My Turn: Trump budget attacks Medicaid, breaks promises

For the Monitor
Published: 10/30/2017 12:15:05 AM

On Thursday President Donald Trump declared war on the opiate crisis. That same day congressional Republicans effectively raised the white flag in that war by advancing Trump’s budget. To quote the Wizard of Oz, “Pay no attention to that man behind the curtain.”

The budget would decimate funding for Medicaid. According to nonpartisan analysis, cuts are more than $1 trillion for Medicaid over a decade’s time and $473 billion for Medicare. They’re almost certainly worse, as additional “savings” from safety net programs is undefined.

Medicaid expansion has provided critical access to substance misuse treatment in New Hampshire, which Trump famously described as “a drug-infested den.” Without committing resources, and indeed taking them away, declaring a “public health emergency” was an empty exercise. In contrast to its huge health care cuts, the Trump administration’s Public Health Emergency Fund has $57,000 in it.

Severe Medicaid and Medicare cuts were, in fact, urged on by Trump, who proposed cutting Medicaid alone 47 percent by 2027. The president has abandoned his many campaign promises to protect Medicaid and Medicare. In 2015, for example, he advertised himself to New Hampshire voters on Twitter as “the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.”

States partner with the federal government in covering the costs of Medicaid care, and it’s now clear the federal government wants to sever that partnership. This isn’t just Affordable Care Act expansion, but the traditional Medicaid dating back to the 1965 enactment of the federal Medicare-Medicaid safety net. New Hampshire’s own budget cannot afford the loss of federal resources necessary to care for seniors in the state with the nation’s second-oldest population.

The Trump budget effectively resuscitates failed congressional attacks upon seniors under the guise of ACA repeal and replacement. And both its Medicaid and Medicare cuts are used to pay for what the president, on Twitter, calls “MASSIVE tax cuts for the American people!” But tax cuts should be considered on their own merits, not financed by defunding care.

The human consequences are clear. As Sen. Angus King, I-Maine, noted during floor debate, “If you are cutting Medicare, you are hitting seniors.” Furthermore, “70 percent of the nursing home beds in America are paid for by Medicaid. By definition, who is in those beds? Seniors.”

As they had done during debate over their failed health care bills, congressional Republicans mischaracterized cuts as simply a reduction in increases. More confusingly, Senate Budget Chairman Mike Enzi claimed “Medicaid outcomes” were “lackluster” as his excuse for cuts. I can’t speak for Enzi’s Wyoming, but I’m proud of the care provided in New Hampshire.

According to the Census Bureau, by 2030 there will be 3 million more Americans 85 and older than there were in 2012. This is a demographic where one commonly has long-term care needs, and has exhausted resources to pay for them. If the elderly population has very substantially grown, while funding for it has very substantially decreased, how will a cut have not occurred? What “outcomes” would Sen. Enzi then predict?

The Trump budget would undo modest gains achieved in traditional Medicaid funding this past session by our Republican-controlled Legislature, and imperil our state’s admirably bipartisan approach to Medicaid expansion.

As these federal cuts are implemented over time, it will be incumbent upon New Hampshire policymakers, of both parties, to fight them.

(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)




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