The Trump budget

Let’s look at some of the highlights of the Trump budget:

For example, the budget would cut $554 billion from Medicare spending over 10 years.

It also would make changes to Medicaid, the health program for lower-income Americans that is funded by the federal government and states. It would create a “market-based health-care grant” that could fund programs in addition to the traditional Medicaid program, a change that would lower Medicaid spending by about $250 billion over 10 years.

One program that would face the biggest reduction is the Supplemental Nutrition Assistance Program, which is a version of food stamps run by the Agriculture Department. The White House proposes cutting $214 billion from the program over 10 years, although Congress often fights about changing SNAP and rarely has enacted changes.

Kevin Drum adds in some more:

The Post Office loses $4 billion, primarily by giving them “the ability to address their expenses—including the cost of personnel.” In other words, by slashing pay and pensions. Low-income energy assistance is eliminated. Foreign aid is cut $5 billion. PBS funding is eliminated. Ditto for the National Endowment for the Arts and the National Endowment for the Humanities. HUD loses $9 billion, including a $4 billion cut in rental assistance. Etc. etc.
On the mandatory spending side, the budget proposes cuts of $266 billion to Medicare over ten years. SNAP loses $213 billion. Obamacare is eliminated, of course. “Waste and abuse” will generate savings of $187 billion. Farmers lose $47 billion. Subsidized student loans go away, as does the student loan forgiveness program.

And yet it still increases the deficit by a lot:

The White House projects a large gap between government spending and tax revenue over the next decade, adding at least $7 trillion to the debt over that time. In 2019 and 2020 alone, the government would add a combined $2 trillion in debt under Trump’s plan.

And even to get that they assume very rosy projections that are unlikely to happen.

On the one hand this budget is meaningless since the recently passed budget doesn’t follow this plan, on the other this tells us what the Trump administration wants: massively increase defense spending even though the US easily has the largest defense budget in the world already; cut almost all domestic spending, especially that which goes to the non-rich and science; pass large tax cuts that mostly go to the rich and big corporations even if it explodes the deficit.

 

Punish the poor

Hmm, should there be work requirements for Medicaid?

Conservatives like to assert that Medicaid somehow suppresses the desire to work, but that appears to be a fantasy. Studies have found no evidence for it. For example, a study published in the journal Health Affairs in 2016 found that “Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status.”

What the evidence does show, however, is that work requirements attached to social programs are ineffective. The best research involves TANF, or Temporary Assistance for Needy Families program, which replaced traditional welfare and added a work mandate. Several studies have shown that TANF recipients who are able to work do so whether or not they’re subject to the requirement, which suggests that it’s not necessary. Those who find employment end up in low-wage jobs, typically earning about as much as the TANF and food stamp benefits their earnings replaced.

Work had not lifted them out of poverty or increased their income relative to what they had received from TANF and food stamps,” one study found, contrary to Verma’s aspirational language. The work requirements failed to reflect that many of the program enrollees faced social, educational or physical barriers to employment, conditions that are likely to be replicated among unemployed Medicaid recipients.

Moreover, the work requirements added bureaucratic burdens that affected program administrators as well as enrollees, sometimes severe enough to discourage enrollment.

Those studies aren’t politically correct so the Trump administration ignores them and says:

Verma tried to put an uplifting spin on the new policy on work requirements: “We owe beneficiaries more than a Medicaid card,” she tweeted; “We owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty.”

Now that’s something the Republicans can believe (but they won’t actually increase funding for job training). Really they just want to punish the poor but they can’t say that so they make stuff up.

Who needs evidence?

Well, this is surprising if by surprising you mean completely expected:

The Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective “evidence-based” treatments for substance abuse and behavioral health problems from worthless interventions.

The program, called the National Registry of Evidence-Based Programs and Practices, was launched in 1997 and is run by the Substance Abuse and Mental Health Services Administration. Its website lists 453 programs in behavioral health — aimed at everything from addiction and parenting to HIV prevention, teen depression, and suicide-hotline training — that have been shown, by rigorous outcomes measures, to be effective and not quackery. The most recent were added last September.

It seems there were problems with registry:

In fact, a recent paper in the International Journal of Drug Policy found the registry contained programs with limited studies evaluating them or studies with very small sample sizes to accurately measure their success.

So there was a good reason to look at it and try to make it better, but this is the Trump administration:

However, no specific details regarding when the new program will begin and when results will be made public were provided. The current registry will remain online as of now, but will not be updated.

SAMHSA’s statement was the first public response it had provided since the email it sent out two weeks ago announcing the registry would be frozen. That announcement took mental health advocates by surprise. “It came with such a blinding speed,” said Richard Yep, CEO of the American Counseling Association. “People were initially really shocked by the whole thing.”
Without any additional information from SAMSHA, Yep said mental health professionals were left to speculate what was next and why the registry had stopped.
Yep admits that the program wasn’t flawless but said “it has stood the test of time.” He questioned why a replacement wasn’t up and running to take over the work and called the decision to freeze the registry short-sighted. “Why didn’t you start that system up and compare it side-by-side? Instead, to just cut it off, it makes no sense professionally.”
The Trump administration is, by its nature, sloppy and that’s what you get here.

Children’s Health

Ok, this is stupid:

CBO and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary estimate of the budgetary effects of extending funding for the Children’s Health Insurance Program (CHIP) for 10 years using specifications provided by your staff. Under those specifications, the provisions of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017 (KIDS Act), would be extended. In particular, all of the provisions that would be in place in 2022, the final year of funding under that Act, would continue unchanged for the remainder of the 2023-2027 period. The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period.

And yet:

Some states will run out of money by February 1 if an agreement is not made, according to estimates from Georgetown University’s Health Policy Institute based in Washington, D.C., but more conservative estimates from the U.S. Centers for Medicare and Medicaid Services (CMS) suggest several states risk burning through the federal funds by January 19.

What’s the problem?

In December, Congress provided short-term finances for CHIP, but lawmakers have not moved to give the program another five-year allotment because Democrats and Republicans disagree on how to finance it. Republicans wanted to pull money from public health programs—like Medicare—and Democrats refused. The minority party’s votes will be necessary for Republicans to pass a solution, and some politicians have predicted a deal will be struck next week before the January 19 deadline.

Now that the CBO says it will save the government money, will Republicans actually pass it? Who knows–it’s not like they care about people.

The poor don’t need healthcare

Here’s the Trump administration’s idea of helping people out:

Underpinning that effort is Verma’s belief that the expansion of Medicaid under the Affordable Care Act was a disastrous move that extended coverage to millions of low-income people who shouldn’t be getting insurance from the government.
“We’ve put more than 10 million people, 12 million people into this program where the doctors won’t see them, and the policies that are in the Medicaid program are not designed for an able-bodied individual,” she said. Verma added that the administration’s goal is to keep those people in the private insurance market, where they would not be “dependent on public assistance.”

Umm, Verma, the whole reason they are on Medicaid is they don’t have and can’t afford private insurance so keeping them in the private insurance market means keeping them without insurance. I know that’s the Republican ideal but you would think she might want to circumspect when she says people don’t deserve insurance.

Trump contradicts himself

During the campaign Donald Trump proclaimed that he was a friend to the LGBT community, but this still isn’t surprising:

Attorney General Jeff Sessions has reversed a three-year-old Justice Department policy that protected transgender workers from discrimination under federal law.

In a memo to his US attorney offices and agency heads, Sessions said that Title VII of the Civil Rights Act of 1964 does not protect transgender people from workplace discrimination by private employers and state and local governments.

‘‘Title VII’s prohibition on sex discrimination encompasses discrimination between men and women but does not encompass discrimination based on gender identity per se, including transgender status,’’ Sessions wrote in the memo dated Wednesday.

Trump lies all the time so you should never trust what he says and he has surrounded himself with cultural warriors (Pence, Sessions, …).

Republicans always claim that they are against abortion but won’t go against contraception. You can trust them about as much as you can trust Trump:

The Trump administration issued a rule Friday that sharply limits the Affordable Care Act’s contraception coverage mandate, a move that could mean many American women would no longer have access to birth control free of charge.

The new regulation, issued by the Health and Human Services Department, allows a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds. The decision, anticipated from the Trump administration for months, is the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health-care law nearly from the start.

And then there’s foreign policy. North Korea is a mess, especially now that it has nuclear weapons, so it’s a great time to try to pull out of the treaty with Iran that has kept Iran from developing nuclear weapons:

But Trump, after twice certifying the deal, has warned his aides that he would not do so again. As a result, the administration is looking for ways to claim Iran is in violation of the “spirit” of the accord, even if it has complied with inspection criteria.The International Atomic Energy Agency has said that Iran was in compliance. When the agency has found minor violations, they have been quickly fixed.

This will indeed isolate a country but it might not be the US:

Britain, France, and Germany, all signatories to the agreement, are watching Trump’s deliberations with deepening concern. Diplomats from the three countries, as well as from the European Union, met with dozens of senators this week to warn them that if the United States withdrew, Europe would not follow.

Trump has no problem with being inconsistent:

The United States is poised to permanently lift sanctions on Sudan, US officials said on Thursday, recognizing the long-estranged country’s progress on human rights and counterterrorism after decades of war and abuses.

Sure, Sudan has done a lot more worse things than Iran but … Trump just doesn’t like Iran.

For fun (if you like worrying about nuclear war):

‘‘You guys know what this represents?’’ Trump asked. ‘‘Maybe it’s the calm before the storm. Could be the calm, the calm before the storm.’’

‘‘What storm Mr. President?’’ one reporter shouted. ISIS? North Korea? Iran?

‘‘You’ll find out,’’ the president said.

Finally, via Kevin Drum, let’s look back at that IRS scandal where they targeted the Tea Party groups. Here’s KD’s summary:

In total, the IRS audited 111 left-wing groups and 19 right-wing groups based on BOLO criteria. (It’s unclear how the “healthcare” category broke out between left and right.)

The vast majority were left-wing groups, but the IRS was being so unfair to the TEA Party groups.

Republicans care

Let’s look at how Republicans care about the people.

First, they’ve so busy trying to take medical insurance from tens of millions of people they let medical insurance for children lapse:

Congress has allowed the Children’s Health Insurance Program, which provided low-cost health insurance to 9 million children, to expire.

If action is not taken soon to restore the funding, the effects will become obvious in schools across the country, with many of the children in the program unable to see a doctor for routine checkups, immunizations, visits when sick, and other services.

Second, they will probably get rid of a program that made it so students scammed by fake universities didn’t have to repay their loans:

Relief seemed to be on the way last year after she learned the Obama administration would forgive her Department of Education loans if she could prove she was defrauded by the for-profit college. But President Trump has brought the worries back.

Trump has thrust Cabrera Garcia and more than 65,000 other student borrowers across the country, including about 1,500 in New England, into a new state of financial limbo by suspending applications under Obama’s program of loan forgiveness.

I wonder why? Oh:

DeVos has investment ties to the for-profit education sector. She also has installed former executives and other officials from the for-profit education industry in her department.

Among them: Julian Schmoke Jr., as the Education Department’s top cop looking for schools that are cheating taxpayers and students of federal aid dollars. Schmoke is a former dean at DeVry University, a for-profit school that, along with its parent company, last year agreed to pay the Federal Trade Commission $100 million to settle allegations it lured students with false job and salary information. Critics also say he has little to no experience running investigations.

It’s obvious that DeVos just doesn’t care about public education.

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