Trump's proposed trillion-dollar cuts to Medicaid are a stunning reversal from one of his biggest campaign promises
The plan calls for cuts amounting to $627 billion over the next 10 years.
That number does not include the roughly $880 billion in proposed cuts to the program through the American Health Care Act, the GOP leadership's plan to repeal and replace the Affordable Care Act, which the administration supports.
The plan has already received near-universal pushback in Congress, as even members of President Donald Trump's own party expressed skepticism over its provisions. The drastic cuts to Medicaid, among other programs, have drawn blowback from lawmakers in districts whose constituents would stand to be affected by the slashes.
Rep. Hal Rogers, the Republican chair of the House Appropriations Committee, told The Washington Post that the proposed Medicaid cuts are a particular problem for his district.
"I've got one of the poorest districts in the country, with lots of Medicaid recipients as well as other programs. ... The cuts are draconian," Rogers said.
The proposal also amounts to a reversal from Trump's repeated assertions throughout his presidential campaign that he would not make cuts to social safety-net programs.
Health and Human Services"I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid," Trump tweeted in 2015. He repeated similar statements throughout the campaign.Robert Greenstein, president of the Center on Budget and Policy Priorities, slammed the proposal as "the most radical, Robin-Hood-in-reverse budget that any modern President has ever proposed."
In a statement, Greenstein said Trump's "steep cuts" lay to "rest any belief that he's looking out for the millions of people the economy has left behind."
What is striking is that the budget enacts drastic cuts on top of those proposed by AHCA, which were denounced by politicians of both parties when announced in March. The AHCA proposed a significant rollback of Medicaid and the ending of the Medicaid expansion program established under the ACA, the healthcare law better known as Obamacare.
Under the ACA, eligibility for Medicaid was expanded to include any adult living under 138% of the federal poverty level - an income of $27,821 for a family of three in 2016. It's up to states to decide whether they want to participate. States that expanded Medicaid under the new ACA requirements received federal funds to do so.
Thirty-two states and the District of Columbia have chosen to participate so far, leading to more than 11 million new people nationwide gaining coverage, a number that continues to grow.
The Congressional Budget Office estimated in March that changes to eligibility under the AHCA would most likely result in a loss of 14 million people from the Medicaid rolls by 2026. While the AHCA has since been amended, and a new CBO report should arrive soon, it is unlikely that it will find drastically different results in regards to Medicaid.
When rumblings of Trump's proposed cuts to Medicaid began to surface in February, the Kaiser Family Foundation did a tracking poll to gauge public sentiment on the plans. The February poll found that 65% of Americans said Medicaid should continue largely as it exists today, despite Republican proposals to change the program,
Governors in charge of expansion states, 16 of them Republican, have also been in favor of retaining the expansion. Many have acknowledged the program's importance to their states in recommendation letters solicited by Republican congressional leaders.
It is unlikely they will be in favor of the further cuts proposed by Trump's budget.
Bad news for states suffering from the opioid crisisSkye Gould/Business InsiderSkye Gould/Business Insider
The Health and Human Services Department 2018 budget proposal released by the Trump administration states that the cuts are being made in the interest of "financial stability" and to "focus Medicaid on the most vulnerable Americans-the elderly, people with disabilities, children, and pregnant women-those Medicaid was intended to serve."
But the expansion to Medicaid that the Trump administration has proposed to gut have gone to extremely vulnerable populations, namely those states suffering from the opioid crisis. States have leaned heavily on Medicaid to treat those affected by the opioid crisis in recent years.
Of the 10 states with the highest drug-overdose death rates, only Tennessee and Utah opted out of the ACA's Medicaid expansion.
About 1.29 million people in the US are receiving treatment for substance-use disorders or mental illnesses thanks to the Medicaid expansion, according to research conducted by Harvard Medical School health economics professor Richard Frank and New York University dean Sherry Glied.
If the AHCA does become law and the Medicaid expansion is phased out, then Ohio, Pennsylvania, and West Virginia, among other states suffering the brunt of the opioid crisis, would be ill-suited to handle the loss in funds, government officials and treatment experts told Business Insider in February.
Pennsylvania was suffering a $600 million budget shortfall as of December that could reach $1.7 billion by July, according to the Pittsburgh Post-Gazette. Republican State Rep. Gene DiGirolamo of Pennsylvania told Business Insider that there were "no extra dollars" to insure residents or provide addiction treatment to those who lose coverage because of an ACA repeal. The situation is equally dire in West Virginia.
"I'm really, really worried about what's happening in Washington," DiGirolamo said in February. "And I say that as a Republican."
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