As House Speaker Nancy Pelosi famously said in 2017, “Show me your budget, show me your values.” On Monday, officials from President Donald Trump’s administration released their new budget, and it definitely shows us who they are. When it comes to health care, they are the same Republicans who tried to destroy Medicaid in 1981, 1995, 2003, 2005, 2010, and 2017.
Under the 2019 Trump budget, Medicaid would lose $300 million, come with draconian work requirements (a policy currently failing in Arkansas), and eliminate the Affordable Care Act’s Medicaid expansion that has done so much good. Moreover, by changing the basis of funding the program overall, the Trump administration is proposing ending Medicaid as we know it.
The latest Trump budget proposes turning Medicaid into a block-grant program that would cut Medicaid expenditures by $1.5 billion over 10 years, while adding a $1.2 billion “marketplace health-care grant,” i.e. a block grant. Block grants release fixed sums of money to the states rather than basing federal reimbursement on actual costs, so they inevitably represent a cut to services. What’s more, the Medicaid statute prioritizes nursing homes for people with disabilities over community-based living, so these cuts would force impoverished, disabled Americans to choose between institutionalization or homelessness. (It was the proposal of block grants that caused the big protests when the GOP tried to cut Medicaid and undo the Affordable Care Act in 2017.)
This is nothing new. As I wrote for the Washington Post during the height of the Senate GOP’s attempt to destroy the ACA in 2017, Republicans have been proposing block-grant programs since at least the Reagan administration, with continued efforts under House Speaker Newt Gingrich, under the Bush Congresses of 2003 and 2005, and under House Speaker Paul Ryan in 2010. The Trump administration is also proposing an $845 billion cut to Medicare, another sign of its hostility to these fundamental programs that keep vulnerable Americans healthy, housed, supported, and alive.
During the 2015 campaign, Trump made lots of promises about protecting these social programs. He tweeted, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.” As with so many other promised reforms, he has broken this vow.
One of the challenges of reporting on the Trump administration is how to balance covering new and often unique threats while also acknowledging the many ways in which the administration’s most dangerous ideas stem from typical Republican ideas. Republican politicians have long wished to cut popular programs like Social Security, Medicare, and Medicaid while avoiding the political consequences of doing so. When it comes to corruption, lies, ignorance, anti-Semitism, and other forms of bigotry, Trump has outdone many of his GOP predecessors. But when it comes to attacking the programs that the most vulnerable Americans need, Trump is right in step with his predecessors and his party.
Any presidential budget is a fiction. Even administrations with friendly congresses think of it as a negotiating platform, not as a plan they expect to see implemented. But fictions are important. They reveal motivation, identity, and worldview—the ideals after which one chooses to strive. Trump has shown us his budget. He has also, once more, shown us exactly who he is.
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