poses to the “more than 200,000 Nevadans who now have healthcare because of Nevada’s decision to expand Medicaid.”

ObamaCare allowed states to expand their Medicaid programs to include other low-income people who didn’t qualify before. The AHCA would roll back that expansion in 2020, impacting about 14 million people, according to an earlier Congressional Budget Office analysis.

“If you’ve already eliminated the expansion” population, the ones left to bear the brunt of the cuts are seniors and people with disabilities, said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

“This really flies in the face of the rhetoric that pervades in the budget that says states have the flexibility to focus on the most vulnerable,” Solomon said. “It would force states to make cuts to most vulnerable.”

Senate Democrats, for their part, have indicated that Trump’s budget is dead on arrival. Sen. Ron WydenRonald (Ron) Lee WydenOvernight Health Care — Presented by Purdue Pharma — Trump says GOP will support pre-existing condition protections | McConnell defends ObamaCare lawsuit | Dems raise new questions for HHS on child separations Republicans should prepare for Nancy Pelosi to wield the gavel US to open trade talks with Japan, EU, UK MORE (Ore.) tweeted a photo of the proposal in a recycling bin, saying, “This is where the #TrumpBudget belongs.” 

AARP in a statement said the budget "sends a powerful message to older Americans and their families that their health and financial security is at risk.”

The proposal also contradicts Trump’s campaign promise not to cut Medicaid.

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” candidate Trump tweeted in May 2015. In his presidential announcement speech, Trump said: “Save Medicare, Medicaid and Social Security without cuts. Have to do it."

Mulvaney told reporters at a briefing Monday that Trump’s promise to leave Medicaid untouched was overridden by his commitment to repealing ObamaCare.

“I think once the president said ‘I support the American Health Care Act,’ part of that was Medicaid reform,” Mulvaney said.