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Health Care, Social Security, Medicare, and Medicaid Are Under Threat…Again

April 15, 2019
Commentary by Tom Nash

President Trump said he wouldn’t do it, but here he goes. He now owns the Republican Party. In 2015, then-candidate Donald Trump tweeted, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.” He then repeated this promise time and time again on the campaign trail.

Fast forward to today, and Trump’s latest budget plan, which he proposed last month, calls for spending billions less on Medicare over the next 10 years, and $25 billion in cuts to Social Security. That will matter to you.

In the administration’s proposal, the slash in Social Security spending would come from several schemes, the largest of which would cut retroactive disability benefits from twelve to six months. This is not the first time the administration has painted a target on the Social Security disability program. In 2017, Budget Director Mick Mulvaney, now the President’s Chief of Staff, appearing on the CBS Sunday morning news show, Face the Nation, singled out disability benefits as an expenditure the administration is examining. “Let me ask you a question,” Mulvaney said, “do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so. It’s the fastest growing program…it grew tremendously under President Obama. It’s a very wasteful program and we want to try and fix that.” But Mulvaney was wrong when he said disability insurance is “the fastest growing program.” In fact, the disability insurance rolls have actually been shrinking for years. In 2014, disability enrollment peaked at 8.95 million disabled workers, and in 2019 that number decreased to 8.5 million disabled workers.

And what of Trump’s promise that repealing and replacing the Affordable Care Act with something terrific would be done on day one? For eight years, the GOP attacked Obamacare. But with a Republican House, Senate, and President, all they did was sabotage the Affordable Care Act to the great harm of Americans.

A couple of weeks ago, the president said he was about to shortly unveil a great plan (“way better care and a lot cheaper”), but this manipulative B.S. was quickly changed to “we’ll have something in ….in…. 2020!” Meanwhile, the GOP and the president have sent the Justice Department lawyers to court to fight the very important ACA preexisting condition protections, despite the overwhelming majority of Americans supporting those protections because they are the right thing to do. This is all how the president pitches that the GOP will be the “party of health care.” To lead this mission, Trump has named Florida Senator Rick Scott. As Florida’s governor, Scott presided over an epic decline in the state’s insurance coverage rate. He refused to accept Medicaid expansion under the ACA, depriving 1.4 million residents of coverage they would have received with the change. Scott left the healthcare company he led, Columbia/ HCA, just before they were charged and held accountable with the largest government and health care fraud in U.S. history.

Many readers likely already know how long and tough the SSA disability adjudication process is. And how many people, knowing this and not wanting to get caught up in the red tape to grovel for help from the government (which is based upon their FICA taxes!), delay filing their application—even when health problems have stopped them from working. Or they may have delayed because they always were proud (like you, your relative, neighbor, friend?) of their work history and desperately hoped their health would get back on track. But with the President’s proposal, he seeks to cut in half the retroactive pay disabled persons can receive— cutting $10 billion over the next decade.

Have you heard the notions of work requirements for those receiving Medicaid? At first blush this makes sense. The nonprofit Kaiser Family Foundation confirms, however, that only a “small share of adult Medicaid enrollees are not already working or are unlikely to meet exemption criteria” (https://www.cbpp.org/most-people-estimated-to-lose-medicaid-coverage-under-work-requirements-are-working-or-should-be). The devil emerges in the details of how those “exemption” criteria are applied by those implementing health care policy. Think about a client of ours I’ll call Gene from Streamwood. With treatment and evaluation, he was found to be on the autism spectrum. He was also found to have several mental conditions. He was not working, but few tried harder to find work than Gene. Fortunately, with the ACA, he was able to receive medical treatment via Medicaid during the 2-plus years it took to finally get approved for SSDI. During that time, he was homeless, sleeping on CTA trains and hiding in whichever Starbucks would not roust him. Nobody wanted to work more than Gene. Part of the reason the SSA Administrative Law Judge eventually approved the claim was because it was evident how hard Gene had been trying.

Gene was always viewed by the “system” as part of the able-bodied until we finally got him approved. There is no way states are going to be better at recognizing complex disability profiles so as to exempt people like our Gene. This is especially the case when the object is not to be the real “party of health care,” but to erect barriers and cut people off. Instead, they will be denied Medicaid, harming their health, disrupting their families, increasing costs, and making it even harder to provide the “medical evidence” for Social Security Disability Insurance benefits.

Critics of the President’s 2018 tax reform bill say it amounted to tax breaks for the wealthy, and they predicted that the president and his allies would go after popular social programs like Social Security, Medicare, and Medicaid as a way to help pay for the cuts. With this new budget plan, President Trump is proving them right.

Fighting these threats is not the “socialism, socialism!” the boogeyman President Trump tries to scare us about. There is a saying: “You don’t care about politics, but politics cares about you.” Stated another way, there is no way to avoid the necessity of fighting these assaults.