Week In Washington: President's Budget

March 14, 2019

This Week President Trump unveiled his 2020 budget that included large cuts to nearly all major Federal health programs.

  • The 2020 President’s budget is a wish-list submitted to Congress. It has no force of law and instead should be thought of a priorities list (what does the President want to do on health policy rather than what he is doing). You can read the budget hereor a news article talking about it here.
  • That said, these are policies that the President might enact given the opportunity (i.e., if Republicans regain the House in 2020).
  • The budget calls for ~$800 billion in Medicare cuts over the next decade. About a fourth of those are cuts to graduate medical education payments. The remainder centers on shifting drugs from Part B to Part D, capping senior out-of-pocket costs in Part D, Part B inflation-adjusted reimbursement increases, increases in cutting “fraud and abuse”.
  • Generally, these are all things proposed last year by President Trump (i.e., nothing new) but the administration estimates the savings will be greater this year (last year’s proposed budget cuts totaled about $500 billion).
  • As a reminder, due to the tax cut legislation from last year, the trust fund is expected to be depleted in 2026, which will drive rhetoric on this topic in the upcoming 2020 Presidential election.
  • Outside of Medicare, the budget also calls for block granting of ACA subsidies and Medicaid Expansion. The proposal mirrors many of the previous ACA repeal efforts.
  • The proposal also calls for nationwide imposition of work requirements.

Other Things in the News

  • House Democrats will hold hearings on short-term duration plans. The goal of the hearing is to drum up support for restricting their marketing and sales.
  • A Federal judge will hear a case on work requirements today (March 14th). Currently, eight states have had waivers approved to implement work requirements.
  • The American Hospital Association unveiled analysis that a universal Medicare buy-in policy would cut hospital revenue by $800 billion over a decade. Hospital associations have been pushing against the bubbling ideas of expanding Medicare to new populations.