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WASHINGTON – If President Trump allows states to convert Medicaid into a global subsidy limiting health care spending to low-income people, he will face a storm of opposition to Congress, Democrats in the House said Tuesday to the senior health official.
The manager, Alex M. Azar II, Secretary of Health and Social Services, has had more than four hours of bipartisan criticism of the President's budget for 2020, which would significantly reduce planned spending for Medicaid, Medicare and research biomedical. The Democrats, confronting Azar for the first time with a majority in the House, have scorned most of the president's proposals.
But few of them got as much heat as Trump's proposed Medicaid review. Its budget plans to replace the current indeterminate federal commitment to the program with a lump sum of federal funds for each state in the form of a block grant, a measure that would essentially limit payments and would not follow. the increase in health care costs.
Congress rejected a similar Republican plan in 2017, but in his testimony Tuesday before the health committee subcommittee of the House on Energy and Commerce, Azar refused to rule out the possibility that it could grant derogations to States wishing to move in this direction. .
Under such waivers, Azar said he could not guarantee that all people now registered with Medicaid would retain this coverage.
"You can not take this kind of commitment regarding a waiver," Azar said. He acknowledged that the president's budget would reduce Medicaid's growth by $ 1.4 trillion over the next decade.
North Carolina Democrat Party Representative GK Butterfield said that "granting subsidies and capping Medicaid would jeopardize access to care for some of the most vulnerable people" in the country, such as the elderly, children and the disabled.
Mr. Trump provoked a bipartisan opposition declare a national emergency to spend more money than Congress has planned to build a wall along the southwestern border. If the president bypasses Congress and allows states to convert Medicaid into a global grant, Butterfield said, he could face an even greater outcry.
"You're just waiting for the storm that's going to create," said Mr. Butterfield, pointing out that more than a fifth of Americans – more than 70 million low-income people – depend on Medicaid.
As a candidate, Mr. Trump said he would not cut Medicare, but his new budget proposes to cut more than $ 800 billion in planned spending on the program for older Americans. over the next ten years. Azar said the proposals would not hurt Medicare beneficiaries.
"I do not believe that any of the proposals will have an impact on access to services," Azar said. Indeed, he said, the cuts could be a boon for Medicare beneficiaries, reducing their direct costs.
After reaching an annual deductible, beneficiaries typically pay 20% of the Medicare approved amount for medical services and some prescription drugs administered in doctors' offices and inpatient clinics.
Mr. Azar defended a budget proposal to impose work requirements on non-disabled adults enrolled in Medicaid. Arkansas began enforcing such requirements last year under a waiver granted by the Trump administration. Since then, at least 18,000 Arkans have lost Medicaid coverage.
Mr. Azar said that he did not know why they had been dropped from Medicaid. It is possible that some have found a job that is beneficial to health.
Massachusetts Democratic Representative Joseph P. Kennedy III said it would be unwise to extend the demands of Medicaid work to the entire country without knowing why people were falling off the wheels in Arkansas .
If you get free coverage through Medicaid, Mr. Azar said, "It's not too much to ask that you engage in some form of community involvement."
Michigan Republican Representative Fred Upton expressed deep concern over Trump's proposal to cut the National Cancer Institute's budget by $ 897 million, or 14.6 percent, to 5.2 percent. billions of dollars.
Azar said the proposal was typical of "difficult choices" in Trump's budget. He defended the cuts proposed for the National Cancer Institute, claiming that they were commensurate with the cuts proposed for his parent agency, the National Institutes of Health.
The president's budget would reduce funds for N.I.H. as a whole, 12.6%, to reach $ 34.4 billion next year.
Azar was also urged to justify Trump's proposal to reduce federal payments to hospitals serving a large number of low-income patients. New York Democrat Representative Eliot L. Engel said the cuts totaling $ 26 billion over 10 years would be devastating for "hospitals with a safety net" in New York and in the United States. other urban areas.
Mr. Azar said that the Affordable Care Act, by expanding coverage, was supposed to "eliminate unpaid care", so special payments would be less necessary.
As Democrats assailed the president's budget, Azar took the opportunity to tackle the Democrats' proposal to put in place a Medicare-For-All-Single-payer health system for all.
These proposals could eliminate coverage for more than 20 million people through private Medicare Advantage plans and more than 155 million people through employer-sponsored health plans, he said.
But Mr. Azar found himself defending on another issue outside the president's budget: immigration. He said he was doing his best to take care of migrant children who entered the United States illegally, separated from their parents and detained in shelters for which his department is responsible.
He stated that he was not aware of the so-called "zero tolerance" immigration policy before Attorney General Jeff Sessions publicly announced it in April 2018. S & P He was aware of the policy, Mr. Azar said: "I could have raised objections and concerns."
Representative Anna G. Eshoo, California Democrat and Chair of the Subcommittee, summarized the case against the President's budget.
"The Trump Administration," she said, "has brought the hatchet to every part of our health system, undermining the Affordable Care Act, proposing to fundamentally restructure Medicaid and to negate it. This budget proposes to continue this sabotage.
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