The President’s proposed budget is a wholesale shift of federal responsibilities onto states, with little to no support for those states to fulfill those responsibilities. It includes cuts to fundamental federal programs such as public housing, utilities, and food assistance programs. It also revives the President’s wish to repeal and replace the Affordable Care Act through the use of Medicaid block grants that would strip $250 billion from state Medicaid programs over the next ten years.
Smart Policy Works is most troubled by the efforts of this Administration and Congress to consistently undermine the Medicaid entitlement. A shift to block grants breaks the 50-year compact between the federal government and states to provide health care to the poor. A block grant – or flat funding – puts the onus on states to deliver the same quality of care without taking into account increases in medical costs, health care epidemics, or increased Medicaid enrollment in times of economic decline. Under this proposed budget, states would be expected to make impossible choices on which health programs would be funded and which ones cut. For example, a state wanting to help more opioid users break their addiction through medication-assisted treatment may be forced to cut from other critical Medicaid services that would help those same users stay healthy in the community.
The President’s proposal calls for cuts to other vital programs, including the Supplemental Nutrition Assistance Program ($17.2 billion), Housing and Urban Development ($6.8 billion), and the elimination of the Low Income Home Energy Assistance program.
Smart Policy Works has spent 25 working at the intersection of health policy, programs, and the people who use them. We are seeing more and more payors and states realize that the key to better healthcare includes much more than what happens in a doctor’s office. The social determinants of health – food access, employment, stable and safe housing – all play a role in supporting a person’s health and wellness. We understand that the Administration’s budget is merely a proposal. However, we also understand that it mirrors a trend expressed by many where reliance on support is viewed as a negative. We believe programs and supports have to work smarter to achieve better outcomes and improve lives. Eliminating programs and undercutting critical supports does not nothing to achieve this end.