The Trump Administration has released its fiscal year (FY) 2019 budget proposal, which includes extensive health policy provisions. While most of the President’s policy proposals for Department of Health and Human Services (HHS) programs would require Congressional approval, others are characterized as administrative proposals that presumably would not involve Congress.
President Trump once again seeks to “repeal and replace” the Affordable Care Act (ACA). This year’s budget calls for a “Market-Based Health Care Grant Program” (modeled on pending Graham-Cassidy-Heller-Johnson legislation) as an initial step to help states stabilize their insurance markets during a transition period. The second step of the plan would repeal the ACA’s Medicaid expansion and significantly restructure Medicaid by allowing states to choose between a per capita cap or a block grant. The Administration estimates that these provisions would save $679.7 billion over 10 years, although the Medicaid cuts would total almost $1.4 trillion over 10 years. The budget also proposes a mandatory appropriation for cost-sharing reduction payments to plan sponsors for FYs 2018 through the end of calendar year (CY) 2019, and full funding of the Risk Corridors Program, including exempting the program from sequestration (an $812 million spending increase in FY 2018).
The budget proposal also includes numerous Medicare policy reforms that would save $493.7 billion over 10 years. Many of these reforms involve cuts in Medicare provider reimbursement, including the following proposals (budget savings figures are over the 10-year period of FYs 2019-2028): Continue Reading