Medicaid, Medicare and Social Security are among the most popular federal programs out there. A 2019 Pew Research poll showed majorities across all parties and demographics opposing cuts to Social Security. A Public Policy Polling survey that same year found broad opposition to slashing Medicaid or Medicare.
The programs are so popular that Donald Trump himself, back in his 2016 campaign, promised to keep his hands off of them. And in his State of the Union address on Feb. 4, he reiterated what he called “an ironclad pledge to American families” to “always protect your Medicare and your Social Security. Always.”
These, of course, were falsehoods.
In an interview shortly before his speech, Trump opened the door to cutting Social Security and Medicare benefits if he’s re-elected. Days later, after releasing his budget blueprint for fiscal year 2021, the president rolled out plans to cut $2 trillion from social safety net programs over the next decade.
Trump’s budget proposal will likely go the way of last year’s, when he called for slashing $1.5 trillion from Medicaid over 10 years only to see Congress reject it out of hand. Still, he is already taking concrete steps to undermine these programs, starting with Medicaid.
Currently, Medicaid is what’s known as an open-ended health benefit — it covers poor, near-poor and disabled adults and children as their needs require. The federal government pays 50 to 75% of the cost through the traditional Medicaid program, with states covering the rest. When the program was expanded under the Affordable Care Act, the federal government stepped in to cover 90% of the cost of caring for new enrollees.
But the Trump administration now proposes to let states that opted for the expansion cap what they spend for their portion of the expanded population. This would mean kicking many people — largely vulnerable parents and struggling childless adults — off Medicaid altogether, while reducing coverage for others.
Under the proposal, that capped spending is indexed to inflation, which typically grows at a slower rate than medical costs, instead of according to need. In short, it destroys the program’s fundamental promise to provide coverage — and this from the same folks who worried so much about Obamacare “death panels.”
Trump has also proposed slashing Social Security disability benefits by $2.6 billion over 10 years and requiring millions of people with severe physical and intellectual disabilities to muck through a mass of red tape every two years to “re-prove” that they are still disabled.
This is expected to cost nearly as much to administer as it would save in benefits.
It’s risky business for Trump to try to fundamentally alter the way Medicaid, Medicare and Social Security provide critical health care and security to Americans in need. It’s even riskier to make an “ironclad promise” to protect these programs while trying to cut them to pieces.
Breaking this key promise might shred the safety net — but it could also shred the prospects of the president who tried to destroy it.
Karen Dolan directs the Criminalization of Race and Poverty Project at the Institute for Policy Studies. This column is distributed by Tribune News Service.
