In Trump budget, the poor lose
Medicaid, food stamps would be slashed; defense, border security would get boost
WASHINGTON — Massive cuts to Medicaid and other poverty programs in President Donald Trump’s 2018 “taxpayer first” budget have cast a shadow of uncertainty over 4.7 million patients in Texas — one-sixth of the state’s population — who live close to or below the poverty line.
One of them is Karina Lopez, a 34-year-old FedEx worker who lives with her four children in a rented house in north Houston, the epicenter of the state’s biggest-in-the nation uninsured population. Her children, ages 14 years to 5 months, are covered by Medicaid, the state-federal health care program for the poor. But Lopez, a single mother, has to
do without insurance.
Democrats, patient advocates and some industry groups say Lopez’s predicament will become more widespread under Trump’s proposal to reduce planned Medicaid spending by $627 billion over the next decade — on top of $834 billion in cuts under Obamacare repeal legislation passed by the Republican-led House.
Holding a full-time a job, Lopez isn’t eligible for Medicaid — except when she’s pregnant. Texas is one of 19 Republican-led states that chose not to expand Medicaid eligibility under President Barack Obama’s Affordable Care Act, and the state’s stringent income limits left Lopez in a coverage gap.
Not qualifying for subsidies designed for workers who make more than she does, she said she can’t afford insurance on the Obamacare exchange in Texas. But she earns more than the state’s Medicaid income limits without the Obamacare expansion. And, as a temp agency employee, she gets no health insurance through work.
“When I’m sick, I don’t go to the doctor,” Lopez said. “I just try to let it run its course, or use over-thecounter medications.” Resistance in Congress
Trump promised not to touch Medicaid and other major safety net programs when he was running for office. But White House budget director Mick Mulvaney of South Carolina, formerly a member of the conservative House Freedom Caucus, explained that the cuts were “assumed” in the GOP health care bill and wrapped into the budget.
Both are expected to meet stiff resistance in Congress. There also will be looming battles over a proposed $193 billion cut to the food stamp program known as SNAP, which helps nearly 3.8 million Texans buy groceries, and reduced welfare benefits known as TANF, which helps about 65,000 Texans, nearly 6,000 of them in Harris County.
Although Trump also vowed not to touch Social Security, his budget would cut disability programs by $72 billion. That includes Social Security disability insurance for injured workers and their families. About 617,000 Texans rely on the disability insurance. Mulvaney said the disability programs are separate from “old-age retirement.”
Another change likely to be felt in South Texas: Trump’s budget would restrict the earned income and child tax credits to people who can supply Social Security numbers, effectively withholding the benefit from people who work illegally but pay taxes.
To be sure, the budget also has some bright spots for the state. The president’s request for $54 billion in additional defense spending likely will ripple across Texas, which has a strong military presence with several major bases and facilities. His controversial plan to spend $2.6 billion to beef up the border with Mexico, including $1.6 billion for several dozen miles of wall, could spark new business opportunities and jobs in the Rio Grande Valley.
But the wall funding — one of Trump’s signature campaign promises — is far from certain. Apart from that, the biggest budget battles are likely to be waged over health care and Medicaid cuts, which account for about 14 million of the 23 million people the Congressional Budget Office projects to lose insurance by 2026 under the Republican health care plan.
Of those, an estimated 2.5 million live in Texas, about 700,000 of them in 10 congressional districts clustered around Houston or Harris County. Because so few low-income adults have escaped the Medicaid funding gap like the one that hit Lopez, the vast majority of those affected by the projected program cuts would be their children. Advocates also note that about half of all births in Texas — like Lopez’s four children — are covered by Medicaid.
The impact also would hit minorities hard. Nationally, 19 percent of non-elderly Medicaid beneficiaries are African-Americans, and 31 percent are Hispanic, according to the Center for American Progress, a liberal policy research group.
Republicans counter that the House-passed health care plan would lower premiums and make insurance more affordable for most everybody. They also argue that Trump’s proposed cuts are reductions in planned spending increases for inflation, not from current spending levels.
“It’s actually not going to be cut in the sense that most people think of cuts,” said U.S. Sen. John Cornyn, emphasizing that currently projected spending increases are “unsustainable.” ‘Significant reductions’
But healthcare advocates say that reduced Medicaid spending, however defined, will force large numbers of people off insurance and out of quality health care.
“There’s simply no way to take that kind of money out of the Medicaid funding formula and not have significant reductions in who gets covered or what they’re getting,” said Anne Dunkelberg, associate director of the Center for Public Policy Priorities in Austin.
Compounding the hit, Dunkelberg said, will be the resulting cost shift to the states, which match federal Medicaid dollars in varying amounts. Under the GOP health care bill, the state would have the choice of taking its federal Medicaid dollars through block grants or capped on a perperson basis, as opposed to the current open-ended system based on need.
Either way, there would be less money in the federal pipeline.
“Is there any likelihood that the Texas Legislature would replace that money?” Dunkelberg said.
The same is true for the cost of food stamps, which Trump would shift in part to the states. Shifting a quarter of the burden would force Texas to find $1.3 billion in annual state funding or find ways to cut people from the program, according to Celia Cole, CEO of the advocacy group Feeding Texas.
“Making Texas responsible for more than a quarter of this critical program would be a disaster for hungry families,” Cole said. “There would be no guarantee that funds would be available when the program is most needed, such as during economic downturns.”
Among other changes, the administration would eliminate the minimum benefit of $16 a month, resulting in a $16 million decrease in benefits for 121,000 Texans, according to Feeding Texas.
Gov. Greg Abbott’s office did not respond to a request for comment on the state impact of the Trump budget, and a number of prominent Texas Republicans in Congress, notably U.S. Sen. Ted Cruz, have remained conspicuously silent.
Those who have spoken up, like Cornyn, have chosen to focus on the increased spending for national defense, border security and the economic stimulus of the Republican tax cuts that are assumed in the budget.
Republicans also have praised the budget for its fiscal discipline, calling the cuts necessary to balance the budget and chip away at the nation’s estimated $20 trillion debt. Critics, including a raft of economists, have questioned the 3 percent economic growth rate required to make the budget balance in 10 years. The government’s latest growth projections stand at 1.9 percent.
Either way, Mulvaney said the budget reflects the long-held conservative valuesof personal responsibility and ana version to dependence on public assistance.
“If you’re on food stamps, and you’re able-bodied, we need you to go to work,” Mulvaney said in rolling out the budget on Tuesday. “If you’re on disability insurance and you’re not supposed to be — if you’re not truly disabled, we need you to go back to work.”
The administration also cites numbers showing that the 44 million on food stamps nationally are only slightly below the peak recession level of 47 million, even though the jobless rate has come down sharply.
“I think that raises a very valid question,” Mulvaney said. “Are there folks on SNAP who shouldn’t be?”
Shifting costs to states, Mulvaney argues, also would give them “skin in the game” to look for money-saving reforms.
“We believe in the social safety net,” Mulvaney said, “we really do. … What we’ve done is not to try to remove the safety net for folks who need it, but to try to figure out if there’s folks who don’t need that need to be back in the workforce.” Ending block grants
States and cities also would have to absorb the costs of community projects currently funded by federal Community Development Block Grants, which Trump would end. The program awarded almost $230 million in disaster recovery funds to the Houston region last year to deal with flooding.
Congressional Republicans have been far less forceful in their defense of the budget, partly out of a sober recognition that it represents the president’s wish list. Houston Republican Rep. John Culberson, representing a district that went to Hillary Clinton in November, said he was “encouraged” by the administration’s desire to reduce the deficit, strengthen the military and protect the border.
But Culberson, who sits on the House Appropriations Committee, said nothing about the domestic spending cuts, including the loss of some $250 million in National Institute of Health grants in Texas, money that counts heavily on Houston’ s health and medical research community.
“President Trump’s budget is an important step in the appropriations process,” Culberson said, “but ultimately, Congress has the power of the purse.”
For local service providers, the balancing act in Congress is worrisome because Texas, with a higher than average poverty rate of nearly 16 percent, is already stretching to meet the needs of the poor and uninsured.
“We’re not starting at a good place in this state,” said Kevin Nix of Legacy Community Health, a Houston clinic where Lopez has been a client.
As for Lopez, she sees nothing in the budget that would makeup for children’s Medicaid coverage .“If I couldn’t get insurance for my kids,” she said, “I don’t know what I would do.”