President’s Budget Again Takes Aim at Key Health Care Programs

On Monday, President Trump submitted his annual budget request to Congress. The administration’s plan includes legislative proposals and detailed funding recommendations for Fiscal Year 2021 (FY21). While the president’s budget request is not binding on Congress and does not directly lead to any program or funding changes, it is an important policy document that clearly articulates the administration’s goals and values. Again this year, President Trump’s budget prioritizes deep cuts to programs on which older adults and people with disabilities rely, including Medicare, Medicaid, and the Affordable Care Act (ACA).

The President’s FY21 budget includes harmful policy and payment changes that could create barriers to care for people with Medicare. Among other things, the administration’s proposal could jeopardize beneficiary access to critical services by significantly cutting provider payments. 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. Additionally, the budget includes a concerning site-neutral post-acute payment model. This payment policy could improperly divert patients from clinically appropriate settings to less costly settings that are not able to provide the full array of services they need.

The budget also calls for $1 trillion in cuts to Medicaid and the ACA’s premium tax credits, which could cause millions of people to lose health coverage and access to care. Gutting Medicaid could lead to the rationing of care and force many low-income older adults and people with disabilities out of their homes and communities. In addition, the proposed policies could endanger Medicaid coverage for struggling families by imposing punitive eligibility restrictions and administrative barriers.

While the budget includes an allowance for prescription drug pricing reform, it does not provide a roadmap for improving the current system. We urge the administration to support the Lower Drug Costs Now Act (H.R. 3), which passed the House of Representatives last year. That bill would restructure the Part D benefit, limit beneficiary out of pocket drug costs to $2,000 per year, and empower Medicare to negotiate directly with drug companies to lower the price of certain prescription drugs. H.R. 3 would reinvest much of these savings back into the Medicare program, achieving monumental coverage and affordability gains for consumers.

Similarly, the budget fails to identify a replacement plan for the ACA that would maintain the health law’s coverage pathways and consumer protections, even as the administration is actively supporting its full repeal.

As in previous years, President Trump’s FY21 budget is full of damaging policies that would make it harder for older adults, people with disabilities, and working families to meet their basic needs. We urge Congress and the administration to reject this flawed budget, and to instead pursue solutions that prioritize the health and well-being of all Americans.