Donald Trump’s latest budget proposal does not shrink the American welfare state. It beheads it. The proposal cuts $266 billion from Medicare, $213 billion from the Supplemental Nutrition Assistance Program (SNAP), and billions more from the Temporary Assistance for Needy Families (TANF) program, Medicaid, and regional-development agencies like the Denali Commission and the Delta Regional Authority over the next decade. It would repeal the Affordable Care Act and replace it with the skeletal Graham-Cassidy bill. If it is implemented in its current form, Trump’s budget will all but strip America’s most vulnerable of access to affordable health care, food stamps, and job training.
Welfare cuts are a predictable priority for Trump, whose first budget proposed similarly drastic cuts to social spending. The president packed his cabinet with millionaires and billionaires: It follows that the policies his government produces are good for people who already have money—and bad for people who do not. Official hostility toward the poor is not a bug but a feature for the Trump administration; at times, that hostility even seems to be its raison d’être. Monday’s budget only truly deviates from norms in one respect: It raises the federal deficit by more than $7 trillion over the next ten years.
Strange move for a Republican president? Not really. Congressional Republicans had already paved the way for Trump. On Friday, Senate Republicans and Democrats reached a bipartisan spending agreement that did not reduce federal deficits. “Now we have Republicans hand in hand with Democrats offering us trillion-dollar deficits,” Senator Rand Paul complained mid-filibuster. “I can’t in all honesty look the other way.” Paul now seems like an outlier: His colleagues had little trouble abandoning the deficit, and their decision officially renders the party’s priorities transparent.
“Even under the weird linguistic conventions of American conservative politics where deficits caused by tax cuts don’t count as real deficits, today’s budget deal—a big, multi-billion dollar increase in military spending ‘offset’ by a nearly-as-large increase in non-military spending — gives up the game entirely,” Matt Yglesias wrote for Vox last Wednesday. “They don’t care, on any level, about the size of the federal budget deficit.” Trump’s budget affirms this conclusion. It also answers an implicit question: If Republicans don’t care about the deficit, what do they care about?
Trump is a useful megaphone, bluntly amplifying the beliefs his party has had a tendency to dress in more understated and graceful language. “Spending cuts” always mean “welfare cuts”; welfare reduction is in the party’s DNA. Understanding this does not require one to reduce the Republican Party to an entity motivated by simple greed, though greed is certainly an influence. For ideological reasons, Republicans oppose the very notion of welfare. It is this, and not deficit reduction, that truly animates Republican policy.
Monday’s budget proposal attacks the poor on multiple fronts. In a departure from Trump’s first budget proposal in 2017, it leaves funding for the Appalachian Regional Commission alone. But it nearly defunds the Delta Regional Authority and the Denali Commission, development agencies whose work disproportionately impacts low-income people of color. It ends job-training and educational-development programs for Native Americans and seasonal laborers. It ends the Department of Education’s Promise Neighborhoods program. It ends subsidized student loans and public-service forgiveness for student loans. It ends the low-income-housing energy-assistance program, which low-income Americans rely on to properly heat and cool their homes. It proposes testing out time-limited benefits and work requirements for recipients of disability assistance.
The budget’s strict health care cuts provide the starkest proof of the Republican Party’s antipathy toward the poor. Experts told me that the Medicaid cuts will be particularly harmful to low-income people. “For the Medicaid part, some of these provisions with reference to moving back to and supporting the Graham-Cassidy-Heller-Johnson Bill would have major implications for the Medicaid program,” Robin Rudowitz, the associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, said. “These provisions on repealing the Medicaid expansion and transitioning Medicaid financing to a block grant or per-capita cap have major implications for the Medicaid program and for low-income people. It just limits the dollars going to the states for that coverage.”
This states-rights language, then, is mostly code for cuts. Judy Solomon, the vice president for health policy at the Center for Budget and Policy Priorities, told me that a proposal to change Medicaid’s drug-rebate program could have troubling consequences. “Right now, the way that works in Medicaid is that pharmaceutical companies have to provide rebates to states for the purchase of their drugs, and if they provide rebates in accordance with the rules, then the drugs are on the formulary of the state’s Medicaid program,” she explained. “It’s not like a lot of private insurers, who have restrictive formularies where certain drugs are not provided even if they’re considered medically necessary.” States can have preferred drugs or different methods of cost-sharing, she said, but if the state is provided a rebate for the drug, then it’s on the formulary. This is “particularly important for people with mental illness,” Solomon added, “where people need one drug over another.”
In practical terms, the Trump administration’s proposal would likely restrict access to necessary medication. And this is not the only barrier to care the budget would raise. It would also allow states to increase scrutiny of legal immigrants applying for Medicaid and to increase co-pays for Medicaid beneficiaries who use the emergency room for non-emergency purposes.
“For higher-income people, higher co-pays can actually encourage people to use care more efficiently,” Solomon said. “But when they’re applied to low-income people, research going back to the ’70s shows they don’t get necessary care.”
Sicker people, colder homes, hungrier children: These are the realities the Trump administration would create. Congressional Republicans will probably fight the details, but on welfare reduction itself, the party is of one mind. It’s almost trite now to point a tired finger at Democrats and urge them to see the obvious way ahead, but there’s value in the exercise now that Republicans have debunked their own deficit concerns. Democrats should have never capitulated to budget hawkery. Now they must leave it entirely behind them.