Trump-O-Meter

Make no cuts to Medicaid

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.” 


Updates

White House budget reduces Medicaid spending

Trump's 2018 budget directly contradicts his campaign promise not to cut Medicaid, the government health insurance program for poor people.

White House budget director Mick Mulvaney denied this characterization when introducing the budget May 23.

"There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut," he said. "We are not spending less money one year than we spent before."

Yes, the White House's proposed Medicaid appropriations increase year to year. But they are increasing less than they would under current funding levels.

If Congress adopts the White House's proposal, the government would spend an estimated $4.7 trillion on Medicaid over the next 10 years, compared with $5.3 trillion under current funding levels, according to the budget document.

The budget calls for reforming Medicaid by allowing states to choose whether they get their funds either per capita or in the form of a block grant. The White House Office of Management and Budget estimates this would save $610 billion dollars.

The budget also assumes that the House's replacement for the Affordable Care Act, which makes significant changes to Medicaid, passes.

A May 24 report out of the nonpartisan Congressional Budget Office estimates that the House bill, the American Health Care Act, would reduce Medicaid-related spending by $834 billion over 10 years. According to CBO estimates, if the bill becomes law in its current form, 14 million fewer people would enroll in Medicaid over the next decade.

There are are numerous obstacles standing in the way of Trump's budget proposal or the American Health Care Act in its current form becoming law. It's clear Trump has backed away from his pledge to preserve Medicaid funding, but until he signs the cuts into law, this promise stays at Stalled.

Sources:

White House Office of Management and Budget, "A New Foundation For American Greatness Fiscal Year 2018," May 23, 2017

CBO, Cost Estimate: H.R. 1628 American Health Care Act of 2017, May 24, 2017

White House, "Off-camera Briefing of the FY18 Budget by Office of Management and Budget Director Mick Mulvaney," May 22, 2017

White House, "Press Briefing on the FY2018 Budget," May 23, 2017

President Donald Trump pushes the Republican Affordable Care Act replacement at a listening session March 13, 2017. (AFP video)

Despite promise, Trump supports Obamacare replacement that would cut Medicaid

On the campaign trail, President Donald Trump promised that he wouldn't make any cuts to Medicaid, the government-run health insurance program that primarily serves poor Americans.

But two months into his presidency, he has endorsed a House Republican bill that would reduce federal spending on Medicaid by $880 billion over 10 years, 25 percent less than under current law, according to an analysis by the nonpartisan Congressional Budget Office. The bill is the American Health Care Act, House Republicans' leading proposal to replace the Affordable Care Act, or Obamacare.

"The House bill to repeal and replace Obamacare will provide you and your fellow citizens with more choices — far more choices at lower cost," Trump said during a March 13, 2017, event to promote the bill.

Trump didn't mention that some of the largest changes the bill makes have to do with Medicaid, a program that preceded Obamacare by more than 40 years.

Individual states administer their own Medicaid programs, but they share the financial burden with the federal government. There are two main provisions of the House Republican proposal that affect federal spending on Medicaid.

First, it scales back enhanced federal funding for 31 states that expanded Medicaid eligibility requirements, as permitted by the Affordable Care Act. If the law passes and the states don't revert to their old eligibility requirements, it could force states to pay a much larger share of the costs.

The Republican proposal also places a cap on spending per Medicaid enrollee. Under current law, state governments reimburse medical providers who serve Medicaid patients, and the federal government in turn reimburses state governments for a portion of those costs. The proposal would limit the federal government's spending to a per-enrollee amount, based on the consumer price index for medical care, a way of measuring price changes among medical products and services. This might force states to decide whether to limit the services they offer or put more of their own money into Medicaid.

The CBO predicts that these changes, among others, will result in 14 million fewer Medicaid enrollees — there are currently 68.6 million enrolled — which would also cause the federal government to spend less on the program.

Of course, this bill is in its early stages, and there are several indicators it might not even make it past the House of Representatives. And if it does become law, the Medicaid cuts wouldn't start until 2020. But because Trump is pushing hard for Congress to pass it, we're rating his promise not to cut Medicaid Stalled.

Sources:

CBO, American Health Care Act cost estimate, March 13, 2017

Washington Post, "The GOP health-care plan would quietly kill the Medicaid expansion. Here's how." March 9, 2017

Kaiser, "Compare Proposals to Replace The Affordable Care Act," accessed March, 14 2017

House Energy and Commerce Committee, AHCA section-by-section summary, accessed March 14, 2017

Brookings, "Expect the CBO to estimate large coverage losses from the GOP health care plan," March 9, 2017

Georgetown Center for Families and Children, "What Does House ACA Repeal Proposal Mean for Children and Families?" March 7, 2017

CBPP, "House GOP Medicaid Provisions Would Shift $370 Billion in Costs to States Over Decade," March 7, 2017

PolitiFact, "Mick Mulvaney's misleading claim that House GOP health care plan keeps Medicaid expansion," March 14, 2017