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.

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