Trump's cuts in Medicaid, Social Security and Medicare, explained

President Donald Trump's 2020 budget breaks one of his biggest election promises: he would leave Medicaid, social security and Medicare intact.

"I'm not going to reduce social security, like all other Republicans, nor Medicare or Medicaid," Trump told The Daily Signal, a Heritage Foundation affiliated publication in 2015.

Over the next 10 years, Trump's 2020 budget proposal aims to spend $ 1.5 trillion less on Medicaid – instead of spending $ 1.2 trillion on a global grants program to the states – $ 25 trillion less social security and $ 845 billion less Medicare (in part). reclassified to another department). Their intentions are to reduce benefits under Medicaid and Social Security. The impact on Medicare is more complicated, which I will discuss a little later.

Over time, the Trump administration has tried to mitigate the president's promise of only social security and health insurance. Deputy Director of the Office of Management and Budget, Russ Vought, said on Monday, March 11 that Trump "is keeping his commitment to the Americans by making no changes to Medicare and Social Security." But even that is not true.

Like "all other Republicans," Trump has repeatedly proposed and supported the removal of these programs. The White House has not responded to a request for comment.

How Trump Proposes to Modify Medicare, Medicaid and Social Security

When it comes to MedicareThe White House has been very clear: "It has not reduced Medicare in this budget," Vought said. "What we are doing is proposing reforms that lower the price of drugs. Because Medicare pays a very large [share] prices of drugs in this country, [that] has the impact of saving money. We are also seeing waste, fraud and abuse. "

Here's what's really happening: this budget proposes to save Medicare $ 845 billion over 10 years as we know it. But $ 269 billion of this amount is reclassified into the Department of Health and Human Services, bringing health insurance cuts to $ 575 billion. As Vox explained, the administration announced that it would achieve these cost reductions by targeting unnecessary spending and payments to claimants and reducing prescription drug costs.

The Federal Accountability Committee, which advocates for fiscal responsibility, estimates that 85% of these reductions will come from reductions in payments to providers, 5% from medical negligence and 11% from cost reduction. medication. Medicare Part D. Part D of Medicare is the only area of ​​these reforms that could raise the price of drugs for some, while lowering it for others. Otherwise, premiums, deductibles and copays would be largely left unchanged.

Not surprisingly, the Federation of American Hospitals is not a fan of this part of Trump's budget proposal. In one declarationThey called the reforms "devastating for the elderly". More surprising, as pointed out by Sam Baker, of Axios, these reforms are very similar to the policies that Barack Obama had proposed in 2012 and that the Republicans had dismantled.

But when it comes to the changes proposed by Trump Medicaid and Social Security, the intention is unambiguous: it is about benefit reductions.

The Medicaid reforms in the 2020 budget include the addition of working conditions and the repeal of the Medicaid extension and one of the most effective policies of the Affordable Care Act. The Medicaid expansion has reduced the uninsured rate by more than 6% in states that have enacted this policy. it continues to show better health outcomes and is popular in conservative states. But Trump is considering changing Medicaid completely; Its budget proposes to transform the current payment system as needed into a global grant, in which states receive a flat-rate lump-sum fund that does not grow with increasing needs or rising costs. The budget proposes a $ 1.2 trillion grant for market-based health care.

Taken in isolation, budget cuts in Medicaid rise to $ 1.5 trillion over 10 years, but in the context of the new global grant as well as work demands and cuts from the ACA, the Reductions have been rounded to approximately $ 777 billion, which could leave millions uninsured.

The budget is also pursuing an attack against Social Security, including a program that helps people with disabilities who prevent them from entering the labor market. In total, cuts in social security will rise to $ 25 billion over the next 10 years, or about $ 10 billion from the Social Security Disability Insurance Program (SSDI). point.

Trump broke this promise from the beginning

Trump is on the road to the campaign in 2015:

Trump's budgets – and the policies he has championed around health care – and government spending in Congress reflect the opposite. Part of this can be attributed to Mick Mulvaney, Trump's appointed budget chief; The former congressman who was part of the ultra-conservative group of liberty has long been mobilized in favor of the reduction of Medicare, Social Security and Medicaid.

In fact, Mulvaney once boasted in front of a Politico reporter to have persuaded Trump to accept a proposal to reduce social security by simply calling SSDI disability insurance, turning it into a social assistance reform to the president. The idea has been the subject of all Trump's budget proposals to Congress since the president took office.

Then there was the Republican Obamacare repeal thrust; each bill proposed massive cuts to Medicaid in order to pay tax cuts elsewhere. Trump has backed every iteration of repealing and replacing Republican Obamacare bills. He even staged a party for House Republicans in the White House Rose Garden when Congress' lower house narrowly passed a proposal that cut more than $ 800 billion to Medicaid in 10 years.

Republican legislators have long argued that spending on mandatory programs accounting for 70 percent of the federal budget – such as Medicare and Social Security – needed to be reduced in order to reduce the national debt. Trump put the bureaucracy at the center of these programs, as well as Medicaid, during the 2015 election campaign because they are extremely popular federal programs.

Now, his political positions around these programs break with this promise.