During the 2016 presidential campaign, Donald Trump stumped hard on promises not to touch Social Security, Medicare, and Medicaid. There are about 59 million Social Security beneficiaries in the US now, and Medicare provides health coverage to 56 million, and Medicaid 71 million, including 14 million covered under the Affordable Care Act’s Medicaid expansion.
Trump on Capitol Hill on Tuesday to rally for the Obamacare repeal bill, the AHCA. Source: AP
“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me,” Trump tweeted in 2015, following up with: “Huckabee is a nice guy but will never be able to bring in the funds so as not to cut Social Security, Medicare & Medicaid. I will.”
He doubled down and kept doubling down, a month later tweeting, “The Republicans who want to cut SS & Medicaid are wrong. A robust economy will Make America Great Again!”
Within the first 70 days days of his presidency, Trump has followed through on another campaign promise, dismantling Obamacare, by promoting a repeal bill. However, the pursuit of that goal has led him to break his promises to fully protect Medicare and Medicaid. The repeal bill makes significant cuts to Medicaid coverage and shrinks Medicare funding.
The AHCA hurts Medicare and Medicaid
Known as the American Health Care Act, the bill would repeal much of the ACA (known as Obamacare) if Congress approves it, including wiping out the Medicaid expansion by removing coverage for an additional 14 million people. This would violate the campaign promise not to cut Medicaid.
On the Medicare side, President Trump, despite numerous promises to save the federal health insurance program for those over 65, is supporting a bill that would strip Medicare of a key funding source, a 0.9% surtax on earnings over $200,000 that would have taken in $117 billion in the next decade. According to the Committee for a Responsible Federal Budget, removing this funding would cause Medicare’s Part A fund, which helps with hospital costs, to be insolvent two years early, in 2023. As a result, it would have to pay out 14% less to providers, potentially crippling seniors’ ability to receive care.
“The overriding law means [Medicare] can’t pay out more than it has in its trust fund. This would spell a major cut,” CRFB Senior Policy Director Marc Goldwein told Yahoo Finance recently. “If providers aren’t getting paid on time or get paid less, it’s hard to imagine this doesn’t at least hurt access if not quality or availability of care for seniors.”
As the House prepares to vote on the legislation Thursday, Trump made a trip up the Hill on Tuesday to sway some GOP members who remain unconvinced, tweeting, “PassTheBill.GOP #PassTheBill #MAGA.” (sic). Moderate GOP members have thrown their arms up at the massive losses of coverage the Congressional Budget Office expects and the Freedom Caucus referred to the bill as “Obamacare Lite,” a partial repeal that compromises too much. Joined by Democrats, opposition is fierce.
“While I’ve been in Congress, I can’t recall a more universally detested piece of legislation than this GOP health care bill,” tweeted Rep. Justin Amash (R-MI) on Monday.
But going beyond the unpopularity, it’s the first major betrayal of a campaign promise by the 45th president.
“President Trump couldn’t have been more clear on the campaign trail that he would not cut Medicare and Medicaid,” Sen. Elizabeth Warren (D-MA) told Yahoo Finance. “Now he’s giving a big hug to Paul Ryan’s plan to slash $880 billion from the Medicaid program, which will hurt people with disabilities, working families, babies, and seniors in nursing homes.”
This hypocrisy was also the gist of Sen. Bernie Sanders’s (I-VT) giant poster of one of Trump’s tweets promising not to cut these social safety nets. “Either Donald Trump lied to the American people or he’s got to say that he will veto any cuts to Medicare, Medicaid or Social Security,” Sanders tweeted.
Much of the analysis of the AHCA noted that the legislation would hurt core Trump voters, and in a March 15 interview with Tucker Carlson on Fox News, Trump acknowledged as much. When Carlson said, “the counties who voted for you will do far worse under your plan,” Trump responded, “Yeah, oh I know. I know,” before noting it was “very preliminary.”
On Monday, a few days before the vote, only a few minor changes were made to the bill, which has not changed substantively.
Whether this broken promise will make a meaningful difference to Trump’s popularity in the future is as unknown as anything else in his presidency—CBO projections are simply projections. But if they prove correct and members of his base are significantly hurt by these policies, the fallout will likely be much worse than the myriad scandals that plagued the Trump campaign.
“The president may have just discovered that healthcare is complicated,” says Warren, “but one thing is very simple: Trump is breaking his word to the American people.”
