Healthcare

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 Obama’s final budget never even got a vote.

{mosads}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 Collins (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 Portman (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 Heller (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 Wyden (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.

Tags Barack Obama Dean Heller Rob Portman Ron Wyden Susan Collins
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