As a presidential candidate, Donald Trump promised not to cut Social Security, Medicare, or Medicaid.
However, that eye-popping figure appears to involve some budgetary legerdemain.
A more traditional conservative proposal is block grants for Medicaid, part of an ongoing effort to move healthcare decisions to the states. "The president seeks to slash domestic spending in order to reduce the budget deficit generated by his tax cut", said Darrell West, a senior fellow at the Brookings Institution.
The Federation of American Hospitals called the proposed cuts "arbitrary and blunt" and the American Hospital Association warned they raise "serious concerns about how hospitals and health systems can ensure they serve as the safety net for their patients".
In his $4.7 trillion budget unveiled on Monday, Trump called for overhauling social programs that help poor and elderly Americans, while boosting military spending and funding a U.S. -Mexico border wall.
"Every Republican wants to do a big number on Social Security, they want to do it on Medicare, they want to do it on Medicaid", he said at a 2015 event in New Hampshire.
"If we can reduce the regulatory state and get health care costs down, we can get the economic engine going, and then restrain spending".
However, the budget is unlikely to affect public spending levels, which are controlled by Congress.
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Galdieri said the White House "still does not seem to have internalized the fact that they did so badly in the 2018 midterms and that the Democrats now have a major role in the budget".
The latest 2020 budget proposal from Trump also outlines a substantial funding increase for the FDA - although commentators are already saying that the plan faces nearly certain rejection from Democrats controlling the US House of Representatives. The committee estimates only 11 percent of the proposed Medicare cuts come from Medicare Part D reforms. Because the program is so big, even a small reduction in percent terms can add up to hundreds of billions of dollars over time.
President Trump's 2020 budget request of an extra $291 million to fight the spread of H.I.V., experts said on Tuesday, will not be remotely sufficient to meet the goal he announced in his State of the Union address: to almost eliminate the AIDS epidemic in the United States within 10 years.
"The proposals generally target hospitals and other health care providers", Neuman said.
Advocates for Medicare beneficiaries had a measured reaction to the budget.
The Democrats also denounced Trump's proposed cutbacks in education, community development, student loans and free school meals for low-income students.
Republican strategist David Kochel, a 2016 adviser to Jeb Bush, said there was little evidence that Trump's voters would abandon him over the Medicare proposal.
The Medicare Rights Center said "it is hard to envision a situation where these changes do not profoundly impact the lives of people who depend on the program". Seniors with very high costs would benefit from a proposed cap on their copays, but others may actually wind up having to pay more.