This Is My Shocked Face: Donald "No Cuts to Medicare/SSI" Trump proposes MASSIVE cuts to Medicare, SSI, Medicaid & the ACA

Four days ago, from Trump Administration Centers for Medicare & Medicaid Administrator, Seema Verma:

No, the Trump administration is not cutting Medicaid.

— Administrator Seema Verma (@SeemaCMS) February 6, 2020

(sigh) Honestly not sure why I'm bothering posting this. Anyone who doesn't understand that the only promises Trump keeps are the racist, xenophobic, homophobic, misogynistic, antisemitic and corrupt ones by this point is either a complete idiot or willfully ignorant:

The Trump administration wants to slash billions of dollars in federal support from Medicaid, food stamps and other safety net programs for the poor, while largely sparing the Medicare program that benefits seniors.

The $4.8 trillion federal budget proposal for 2021, which the White House unveiled on Monday, is largely a wish list of President Donald Trump's priorities. But few of these cuts are expected to get past the Democrat-controlled House of Representatives.

Trump told the nation's governors at a White House event that he would preserve entitlement programs.

"We're not touching Medicare. We want to keep Medicare. We're not touching Social Security," he said. "We're not decreasing Medicaid. But we're doing a lot of things that are very good, including waste and fraud."

This, of course, is utter bullshit:

The White House on Monday proposed a $4.8 trillion election-year budget that would slash major domestic and safety net programs, setting up a stark contrast with President Trump’s rivals as voting gets under way in the Democratic presidential primary.

The budget would cut Medicaid and the Children’s Health Insurance Program and also wring savings from Medicare despite Trump’s repeated promises to safeguard Medicare and Social Security.

It takes aim at domestic spending with cuts that are sure to be rejected by Congress, including slashing the Environmental Protection Agency budget by 26.5 percent over the next year, and cutting the budget of the Health and Human Services department by 9 percent. HHS includes the National Institutes of Health and the Centers for Disease Control and Prevention, which will see a budget cut even as the coronavirus spreads -- although officials said funding aimed at combating the coronavirus would be protected.

...The budget cuts Medicaid spending by about $920 billion over 10 years, a change Democrats and administration critics warn would lead to reductions in benefits and the number of people on the health care program.

I honestly don't even have the energy to document how devastating even a fraction of this would be, so let me just say:

Republican budget:
1) One trillion dollars cut from Medicaid and ACA
2) 700 million, 9 percent cut to CDC
3) Epidemiology & Laboratory Capacity Program (CDC) Request (FY 2021): $0

They are coming for your healthcare. For real they are.

— Brian Schatz (@brianschatz) February 10, 2020

BREAKING: Trump's budget repeals the Affordable Care Act and slashes Medicaid with cuts of about **$1 TRILLION**. Screenshots coming.

— Topher Spiro (@TopherSpiro) February 10, 2020

Here is the repeal: "health reform vision" "market-based health care grant"

We've seen this before. It's Graham-Cassidy repeal on steroids.

— Topher Spiro (@TopherSpiro) February 10, 2020

"Graham-Cassidy", you may recall, was the last version of the GOP's 2017 "Repeal/Replace Obamacare" plans. As a refresher, here's what it would do to healthcare coverage nationally and by state:

Graham-Cassidy’s impact on coverage in 2027 would be similar to that of the Obamacare Repeal Reconciliation Act (ORRA), the so-called “repeal and delay” bill that the Senate failed to pass in July. Under both the ORRA and Graham-Cassidy, these three major policies would be in effect a decade from now:

  • Repeal of the mandates for individuals to obtain health insurance coverage and large employers to offer insurance
  • Elimination of subsidies for nongroup health insurance
  • Elimination federal funding for the ACA’s Medicaid expansion

The CBO estimated that the ORRA would have resulted in tens of million more uninsured in 2026. It projects that Medicaid would cover 19 million fewer people and that the individual market, with 23 million fewer people, would nearly disappear. Although the CBO expects that about 11 million more people would have coverage through an employer, the ORRA’s net effect would be 32 million fewer people with coverage in 2026.

...Last week, Sens. Lindsey Graham (R–S.C.) and Bill Cassidy (R–La.) unveiled congressional Republicans’ latest bill to repeal and replace the Affordable Care Act (ACA). The Congressional Budget Office (CBO) has indicated that it will not release a score of the bill that includes its effects on insurance coverage for several weeks, but Senate leaders have indicated they will hold a vote without a score. The bill, however, is similar to prior ACA repeal-and-replace bills for which we do have CBO scores. Based on those estimates, it is likely that the bill, if enacted, would lead to a loss of health insurance for at least 32 million people after 2026.

The bill can be boiled down to five key provisions:

  • Repeals the ACA marketplace subsidies and federal funding for the Medicaid expansion in 2020.
  • Creates a temporary block grant for states that ends in 2026. States can use the funds for a wide range of purposes.
  • Repeals the individual and employer mandates.
  • Creates a waiver program for states that would allow insurers to charge people more based on their health and cut benefits like maternity care.
  • Places per capita spending limits on funding for the traditional Medicaid program.

...and so on, and so on. That's roughly 10% of the country who would lose coverage (although I supposed it'd be more like 8-9% now, since the number of uninsured Americans has already gone up by as many as 7 million people under the Trump Administration's other policies already anyway).

Here are the *additional* cuts to Medicaid: "modernize Medicaid and CHIP" "Medicaid community engagement requirement"

This is national work requirements designed to throw people off coverage by burying them in paperwork.

— Topher Spiro (@TopherSpiro) February 10, 2020

Breaking his campaign promise, Trump DOES NOT include Medicare negotiation of prescription drug prices. There is an extremely watered down proposal that does not save hundreds of billions like Medicare negotiation.

— Topher Spiro (@TopherSpiro) February 10, 2020

To be clear this is a budget, not legislation that will pass this year. But make no mistake: this is what's on the ballot. We can't afford to be complacent, forget what's at stake, or lose focus.

— Topher Spiro (@TopherSpiro) February 10, 2020

Seriously, I often start writing up a detailed analysis of something horrible that the Trump Administration is doing and then wonder whether it's even worth the effort when so many of those who would see their lives destroyed or ended by it don't seem to care anyway.