PRESIDENT TRUMP'S BUDGET FOR FISCAL YEAR 2019

The Trump administration has made considerable efforts to reform the ACA. In spite of all of the failed efforts in 2017, the Whitehouse is once again targeting the nation's healthcare safety net. The recently introduced budget for Fiscal Year 2019 clearly outlines the president's aim to restructure Medicaid over the following twelve months.

REVISE THE AFFORDABLE CARE ACT AND REFORM MEDICAID

The Trump administration will continue its attempts to remove and replace the ACA with a bill reminiscent to what Senators Graham and Cassidy presented last fall. Had the Graham/Cassidy bill passed, the landscape of Medicaid would have dramatically changed. The approximated number of uninsured Americans would have risen to 20 million by 2026 and federal health care expenditures would be cut in 10 years by $215 billion.

In Trump's budget proposal, the funding from the ACA for Medicaid expansion and premium subsidies would be distributed as block grants to each state. In addition, the proposal would put into place a per-person spending cap for Medicaid. Trump's proposed budget places serious cuts for Medicaid above and beyond the Graham/Cassidy block grants. For instance, $675 billion would be cut from federal spending and Medicaid would experience a $1.4 trillion cut due to offset spending on block grants.

While the president's health care reform initiatives have not yet materialized, the numerous attempts are definite indications of intent for the nation's healthcare system. In the event that the GOP can secure a larger Senate majority in the upcoming midterm elections, the administration's vision could quite possibly become a reality.

BIG PHARMA AND MEDICAID DRUG PRICES

Though the Trump administration has not made any progress to bring down the price of pharmaceuticals, the budget does include a number of drug cost proposals. For instance, Medicaid could create drug formularies of preferred drugs so private insurers could negotiate drug prices with pharmaceutical companies. However, it is uncertain if President Trump and Congress would approve the formulary system.

MEDICAID COULD GO THROUGH ADDITIONAL CUTS

Aside from the $1.4 trillion in reform cuts and spending caps, the president might also:

• Cut $2.2 billion by denying benefits to individuals that cannot verify their immigration status
• Cut $1.3 billion over 10 years by increasing the copayments of beneficiaries for improper use of the ER
• Cut $2 billion by 2028 by authorizing asset and income testing for Medicaid eligibility

The president has made evident through his budget that he plans to restructure healthcare and Medicaid. Although the president and the GOP's attempts did not happen last year, it is clear that they will continue their efforts in 2018.

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