The White House, via Flickr creative commons
At a time when state policymakers are exploring ways to increase health care access and affordability, the newly-released 2020 budget from President Trump is the exact opposite. The proposed policies and significant cuts would make health care harder to access and afford. Not only that, but they are policies that broad swaths of the American people have already opposed.
The budget makes deep cuts to health care and safety net programs
First, the budget proposes to repeal the Affordable Care Act (ACA). Although the many congressional proposals to repeal the ACA were extremely unpopular, President Trump’s budget would resurrect one of the plans – the Graham-Cassidy Plan – which was viewed as the most harmful repeal bill of all that were put forth in 2017. As a brief refresher (and a great way to remember the most egregious attacks on our health system), the Graham-Cassidy Plan proposed to allow insurers to discriminate against people with pre-existing conditions and drastically reduced the financial assistance available for ACA coverage. This plan was only supported by 24 percent of Americans when it was introduced, in stark contrast to the 75 percent of individuals who voiced support for the ACA’s pre-existing condition protections. In addition to implementing this harmful plan, the Trump budget would further require all ACA marketplace enrollees to pay a premium, essentially eliminating the current ability of individuals to access a zero-premium plan, a policy that would likely cause lower-income individuals to lose coverage.
The President’s budget also makes extreme cuts to Medicaid. For example, it eliminates Medicaid expansion, which currently provides coverage to over 17 million individuals and which voters in three states passed ballot initiatives to implement as recently as November 2018. It also proposes to allow block grants and per capita caps in the Medicaid program; two financing proposals intended to reduce federal Medicaid spending in ways that might result in individuals not being able to enroll in coverage. As with Graham-Cassidy, block grants and per capita caps were deeply unpopular when they first surfaced as part of the GOP repeal bills two years ago. The budget also proposes to strengthen and reinforce work reporting requirements in several safety net programs, including Medicaid, despite the fact that all of the available evidence confirms these requirements don’t help individuals gain and maintain employment. In Arkansas, the one state that implemented Medicaid work requirements in 2018, over 18,000 individuals lost their health coverage, while only a small fraction reported that they gained new employment, resounding data that makes clear Medicaid work requirements are a failed policy.
The budget will harm people’s health and worsen health inequities
Lastly, the proposal continues the harsh and startling trend of attacks by the Administration on low-income families and immigrant communities. The budget would cut $1.9 trillion dollars from safety net programs, including $845 million in cuts to Medicare. It also proposes to cut off Medicaid benefits to individuals while their immigration paperwork is being verified, and continues to employ racist and nonsensical policies to implement a “merit-based immigration system” and end the visa lottery program. When safety net programs are slashed and poverty rates increase as a result, individuals and families experience worse health outcomes. Overall, Trump’s budget reverses course from a vision of an equitable health system for all.
While there is ample opportunity and appetite to move the ball forward in health care both in Washington D.C. and in the states, the President’s budget, if enacted, would take our nation several steps backward.