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2018 Federal Budget Proposal

President Trump Slashes Funds for Medicaid and Increases Funds for Defense and Border Wall

On Tuesday, May 23rd, the White House unveiled its $4.1 trillion FY 18 proposed budget. Despite earlier assurances that Medicaid funding would be preserved, the president’s budget eviscerates the program with a proposed $616 billion cut over 10 years, roughly on par with the magnitude of cuts sought in the American Health Care Act (AHCA). The White House plan also includes steep cuts to other safety-net programs including food stamps and cash assistance and would mandate new work requirements for certain individuals. The plan targets students by slashing funds for the federal student loan program which incentive students to pursue careers in health, public safety and education. In stark contrast, the budget includes a 10 percent increase in spending on military defense as well as additional funding for border security and immigration enforcement including funds to help pay for Trump’s border wall.

For more information, view the White House’s full federal budget proposal and accompanying summaries. CPEHN will continue to monitor and weigh in on the proposed budget to ensure the President and Congress are adequately prioritizing the health of our most vulnerable communities.

Highlights:

Defense, Deportation, and a Border Wall:

  • Department of Defense - $52 billion increase: Increases funding for the Department of Defense and other national defense programs including additional resources for the construction of Trump’s border wall, expanded detention capacity, immigration judges, ICE and Border Patrol agents.
  • Tax Reform – TBD: States the president’s intention to simplify the tax code and make sweeping cuts to taxes on individuals and businesses as part of Congress’ tax reform efforts.

Health

  • Medicaid - $610 billion cut: Converts Medicaid to a per capita cap or a block grant program. More than 14 million Californians are enrolled in California’s Medicaid program (Medi-Cal) including communities of color who comprise 68% of enrollees. The program provides comprehensive health coverage to one third of the state’s residents and half of all children in the state. The president’s proposal would cut federal funding for the program in half, resulting in millions of Californians losing their health care coverage and the loss of important federal protections for remaining enrollees.
  • Children’s Health Insurance Program (CHIP) - $6 billion cut: Decreases the federal matching rate for the CHIP program, a health insurance program for low-income children, after 2019. California covers this population through our state’s Medicaid program, Medi-Cal.
  • Affordable Care Act (ACA) Repeal - $250 billion cut: Assumes the ACA is repealed and funding eliminated.
  • Centers for Disease Control and Prevention - $1.2 billion cut: Eliminates funs for the Racial and Ethnic Approaches to Community Health (REACH) program ($51 million) a national program aimed at reducing racial and ethnic health disparities. The budget also includes hundreds of millions in additional cuts to CDC programs that tackle such issues as chronic disease and the leading causes of death (e.g., alcohol use, nutrition, and stroke), global health, prevention research, HIV/AIDS, hepatitis and sexually transmitted diseases and establishes state block grants to fund public health initiatives.
  • National Institutes of Health - $6 billion cut: Includes a 20% cut to the National Institutes of Health (NIH), the nation’s medical research agency, negating a boost in funding from passage of last year’s CURES Act. The budget also consolidates the Agency for Healthcare Research and Quality (AHRQ) within the National Institutes of Health. The AHRQ conducts research on health care quality, costs, outcomes and patient safety and oversees the U.S. Preventive Services Task Force (USPSTF) which makes evidence-based recommendations about clinical preventive services.
  • Women’s Health - $286 million cut: Eliminates hundreds of millions in family planning funds for organizations that provide abortions.
  • Indian Health Services – $59 million cut: Reduces funds for Indian Health Services (IHS) which is responsible for providing federal health services to American Indians and Alaska Natives.

Social Services

  • Supplemental Nutrition Assistance Program (SNAP) - $190 billion cut: Reduces funds for the federal food stamp program through a combination of program cuts, eligibility reforms, and new work requirements. The federal food stamp program currently serves 4.3 million Californians. California’s Central Valley which has seen some of the highest unemployment rates in the state would be particularly hard hit.
  • Temporary Assistance for Needy Families (TANF) - $15.6 billion cut: Reduces funding for the TANF block grants.
  • Earned Income Tax Credit (EITC) and Child Tax Credit (CTC) - $40 billion cut: Assumes savings by barring immigrants without social security numbers from collecting EITC and CTC tax credits when filing their returns.
  • Disability Programs - $72 billion cut: Reduces access to Social Security’s disability program by testing “new approaches to increase labor force participation.”

Education/Civil Rights:

  • Federal Student Loan Programs - $143 billion cut: Eliminates federally subsidized loans and funds for the public service loan forgiveness program which incentivizes students to pursue careers in health, public safety and education. Reduces additional funding for student loan repayment programs.
  • Office of Civil Rights - $6 million cut: Reduces funds for the Office of Civil Rights (OCR) tasked with defending the public’s right to nondiscriminatory access to and receipt of HHS funded health and human services. The budget also continues to underfund the U.S. Census Bureau ahead of the 2020 survey.