President Trump released his full budget plan yesterday, which slashes nutrition, health care and other important assistance programs that help millions meet a basic living standard. With the help from our friends at the Center on Budget and Policy Priorities (CBPP), we have more detail on the President’s budget, as well as an update on Senate health reform developments below.   

President Trump’s Budget

As CBPP President Bob Greenstein’s statement outlines, the President’s Fiscal Year 2018 budget “proposes steep cuts in basic health, nutrition, and other important assistance for tens of millions of struggling, low- and modest-income Americans, even as it calls for extremely large tax cuts for the nation’s wealthiest people and profitable corporations… In fact, this stands as the most radical, Robin-Hood-in-reverse budget that any modern President has ever proposed.”

Among the lowlights, the President’s budget:

• Slashes food assistance (SNAP) by $193 billion over ten years and shifts the cost of more than $100 billion of SNAP benefits, a long time federal responsibility, to the states.
• Cuts Medicaid by $600 billion over ten years—on top of the already-massive cuts in Medicaid and subsidies for private health coverage in the House-passed bill to repeal and replace the Affordable Care Act that President Trump supports and incorporates into his budget. These additional cuts would almost certainly increase the number of uninsured and would shift significant Medicaid costs to states on top of the giant cost shift in the House health bill.

Timing on Health Care

While Senate Majority Leader McConnell would like to bring a health reform proposal to the Senate floor in June, various reports indicate this could easily slip until July.

Today’s release of the CBO analysis of the House-passed bill, will kick off a process within the Senate, including consultations with the Parliamentarian about which aspects of that bill violate the Senate’s reconciliation rules. That process could take a few weeks.

We do know that intense conversations are happening in the Senate around their proposed bill now – which is why we view these next few weeks as incredibly crucial in impacting those conversations by lifting up and amplifying the opposition to ALL of the harmful proposals in this bill.

Senate Negotiations

Sen. McConnell’s appointed Republican working group to design a health reform bill as a replacement to the House’s AHCA bill, has reportedly been meeting very frequently, focusing on a wide array of issues including Medicaid; private market reforms; affordability, etc. There are some signals that the group is not close to an agreement, and that there are growing differences among Republicans on some key issues.

Several press reports confirm that some Republican senators from Medicaid expansion states are working to develop changes and improvements to the House’s Medicaid provisions.

Yet, as of now, it does not appear that this group – or any senator within – is willing to oppose eliminating the Medicaid expansion (e.g. the higher match) or converting the program to a per capita cap. The ideas that the press reports mention from this group, include delaying the effective dates and other relatively minor adjustments.

It appears that there are three particularly salient and politically-powerful harmful impacts of the House’s harmful Medicaid changes among some key Republican senators:

1. the opioid crisis
2. rural communities
3. seniors, especially very elderly, poor Americans

What’s Next & How You Can Help:

CBO Score:

First, the CBO analysis offers yet another opportunity to highlight that the House bill will cause millions of Americans to lose Medicaid coverage. The CBO score estimates that in 2018, 14 million more people will be uninsured under the American Health Care Act than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. We must use that fact to pressure the Senate to reject the House changes and protect Medicaid.

A summary of the CBO score can be found here: https://www.cbo.gov/publication/52752

Memorial Day Recess:

Second, the Memorial Day recess could be the last recess before the full Senate takes up health reform (even though it could slip), so we need to use it to the maximum extent possible to continue your terrific efforts to educate our senators about the impact of the House changes in Medicaid.

In the coming weeks, and during Recess, ideas and asks for engagement on Medicaid include:

• Continue to call our Senators to ask them to commit to not voting for something that would violate our core principles (below)
• Participate in House member “accountability” events – it will be important to show House members who voted for AHCA that we won’t forget their vote; this also sends an important message to our Senators as well
• Write a letter to our Senators asking them to commit to the below principles
• Call, email and tweet at our Senators with the same message
• Commit to get five friends to do the same

We continue to think the most effective message is the one we have shared before: please ask our senators to COMMIT opposing any bill that:

1. Reduces coverage for millions of Americans; OR
2. Effectively ends Medicaid expansion (no matter how delayed the effective date is) by phasing out the higher federal funding match; OR
3. Effectively ends the Medicaid program by converting it to a per capita cap or block grants; OR
4. Makes individual market coverage less affordable for low- and moderate-income people

The “ASK”:

• Cory Gardner, Republican Senator
  • With Colorado’s decision to take part in the Medicaid expansion, it is particularly important to stress that simply delaying the effective dates of the House provisions (such as phasing out federal funding) or making other relatively minor adjustments to the end of the expansion or the per capita cap (PCC) are just unacceptable.
  • There is no policy justification to end the highly successful Medicaid expansion or convert the program to a cap that will lead to the rationing of Medicaid services to the elderly, people with disabilities, and children.

• Michael Bennet, Democratic Senator
  • Democratic senators can play a vital role in this debate by continuing to lift up the harmful impact of the House Medicaid provisions in Colorado.

In the coming days, we will continue to update you on important developments and the state of play, along with sharing relevant information and messaging to help impact ongoing Senate negotiations and help keep the pressure on our Senators!

Thank you again for your hard work and willingness to keep going.

Contact info for Colorado congressional delegation:

Sen. Cory Gardner – 303-391-5777  Email here.

Sen. Michael Bennet – 303-455-7600 / 866-455-9866 Email here.

Rep. Diana DeGette (CO District 1) –  303-844-4988 Email here.

Rep. Jared Polis (CO District 2) – 303-484-9596  Email here.

Rep. Scott Tipton (CO District 3) – 970-241-2499 Email here.

Rep. Ken Buck (CO District 4) – 970-702-2136   Email here.

Rep. Doug Lamborn (CO District 5) – 719-520-0055   Email here.

Rep. Mike Coffman (CO District 6) – 720-748-7514  Email here.

Rep. Ed Perlmutter  (CO District 7) – 303-274-7944 Email here.