President Trump’s fiscal year 2018 budget proposal amounts to a “pro-life” wish list restricting access to reproductive health care while bludgeoning social safety nets that sustain life for people with nowhere else to turn.
The Trump budget targets Planned Parenthood, the only health-care provider for many Medicaid beneficiaries, especially those in rural areas, to access contraception, cancer screenings, sexually transmitted infection testing, and more—a wide range of services minus the abortion care prohibited under the discriminatory Hyde Amendment. The budget converts Medicaid to a block grant program, a shift that could do “irreparable damage” to the nation’s safety net of family planning providers.
Trump is defying his hands-off-Medicaid campaign pledge. His plan instead axes $610 billion from Medicaid over ten years on top of the assumption that Republicans in the U.S. House of Representatives succeed in ushering their American Health Care Act’s $880 billion in Medicaid cuts into law. Trump’s budget chief Mick Mulvaney told reporters at the White House on Tuesday that Medicaid is better suited to the “urban poor” than the “rural poor” in what’s known as a dog whistle or racially coded distinction about who deserves health-care benefits.
NARAL Pro-Choice America summed up the contradiction in five words: “This budget reeks of hypocrisy.”
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“Any administration’s budgets reflect its priorities, and Donald Trump’s budget makes clear his view that women and children are at the bottom of the barrel,” NARAL Pro-Choice America President Ilyse Hogue said in the organization’s statement. “By gutting the programs that help the most vulnerable women and families, this so-called pro-life administration would make life unbearable for those most in need.”
Trump’s budget proposal builds on the “cruel” blueprint his administration released in March. The Temporary Assistance for Needy Families (TANF) program, or welfare, would take a $21.6 billion hit over ten years; the Supplemental Nutrition Assistance Program (SNAP), or food stamps, a nearly $191 billion hit thanks to the threat of work requirements that research shows don’t work. Even a stab at what the budget’s executive summary defined as a “fully paid-for proposal to provide six weeks of paid family leave to new mothers and fathers, including adoptive parents” appears unworkable based on Trump’s campaign proposal.
“We are not placated or fooled by the inclusion of so-called paid family leave in this budget proposal,” the grassroots group MomsRising said in a statement.
“The Trump paid leave plan is wholly inadequate and sets working families up to fail. It would not help families achieve economic security, not boost businesses and not help our economy thrive,” the organization said. “It falls far short of what our country needs and would leave behind millions of workers who need time to care for their own serious medical needs or those of their loved ones. Working families need a comprehensive, consistent, robust paid family and medical leave program that lifts our economy, businesses and families: It needs to be accessible to all working people, offer a meaningful amount of leave, be affordable for businesses, working people and taxpayers, be inclusive in defining family, and include strong job protections.”
The budget has little to no chance of becoming law, as Vox’s Dylan Matthews explained. Rather, it outlines the administration’s fiscal positions ahead of the upcoming months of wrangling in the House and U.S. Senate over spending levels for the federal government, including key programs like Medicaid and SNAP. Congress must pass appropriations bills funding the agencies by the October 1 start of fiscal year 2018, or risk a government shutdown.
The degree to which Republicans hew to the Trump budget could determine outcomes for some of the nation’s most marginalized people and for the U.S. Environmental Protection Agency, the U.S. Department of Health and Human Services (HHS), and other endangered agencies to continue serving the public and those most in need.
House Budget Chair Diane Black (R-TN), a prominent opponent of contraception and abortion rights, is expected to support the budget’s gutting of Medicaid. The conservative Washington Times reported that Black “called the House GOP health care bill a ‘good start’ but said she wants to overhaul Medicaid, the government insurance program for the poor, even further in the Republican budget for the coming year.”
House Appropriations Chair Rodney Frelinghuysen (R-NJ), a member of the more moderate Tuesday Group, put distance between the executive branch’s desire to gut the federal agencies and Congress’ constitutionally defined “power of the purse.”
“It is our job to analyze the request, go through each and every budget line, question every witness, and demand spending justifications on behalf of the taxpayers who are footing the bill,” Frelinghuysen said in a statement. “Only then can Congress put forward our own plan to fund the federal government, ensuring the wise investment of taxpayer dollars on important programs while trimming back or eliminating waste and duplication.”
Few agencies beyond the U.S. Department of Defense, the U.S. Department of Homeland Security (DHS), and the U.S. Department of Veterans Affairs were spared under Trump’s budget. The DHS boost includes $2.6 billion for a border wall and “more than $300 million to recruit, hire, and train 500 new Border Patrol Agents and 1,000 new Immigration and Customs Enforcement law enforcement personnel in 2018, plus associated support staff.”
Congressional gridlock, however, could again force federal agencies to continue running on “continuing resolutions” that largely maintain today’s funding levels, though the Trump administration has threatened to force a government shutdown.
Planned Parenthood in the Crosshairs—Again
The budget’s executive summary specifies that Planned Parenthood can’t participate in any HHS program—”for the first time in history,” according to a statement from parent organization Planned Parenthood Federation of America.
The sweeping prohibition goes beyond what House Republicans proposed in their fledgling efforts to repeal Obamacare.
The House-passed legislation “defunds” Planned Parenthood by cutting the organization off from some $390 million in Medicaid reimbursements for one year. Another $60 million in funding comes from Title X family planning and less than $1 million jointly from the Children’s Health Insurance Program and Medicare, for a total of about $450 million in federal funds, according to nonpartisan Congressional Budget Office (CBO) data from 2015.
Administration officials wrote the proposal with the expectation that the House GOP’s plan will become law “in its current form,” Mulvaney told the White House press corps on Monday. Senate Republicans, however, are writing their own plan after refusing to take up a bill that could strip 24 million people, including 14 million Medicaid beneficiaries, of health insurance. That number could rise pending a new CBO score, expected to rile Washington on Wednesday, accounting for last-minute changes that shuttled the bill to a narrow victory in the House
The administration has given no indication in recent weeks that they would release anything less than a budget that purports to protect life at the expense of life-saving health-care.
Trump’s anti-choice pick to lead the HHS office charged with administering the Title X program and ensuring people with low incomes have access to family planning services believes “contraception doesn’t work.” Days earlier, Trump installed Charmaine Yoest, the former president and CEO of Americans United for Life, an anti-choice copycat legislation mill, to the top communications position at HHS.
Budget Previews Partisan Showdowns
Trump’s budget tested the patience of Democrats on Capitol Hill.
Senate Minority Leader Chuck Schumer (D-NY) called it “comic-book-villain bad.”
“It’s the kind of budget you might expect from someone who is openly rooting for a government shutdown,” Schumer said in a speech on the Senate floor. “Haven’t we heard the president say that?”
The consequences of steep Medicaid cuts on combating addiction disturbed Sen. Maggie Hassan (D-NH), the freshman lawmaker who replaced anti-choice Republican Kelly Ayotte this year.
Sen. Patty Murray (WA), the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, issued a familiar ultimatum to Republicans: Back off Planned Parenthood.
“By slashing key investments in health services that women rely on, including the largest cuts yet proposed to Planned Parenthood, President Trump’s budget doubles down on extreme Republican efforts to interfere with women’s personal health decisions and attacks women’s health in just about every way possible,” Murray said in a statement.
“To my Republican colleagues who decide to stand by this budget, you’ve been warned: Democrats are ready to fight back every step of the way.”
GOP leaders were more welcoming.
Vox’s Matthews noted that Trump’s budget “broadly resembles plans put forward by now-House Speaker Paul Ryan, who as the House Budget Committee chair released a series of extremely aggressive budgets including trillions in cuts to programs for the poor.” Ryan in March told National Review editor Rich Lowry that he’s been “dreaming” of slashing Medicaid “since you and I were drinking at a keg.”