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Photo: Andrew Harrer / Bloomberg via Getty Images

Presidents’ budgets are not legislative documents. They’re wish lists. So it’s easy to make too much of them — there’s really no penalty for swinging for the fences, nor is there much incentive to try to craft a budget that would please a lot of people.

The bottom line: A lot of these proposals would need congressional approval, and that’s why a great many of them will never see the light of day. But this is a pretty good roadmap to the administration’s priorities — one that should make Medicaid advocates, including hospitals, especially nervous.

But with the caveat that the budget is just a statement of priorities, here’s what we can glean from the choices the Trump administration announced yesterday...

  • Public health is out. President Trump’s budget proposed some steep cuts to public-health agencies and programs, including significant reductions at the Centers for Disease Control & Prevention.
  • Medicaid is a prime target. The budget calls for steep, blunt cuts to Medicaid — cuts that would total more than $1 trillion over a decade, by the White House’s math. Those include the dramatic cuts from last year’s repeal-and-replace bills, which are obviously not going to happen. But the budget also calls for tighter eligibility rules, fewer benefit mandates and more rigorous screening for things like immigration status.
  • ACA stabilization is in? Trump’s budget called for fully repealing the Affordable Care Act. But it also says Congress should fund the law’s cost-sharing subsidies — funds Trump cut off last year. And it calls for fully funding the law’s “risk corridors” program, which helps soften the blow for insurers who have had a rough time in the exchanges.
  • Medicare is somewhere in the middle. The budget would significantly reduce Medicare spending, but a lot of those savings are pretty technical, and some are reruns from President Obama’s budgets.
  • Pharma is not completely safe. No, Trump hasn’t formally proposed Medicare price negotiations, and he probably won’t. But his budget does still call for several steps that would lower seniors’ drug costs, including creating a new cap on seniors’ out-of-pocket costs.

Go deeper

House passes George Floyd Justice in Policing Act

Photo: Stephen Maturen via Getty Images

The House voted 220-212 on Wednesday evening to pass a policing bill named for George Floyd, the Black man whose death in Minneapolis last year led to nationwide protests against police brutality and racial injustice.

Why it matters: The legislation overhauls qualified immunity for police officers, bans chokeholds at the federal level, prohibits no-knock warrants in federal drug cases and outlaws racial profiling.

Senate Republicans plan to exact pain before COVID relief vote

Sen. Ron Johnson. Photo: Stefani Reynolds/Bloomberg via Getty Images

Republicans are demanding a full, 600-page bill reading — and painful, multi-hour "vote-a-rama" — as Democrats forge ahead with their plan to pass President Biden's $1.9 trillion COVID-19 relief package.

Why it matters: The procedural war is aimed at forcing Democrats to defend several parts the GOP considers unnecessary and partisan. While the process won't substantially impact the final version of the mammoth bill, it'll provide plenty of ammunition for future campaign messaging.

The new grifters: outrage profiteers

Illustration: Sarah Grillo/Axios

As Republicans lost the Senate and narrowly missed retaking the House, millions of dollars in grassroots donations were diverted to a handful of 2020 congressional campaigns challenging high-profile Democrats that, realistically, were never going to succeed.

Why it matters: Call it the outrage-industrial complex. Slick fundraising consultants market candidates contesting some of their party’s most reviled opponents. Well-meaning donors pour money into dead-end campaigns instead of competitive contests. The only winner is the consultants.