Is it time to broaden health coverage for all, or should we cut the health care budget? The differences between progressive Democrats’ vision of Medicare for All and President Trump’s proposal to make draconian health care cuts couldn’t be starker.

Progressive Democrats have put forward new proposals to achieve health care for all. In February, Washington State Congressional Representative Pramila Jayapal and more than 100 cosponsors introduced a Medicare for All bill that includes all immigrants, documented and undocumented, along with citizens. Rep. Jayapal’s bill is the most inclusive and comprehensive federal health care expansion proposal on the table. Here is National Immigration Law Center’s short blog post and statement about the proposal, and their digital toolkit that can be used to tweet about it. Coverage under the bill includes all primary care, hospital and outpatient services, prescription drugs, dental, vision, women’s reproductive services, maternity and newborn care, mental health, and long-term services and supports for people with disabilities and older
adults.

House Speaker Rep. Nancy Pelosi (D-Calif.) has committed to hearings on the policy this Congress. She has also designated Rep. Brian Higgins (D-N.Y.) to lead Medicare buy-in legislation. Other approaches are also in the works.

The bills are not expected to be enacted under President Donald Trump but they keep the Medicare for All debate alive in the run-up to the 2020 elections. Meanwhile, others in the Democratic caucus are seeking to shore up the ACA by controlling damage done by the Trump administration and by making smaller expansions for near-retirees.

President Trump, however, is set on cutting back the existing health care safety net. His budget (see pp. 39-49) for the fiscal year that starts next October 1 includes measures that would eventually:

• • Slash Medicaid by more than $1 trillion, especially by:
    • • Replacing the Affordable Care Act, which has expanded Medicaid to 17 million people, with something “modeled after” the most drastic of the failed 2017 repeal efforts.
    • • Limiting federal funding to block grants or per-person caps.
    • Making a nationwide work requirement for adult Medicaid recipients that lawsuits are challenging in every state that has imposed this. An analysis by the Center on Budget and Policy Priorities points out that the “vast majority” of recipients are already working or aren’t medically able to; that tying other assistance programs to work requirements hasn’t increased recipients’ employment over time; and that taking away health care makes it harder for people to sustain work. By 2021, this requirement would cut an estimated 1.4 to 4 million people off Medicaid.

• Cut over $500 billion from Medicare by paying providers less, forcing many people to pay more for prescription drugs, requiring prior authorization for many more traditional services, and taking away some appeal rights, as described by the Medicare Rights Center.
  

For the whole dirty “laundry list,” check out Community Catalyst’s blog.  This budget, says the National Health Law Program, breaks the President’s promise to protect Medicare and Medicaid, and his vow that no one would lose health coverage on his watch.

-Janet Varon, NoHLA Executive Director & Charlie Mitchell, NoHLA Senior Attorney