President Trump’s federal budget plan for fiscal year 2021, which begins in October, includes close to
Politicians have tried for years to tamp down Medicaid costs, though soon after he took office, Trump said he would not cut the program.
Medicare -- which covers seniors and the disabled -- is a kind of third-rail to politicians wary of alienating a huge block of faithful voters. Trump has pledged to protect it, too.
“I’m not going to cut
But his budget plan also includes changes to the way Medicare pays for services that, though the stated intention is to reduce unnecessary spending -- not cut services for seniors -- could also affect the care people receive.
Trump’s proposal has gone to
“The president’s budget isn’t an action item -- it’s a statement of priorities,” said
But health advocacy organizations are concerned about the possibilities, said
“We think this is a damaging vision for older adults and people with disabilities," Copeland said.
The budget anticipates
Under the ACA, millions of uninsured low-income people gained coverage for the first time as part of the law’s Medicaid expansion. Trump’s plan would end federal dollars -- which dwarf the states’ contributions -- possibly making some 13 million people again uninsured, if states are unable to maintain expanded eligibility, according to the Center on Budget and Policy Priorities, a
The administration also suggested its health reform vision could save money through greater price transparency, lowering prescription drug prices and ending surprise bills -- but the budget does not offer a plan for accomplishing those initiatives or indicate exactly how much money each could save.
According to the budget, the plan would “protect the most vulnerable, especially those with pre-existing conditions." Yet at the same time, the Trump administration is supporting a
Federal court ruling on ACA could imperil preexisting condition coverage. A
The budget also requires all states to establish work requirements for Medicaid recipients, which it says would save an estimated
About two-thirds of adult Medicaid recipients work full-time or part-time, already; those who don’t typically cannot work because of multiple chronic illnesses, physical limitations or other barriers to employment, according to a study by the
Yet the work requirements could save money in a more roundabout way, by making it a lot harder to meet the demands of bureaucracy. People who are qualified may lose coverage if they fail to properly document whether they qualify for a work exemption every time it’s required, said Rudowitz. Many low-income people may not have access to a computer with Internet, may have irregular work hours or might even be homeless.
“To the effect that individuals don’t comply with the reporting and end up facing consequences from being dis-enrolled from the program, they could lose access to health coverage and access to services,” said Rudowitz, who is co-director of the Kaiser Family Foundation’s program on Medicaid and the uninsured.
The proposal could also hurt hospitals and other providers who serve patients regardless of their insurance coverage, and may see an increase in uninsured patients, she said.
What about Medicare?
The budget proposes several changes to the way health care providers are paid in order to save money, not cut services. An estimated
80-year-old Philly woman gets a surprise bill for
“Though intended to control costs by reducing spending growth rather than by cutting services directly, we are skeptical that reductions of the magnitude proposed could be implemented without negatively affecting beneficiaries,” the Medicare Rights Center wrote in a policy brief.
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