Feb 11, 2020 - Health

Hospitals and Medicaid enrollees lose under Trump's budget

Illustration: Aïda Amer/Axios

President Trump's 2021 budget proposes massive reductions in Medicare and Medicaid spending, which would be felt most acutely by hospitals and Medicaid beneficiaries.

Why it matters: Budget proposals are more about messaging than policies that have any chance of becoming law, but it's still a good indication of the direction the administration would like to head in if Trump wins re-election.

Yes, but: The budget isn't entirely theoretical; the administration is moving full steam ahead on some of its Medicaid proposals — like work requirements and block grants — and is still hoping to notch a victory on prescription drug prices before the election.

Details: The budget would reduce Medicare and Medicaid spending by hundreds of billions of dollars each over the next decade.

  • The budget doesn't include new policy ideas to replace the Affordable Care Act or protect pre-existing conditions, but does include $844 billion in spending reductions from the "President's Health Reform Vision," which accounts for a large portion of its Medicaid savings.

Between the lines: These huge Medicare savings come at the expense of hospitals, including through site-neutral payment policies and reduced uncompensated care payments.

  • Although the Medicaid reforms are largely unspecified, if the Trump administration's past actions indicate future behavior, they'd likely include cuts to the ACA's expansion population and capping federal payments to states.
  • "The level of spending reductions called for would inevitably mean fewer people covered and more uninsured," the Kaiser Family Foundation's Larry Levitt said.

My thought bubble: It's extremely hard to see Congress legislating these kind of cuts to hospitals, no matter who's in charge. But if Republicans are in control after the election, it's pretty easy to see them at least trying to pass these large-scale Medicaid reforms again.

Go deeper: Trump vs. Medicaid

Go deeper

Appeals court rules against Trump's Medicaid work requirements

Illustration: Sarah Grillo/Axios

The Trump administration violated federal law by allowing red states to impose work requirements on their Medicaid programs, a federal appeals court ruled Friday. The court said the administration had not properly justified its decision, and that it was out of step with Medicaid's statutory goals.

What's next: The most likely next step is an appeal to the Supreme Court. In the meantime, the administration has not won a single favorable ruling in lawsuits over what had once looked like one of its most significant health care policies.

Republican voters have moved on from hating the ACA

Data: Kaiser Family Foundation; Chart: Axios Visuals

Republican voters have moved on from the Affordable Care Act, shifting their focus and opposition instead toward Medicare for All.

By the numbers: In our latest Kaiser Family Foundation tracking poll, 19% of registered Republicans said opposition to Medicare for All is their top health care issue, compared to just 3% who said the same for opposition to the ACA.

Go deeperArrowFeb 24, 2020 - Health

What Biden's big Super Tuesday means for health care

Illustration: Axios Visuals

Health care has become the framework that defines the broader ideological and stylistic divisions within the Democratic primary — a contest between political revolution and Medicare for All vs. bipartisan compromise and a public option.

Yes, but: It's kind of a false choice. Passing either of those health care plans would require a knock-down, drag-out party-line brawl just as intense as the fight over the Affordable Care Act.

Go deeperArrowMar 4, 2020 - Health