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.