The budget bans the use of federal funds for abortion. The White House budget director said it was the first spending plan in some time written "through the eyes of the people who are paying the taxes."
The Trump administration will introduce a budget today that calls for significant cuts to Medicaid and other social service programs, according to multiple news organizations. Some planned cuts were contained in a document that was briefly posted on the HHS website and quickly removed, according to The Hill.
That document said the administration will call for reducing Medicaid spending by $610 billion over 10 years, which The Hill reported would be on top of the more than $800 billion in cuts that would be required under the American Health Care Act (AHCA). The AHCA, which repeals portions of the Affordable Care Act (ACA), passed the House on May 4 and awaits a new score from the Congressional Budget Office. Previously, multiple outlets reported that the administration’s budget would assume passage of the AHCA when calculating Medicaid spending.
Medicaid has always been jointly funded by the federal government and the states, but the AHCA would transform it into a block grant program with per capita federal funding and more limited oversight. Advocates for this approach say it will give states more control and reduce spending through less bureaucracy, but critics say the deep spending cuts will inevitably allow fewer people to be covered, and less care for those who remain.
The number of people covered by Medicaid has grown under the ACA, which allowed states to extend coverage to households earning up to 138% of the federal poverty line. Thus, the scope of Medicaid reached many working poor whose full-time jobs offered no health plan or who were working multiple part-time jobs.
According to The New York Times, other social service programs that would be cut in the budget include nutrition assistance, $192 billion; and welfare programs, $272 billion. The budget also calls for a ban on any federal funding to agencies that provide abortions, which would bar Planned Parenthood from receiving funds for other health services, including family planning and cancer screening.
White House Budget Director Mick Mulvaney told reporters, “This is, I think, the first time in a long time that an administration has written a budget through the eyes of the people who are actually paying the taxes.”
However, Representative Mark Meadows, R-North Carolina, chair of the Freedom Caucus, told the Times that even some conservatives might balk at a few proposals, such as a proposed cut to Meals on Wheels, which provides food assistance to homebound seniors.
The Medicaid changes will be hotly debated now that expansion has reached 31 states, including several that supported Trump in the 2016 election. According to a recent report from the Kaiser Family Foundation, Medicaid now covers 1 in 5 Americans, the majority of them low-income children, seniors, and the disabled. While the budget does not contain cuts to Medicare, seniors in nursing home care are often covered by both Medicare and Medicaid.
The Kaiser report said that while Medicaid is one of the largest spending items in any state, it also functions as a high-risk pool for some of the most complex healthcare cases, providing care “at a lower per-person cost than private insurance could.”
Beyond social progams, proposals to cut scientific agencies drew responses like this one from Syapse President Jonathan Hirsch.
"Even if the Trump budget proposal never fully comes to fruition, as is likely, it will still make an impact — forcing NIH to stall programs that physicians and patients rely on," said Hirsch, who is also founder of the precision medicine company. "We stand at the precipice of major breakthroughs in areas like cancer research, and NIH is critical to moving those forward. Now is the time to double down on our commitment to end cancer, not take steps backward."