In the budget that President Donald Trump is expected to release Tuesday, CNN has reported that there will be $800 billion in cuts to Medicaid, which assumes that the reductions contained in the House health care bill become law. With all of the frenzied coverage of President Trump’s trip overseas and the ongoing investigation into “Russiagate,” one of the biggest stories of the day might have slipped under the radar.
But now it’s lighting up on Twitter. The reason: the proposed cuts to Medicaid would be devastating to low-income adults and their children, as well as the disabled and elderly Americans who depend on these benefits to survive.
Indeed, if some voters believed that President Trump might start moderating his tone or moving closer to the political center, this budget should throw some cold water on those kinds of predictions.
And the proposal could have deep ramifications for the political strength of the Republican Party.
Since its enactment in 1965 as part of President Lyndon Johnson’s Great Society, a sweeping program of domestic reforms, Medicaid has emerged as a centerpiece of the US social safety net. Although the program started as a small and insignificant complement to Medicare, over the decades it has grown in terms of the types of benefits provided and the number of Americans covered.
Not only are there over 70 million Americans who depend on the health care benefits that Medicaid provides, but state and local governments as well as health care providers (hospitals, insurance companies, physicians) all depend on this steady revenue flow into our troubled medical system.
In contrast to the history of many social programs, this has been a case where stigmatized benefits that help the “poor” and the “disadvantaged’ evolved into an enormously popular program that has broad political support.
This is the reason that so many Senate and even House Republicans trembled when the Freedom Caucus worked with the administration to place draconian Medicaid cuts into the health care bill. These Republicans understand that cutting Medicaid in this way is different than abstract warnings about the problems with big government.
Taking benefits away from Americans is as difficult politically as creating new social programs. These proposed cuts are very real. Lower-income Americans would lose access to vital health care benefits that come from Medicaid. Children from these communities would see their access to health care curtailed with cuts to the Children’s Health Insurance Program (CHIP), a Medicaid program.
And state governments would struggle as federal funds from Medicaid dry up. States would receive Medicaid as a block grant rather than open-ended entitlement. Even if more citizens needed funds, the amount of federal funds they received would be capped.
The Medicaid cuts come on top of many other proposed reductions that target Americans with the fewest resources. The budget is expected to cut food stamps (a program that over 40 million people received in 2016) and other anti-poverty programs. The budget is also said to include cuts to the Earned Income Tax Credit and the Child Tax Credit, which are tax breaks that have been very beneficial to working Americans who are struggling to stay afloat.
If President Trump was serious about being a populist who stood up for struggling Americans, this budget indicates otherwise. Coupled with his proposed tax cuts, these domestic policies would entail a massive redistribution of wealth from the poor to the rich.
Passing this budget won’t be easy. As a result of the political scandal engulfing his administration, Trump is a severely weakened President. Even his standing among Republicans has finally started to slip. With members of Congress watching each day to see the latest news about Russia and potential obstruction of justice charges, it will be difficult for the President to whip up the necessary votes, especially for spending cuts that are not very popular with large parts of the electorate. Out of the 52 Senate Republicans, 20 of them represent states that expanded Medicaid under the Affordable Care Act.
In addition, Republican senators and representatives from swing states and districts may be concerned that voting for Medicaid cuts could hurt their chances of re-election in 2018. At this point in a turbulent presidency, Republicans are looking for Trump to say and do things that will help them solidify their shaky support rather than cause more tensions within their constituencies. They are tired of going to town hall meetings where they encounter furious residents who don’t like the direction of the nation.
Nothing will do more to energize Democrats than this budget. Even the investigation pales in comparison to what proposed spending cuts like these mean to the opposition party. With this budget, Democrats gain a very clear understanding of what’s at stake if Republicans retain control of Congress and President Trump goes on to finish his term.
The risks are not simply about corruption and undermining the reputation of the nation’s leadership — the risks are about serious slashes to basic social programs that Americans depend on. For all the rhetoric about which party cares more about struggling Americans, punitive cuts such as these make it more difficult for Republicans to claim the high ground.
Today, President Lyndon Johnson must be shedding some tears from his grave. As he watches President Trump attempt to go even further than President Ronald Reagan on dismantling the welfare state, he would be deeply saddened given his understanding of what these kinds of programs meant to “middle America.” Medicaid and Medicare were not about providing government “handouts,” nor where they about accepting some sort of nanny state. The programs were designed to ensure that all Americans had basic access to health care so that they could be good citizens and participate in the marketplace.
Our current President is moving in the opposite direction, and this budget indicates what his real priorities are despite all the bluster from the campaign trail. The problem for President Trump is that this budget, coming when it does in this presidency, might end up being more a part of his undoing than his triumphant political success.