By Tara Golshan
March 12, 2019
President Donald Trump’s 2020 budget breaks one of his biggest campaign promises to voters: that he would leave Medicaid, Social Security, and Medicare untouched.
“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” Trump told the Daily Signal, a conservative publication affiliated with the Heritage Foundation, in 2015.
Over the next 10 years, Trump’s 2020 budget proposal aims to spend $1.5 trillion less on Medicaid — instead allocating $1.2 trillion in a block-grant program to states — $25 billion less on Social Security, and $845 billion less on Medicare (some of that is reclassified to a different department). Their intentions are to cut benefits under Medicaid and Social Security. The impact on Medicare is more complicated, which I’ll get into a bit later.
Over time, the Trump administration tried to whittle down the president’s promise to just Social Security and Medicare. Office of Management and Budget Deputy Director Russ Vought said Monday, March 11, that Trump is “keeping his commitment to Americans by not making changes to Medicare and Social Security.” But even that is not true.
Like “every other Republican,” Trump has repeatedly proposed and supported cutting these programs. The White House did not respond to a request for comment.
How Trump is proposing changing Medicare, Medicaid, and Social Security
When it comes to Medicare, the White House has been very clear: “He’s not cutting Medicare in this budget,” Vought said. “What we are doing is putting forward reforms that lower drug prices. Because Medicare pays a very large [share] of drug prices in this country, [that] has the impact of finding savings. We are also finding waste, fraud, and abuse.”
Here’s what’s actually happening: This budget proposes finding $845 billion in savings over 10 years from Medicare as we know it. But $269 billion of that figure is reclassified under the Department of Health and Human Services, bringing the Medicare cuts to $575 billion. As Vox explained, the administration says it will achieve these cost reductions by targeting wasteful spending and provider payments and lowering prescription drug costs.
The Committee for a Responsible Federal Budget, which advocates for fiscal responsibility, estimates that 85 percent of these cuts will come from reductions in provider payments, 5 percent would come from policies around medical malpractice, and 11 percent would come from reducing drug costs through the Medicare Part D program. Medicare Part D is the only area of these reforms that could raise out-of-pocket drug prices for some while lowering it for others. Otherwise, premiums, deductibles, and copays would largely be left unaffected.
Unsurprisingly, the Federation of American Hospitals is not a fan of this part of Trump’s budget proposal. In a statement, they called the reforms “devastating for seniors.” More surprisingly, as Axios’ Sam Baker points out, these reforms are pretty similar to policies Barack Obama proposed in 2012 that Republicans panned.
But when it comes to Trump’s proposed changes to Medicaid and Social Security, the intent is unambiguous: These are cuts to benefits.
The 2020 budget’s Medicaid reforms include adding work requirements and repealing Medicaid expansion and one of the most successful policies within the Affordable Care Act. Medicaid expansion reduced the uninsured rate by more than 6 percent in states that enacted the policy; it continues to show better health outcomes and is popular in conservative states.
But Trump is envisioning changing Medicaid altogether; his budget proposes transforming the current pay-as-needed system to a block grant, where states are given a capped lump-sum fund that doesn’t grow with increased need or rising costs. The budget proposes a $1.2 trillion “Market-Based Health Care Grant.”
In isolation, the Medicaid budget cuts amount to $1.5 trillion over 10 years, but looked at in the context of the new block grant as well the work requirements and ACA cuts, the cuts round out to about $777 billion — which could leave millions more uninsured.
The budget also continues an attack on Social Security, including to a program which gives assistance to those who have disabilities that prevent them from being in the workforce. In all, the cuts to Social Security amount to $25 billion over the next 10 years, cutting roughly $10 billion from the Social Security Disability Insurance (SSDI) program, which the administration says will be found through cutting down on fraud — a common conservative talking point.
Trump broke this promise from the beginning. See Tweet below.
Donald J. Trump
@realDonaldTrumpI was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
Trump’s budgets — and the policies he has supported around health care — and government spending in Congress reflect the opposite. Some of this can be attributed to Trump’s appointed budget chief Mick Mulvaney; the former congressman who was part of the ultraconservative Freedom Caucus has long rallied for cutting Medicare, Social Security, and Medicaid.
In fact, Mulvaney once bragged to a Politico reporter that he tricked Trump into accepting a proposal to cut Social Security by calling SSDI just disability insurance — spinning it to the president as general welfare reform. The idea has been in every single one of Trump’s budget proposals to Congress since the president came to office.
Then there was the Republican Obamacare repeal push; every bill proposed massive cuts to Medicaid in order to pay for tax cuts elsewhere. Trump supported every iteration of Republicans’ Obamacare repeal-and-replace bills. He even held a party for House Republicans in the White House Rose Garden when the lower chamber of Congress narrowly passed a proposal that slashed more than $800 billion from Medicaid over 10 years.
Republican lawmakers have long argued that spending around mandatory programs that make up 70 percent of the federal budget — like Medicare and Social Security — needs to be reined in in order to tackle the national debt. Trump drew red tape around those programs, as well as Medicaid, on the campaign trail in 2015 because they are extremely popular federal programs.
Now, his policy positions around those programs break from that promise.