The Trump agenda is not all about gagging scientists and people fighting against inequality: the aim is to minimise state spending, not least on health care, to maximise the possibility of tax cuts for Trump’s backers, the super-rich.
But slashing government health spending, and in particular cutting the already restricted Medicaid program which provides for the lowest-income groups, who are least likely to be covered by health insurance, is “a lot harder than many may think,” according to an article in Modern Healthcare.
The first complication is that the $880 billion spent on Medicaid in 2023 does not stay in the poorest households, but flows “into the pockets of hospitals, physicians, nursing homes, health insurers and other healthcare entities,” and these businesses are likely to resist any effort to reduce that flow.
The second complication is that while the Republicans have small majorities in the Congress and the Senate, their ability to pass legislation depends upon them all voting the same way. It’s likely some at least will disagree, not least because it would potentially boost their Democrat opponents at the mid-term elections. So even if they lack the power to block a reconciliation bill, the Democrats are certain to highlight its impacts on voters and businesses.
Back in 2017 it was the potential impact of proposed Medicaid cuts in particular that defeated the Republicans’ attempt to repeal Obama’s Affordable Care Act in 2017. The same could happen again when details emerge in the coming weeks.
An inkling of the kind of problems the Trump administration might encounter in making big cuts can be gleaned from the chaos that has followed a vaguely worded instruction on Monday from the White House Office of Management and Budget for federal agencies to suspend “financial assistance” from programs.
There was an immediate outcry over the potential impact of this directive on both Medicaid and the Medicare program which provides health coverage to senior citizens. But even as the White House belatedly issued clarification and insisted that there was no intention to restrict access to individual benefits, it became clear that the spending freeze will impact a wide range of federal, state and local public health efforts.
On Tuesday there were complaints that community health centres, which subsist largely on federal dollars, couldn’t access funding through the Health and Human Services Department payment system. Modern Healthcare listed the wider range of possible victims as:
“older adults, Alzheimer’s disease programs, HIV/AIDS programs, Medicare enrollment assistance, tobacco cessation, mental health services, maternal and child health programs, health professionals training, rural health research, rural hospitals, telehealth, National Health Service Corps scholarships, teenage pregnancy prevention, nursing and medical school loans and scholarships, health disparities research, women’s health research, chronic disease prevention, bioterrorism preparedness, and sexually transmitted disease prevention.”
So great and instant was the reaction that the next day the U.S. District Court for the District of Columbia, responding to a challenge from the American Public Health Association and other grant recipients suspended the White House action until next Monday, when a hearing will consider the policy’s legality.
If the administration does press ahead with Republican ambitions to make cuts in Medicaid state Governors and legislatures would have to decide whether to make up for reductions in federal funding by tapping state resources to sustain Medicaid. If they will not or cannot do so, it will limit the income of hospitals and community health centres and access to health care— particularly in Republican-leaning rural areas.
It’s clear that any substantial cutbacks in spending that reduce access to front line services will produce a backlash, some of which could involve Trump’s own base of support.
It’s not clear how cutting off the access to health care for their families, and handing a corresponding advantage to the shattered Democrats will make much sense to at least some Republicans facing re-election in two years, let alone fit the rhetoric of Making America Great Again.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.