The Real Story on Trump and Cuts to Essential Programs


January 24, 2020

President Trump was asked by very friendly interviewer Joe Kernen of CNBC, will “entitlements ever be on your plate?”  The President replied, “At some point they will be.” And, when asked whether he’d “do some of the things that you said you wouldn’t do in the past” (specifically, Medicare), he said “Well, we’re going – we’re going look.”  (That’s how the transcript reads.)

Alarm bells went off around Social Security and Medicare, and the President responded via tweet by promising to “save” Social Security.

But for anyone who’s paying attention, the evidence of the Administration’s attempts to make cuts in basic needs programs is abundant.  They are going after Social Security and they have made multiple attempts to throw people off Medicaid and SNAP.  Even more far-reaching, the Trump administrator in charge of Medicaid, Seema Verma, is readying a plan to allow states to agree to capped Medicaid funding.  So far, the unifying factor in their targets is the vulnerability of beneficiaries.  They may not be aiming at retirees on Social Security, at least for now.  But if you’re poor, watch out.

The Social Security Disability program is part of Social Security.  If you have a work history and have a serious, long-lasting health condition, you can qualify for cash benefits; under certain circumstances children with serious conditions can also qualify.  The Trump Administration has proposed a new rule calling for more frequent reviews of their conditions, affecting 2.6 million people.  These reviews are so complex and difficult for people with conditions like cancer, mental or intellectual disabilities, and limited mobility that many will not succeed at jumping through all the paperwork hoops and will be denied assistance.  The point of the reviews is supposed to be to determine if people are able to work.  There is research to show, unfortunately, that the vast majority of people qualifying for Social Security Disability are not able to earn enough to get by.  Some of it is cited in the Administration’s own proposed rule:  in the three years after leaving assistance, only about one in five were able to work at even modest earnings.

When something like this was carried out during the Reagan years, hundreds of thousands of very sick people lost benefits; nearly two-thirds of these denials were overturned, but not before months of suffering.  Others did not manage to appeal; more than 20,000 people died.  There was such an outcry that the Reagan Administration was forced to reverse its policy.  Because the Trump proposal would initiate many more reviews, it is likely that even more people would be terminated.  This does not sound like “saving” Social Security.  You can comment about this reckless proposal by January 31.  Here’s where you can find out more and use a link to make a simple comment.

That’s not all, of course.  You probably know about the Administration’s attempts to approve work requirements for Medicaid and SNAP.  The U.S. Department of Health and Human Services has approved Medicaid work requirements in 11 states and is considering requests to implement or expand work requirements in 9 states.  In two of those states (Kentucky and Arkansas), a court has vacated HHS’ decisions on grounds that they were arbitrary and capricious.  The court recognized that the real impact was to make repeated documentation requirements which many people would find difficult to comply with, resulting in lost Medicaid.  When work requirements were tried in Arkansas (before being stopped by the court), 18,000 people lost their medical care.  Some of them were working but didn’t comply with the documentation rules; others couldn’t show enough work to meet the requirement; many didn’t respond at all because they never received or understood the instructions.  The Administration has recently finalized a rule, set to take effect in April, that would limit adults without dependents who receive SNAP to only three months of benefits if they cannot work a steady 20 hours per week.  A lawsuit has been introduced to block this harsh reduction.

Still worse, the Medicaid “block grant” proposal being advanced by Seema Verma, head of the U.S. Centers for Medicare and Medicaid Services (CMS), would encourage states to agree to receive capped funding for some or all of its Medicaid program in exchange for more authority to reduce eligibility or benefits, or to impose more requirements on beneficiaries.  Some states appear to be interested in this kind of deal for its Medicaid expansion population (people with somewhat higher incomes now eligible if the state opted for the Affordable Care Act Medicaid expansion).  Tennessee has submitted a request to implement a block grant plan even though it has not opted for Medicaid expansion.  Verma’s plan, which apparently is opposed by some in the Trump Administration, could be announced as early as next week.  It might not be called a “block grant,” because the Administration knows that term is viewed unfavorably.  That might be like the previous Trump budget proposal to cut SNAP benefits and replace some of what was lost by requiring people to pick up a package of food items euphemistically called Harvest boxes.  No one bought it, and no one should be fooled about the impact of such a Medicaid plan, even if they call it Opportunity Grants or Medical Rainbows. States will only take this kind of deal if they want to cut their Medicaid expenditures more than they want to provide medical coverage to their low-income residents; Tennessee is apparently one. Congress has opposed capping Medicaid. So the Trump Administration may try to go it alone, again – but court challenges are a sure thing, because waiving current Medicaid rules under law must not result in reduced Medicaid-provided care.
These are all “entitlement” programs the Trump Administration has been working ceaselessly to cut.  Last year, we called Trump’s budget proposal the Bully’s Budget because of a slew of similar proposals, all aimed at vulnerable low-income people who don’t have many resources to fight back.  His next budget is due out February 10 and we’ll do a webinar on February 13, 2:00 p.m. ET to tell you about it.  (Details coming soon.)  All of us who need – or might need – these services should not feel reassured by the President’s tweets about saving them.

Social Security