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President Trump’s Budget Proposal Represents a Vision for the Country That Does Not Prioritize People with Medicare

A shorter version of this post appeared in the New York Times as a letter to the editor written by Joe Baker, president of the Medicare Rights Center and Judith Stein, executive director of the Center for Medicare Advocacy, in response to the editorial board piece titled, “Not All Medicare Cuts Are Bad.“

The President’s annual budget request to Congress is a powerful document, as it represents the administration’s vision for the country—a roadmap for where it would like lawmakers to go. It reflects the administration’s fiscal and programmatic priorities, which again this year do not include people with Medicare.

Further, because many older adults and people with disabilities look to a constellation of programs to stay healthy as they age, the budget’s Medicare cuts alone don’t tell the full story of how the Trump administration’s vision for the future would impact beneficiaries.

The Medicare Rights Center agrees that conserving Medicare resources to preserve the program for generations to come is an important goal. We support commonsense, meaningful reforms that would make Medicare more efficient and sustainable without jeopardizing beneficiary access to care—such as better aligning payment incentives, reducing program and out-of-pocket costs for prescription drugs, and improving program solvency. But achieving federal savings by impeding Medicare beneficiaries’ access to care is unacceptable—and some of the policies in the President’s 2020 budget request would do just that.

Among the budget’s problematic Medicare provisions are changes to the Medicare Part D prescription drug program that would increase enrollee costs, efforts to curtail beneficiary appeal rights, and the proposed expansion of prior authorization in Original Medicare—all of which could make it harder for people with Medicare to obtain needed care.

We have similar concerns with some of the outlined cuts to Medicare providers. Though intended to control costs by reducing spending growth in provider payments rather than by cutting services directly, we are skeptical that reductions of the magnitude proposed could be implemented without negatively affecting beneficiaries. While it’s true that the Affordable Care Act (ACA) also made adjustments to Medicare reimbursements, these savings were coupled with reinvestment efforts to expand and improve health coverage.

The Trump administration’s budget includes no such strategy. Instead, its Medicare spending reductions are recommended alongside significant cuts to other health care programs on which older adults and people with disabilities rely—including Medicaid and the ACA.

These changes echo prior legislative and administrative proposals to deeply cut and fundamentally restructure the Medicaid program, to the detriment of the 12 million older adults and people with disabilities who rely on both Medicare and Medicaid for their health and long-term care needs. They also reaffirm this administration’s commitment to eliminating the ACA—including the law’s consumer protections and Medicare reforms that have made the program more sustainable and its coverage more affordable.

Importantly, these cuts are not hypothetical. The 115th Congress saw repeated attempts to repeal the ACA and dismantle Medicaid, and the administration has relentlessly pursued regulatory changes that would achieve similar goals. The political reality of split-party control in the current Congress appears to have only emboldened the administration’s agenda. It continues to allow states to impose punitive Medicaid coverage restrictions, and recently backed a federal court decision that would render the entire ACA law invalid—threatening to upend the national health care landscape as well as erode the health and economic security of millions of Americans.

Older adults, people with disabilities, and their families deserve better. Working together, we can find ways to reduce health care costs while protecting people who rely on Medicare, Medicaid, and the ACA for high-quality care. But the Trump administration’s vision for the future is not ours.

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