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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

16 mins ago - Health

FDA advisory panel endorses Johnson & Johnson COVID vaccine for emergency use

Photo: Illustration by Cezary Kowalski/SOPA Images/LightRocket via Getty Images

A Food and Drug Administration advisory panel on Friday recommended the authorization of Johnson & Johnson’s one-shot coronavirus vaccine for emergency use.

Why it matters: The FDA is expected to make a final decision within days on the J&J vaccine, which was found to be 66% effective against moderate to severe COVID. An emergency use authorization would allow distribution to immediately begin, helping streamline and speed up the vaccine rollout across the U.S.

Dave Lawler, author of World
17 mins ago - World

Schiff: "Definitive" Khashoggi report sends clear message to Saudis

Photo: Leon Neal/Getty Images

The report released Friday on the murder of Jamal Khashoggi was short on evidence or new information, but Rep. Adam Schiff (D-Calif.) tells Axios that the “definitive” statement assigning responsibility to Saudi Crown Prince Mohammed bin Salman (MBS) speaks volumes.

What he’s saying: Schiff, the chairman of the House intelligence committee, says that while some intelligence couldn’t be published because of the need to protect sources and methods, “we rarely see something published that is this definitive and I think that's an important accomplishment for the administration.”

Exclusive: Law enforcement organizations back Biden pick for assistant AG

Vanita Gupta Photo: Demetrius Freeman/The Washington Post via Getty Images

Local and federal law enforcement officials are backing Vanita Gupta, President Biden’s nominee for associate attorney general, according to letters sent to the Senate Judiciary Committee and obtained by Axios.

Why it matters: The Major County Sheriffs of America noted Gupta “emphasized that she does not support efforts to ‘defund the police'” and highlighted her desire to improve criminal justice through methods that include increased training for law enforcement officials.