When President Trump's budget proposal was released Tuesday, Mick Mulvaney, the budget director, defended "cuts" to Medicaid by essentially saying the president's campaign promise not to reform it was overridden by his promise to repeal and replace Obamacare. "We support the American Health Care Act, and that does change Medicaid."
"Everyone is interested in seeing the truly needy in their state and in our nation get the care that we promised them in Medicaid," Mulvaney continued. "But there's a better way to do it than under current law, which is Obamacare. We can also talk about what a failure that is. But there's a better way to do it, and that's what the American Health Care Act does."
In its current form, Medicaid is costly for taxpayers. The federal government contributes $1.33 for every state dollar spent on Medicaid, on average. It's also failing patients who depend on it. The system encourages states to spend more on people who are healthy than on those who are truly needy. This is part of why 600,000 people with mental illnesses, developmental disabilities or traumatic brain injuries are on a Medicaid waiting list for long-term care.
If the Trump administration is overriding some campaign promises, we have a suggestion. It should override its promise not to touch entitlements. He can do so by letting it be overridden by his promise to Make America Great Again. If that isn't specific enough to cover the volte-face, the president should cite his promise to "cut spending big league."
At nearly $1 trillion a year, Social Security is the biggest federal program. Yet, it is hardly touched in Trump's budget proposal.
Medicare, Medicaid and Social Security accounted for a majority of federal spending in fiscal 2015. You're not cutting spending if you're leaving most spending alone.
Medicare and Social Security have their own revenue streams, but that revenue will soon fall well short of the programs' expenditures.
Medicare's hospital insurance program spent more in 2015 than was brought in by the payroll taxes that fund it. In 20 years, Social Security's revenues will cover only about 75 percent of its expenditures.
This is where Trump has to look to make big league spending cuts.
To satisfy true fiscal conservatives, entitlement reforms wouldn't have to take effect immediately, or even during his administration. President Ronald Reagan signed bipartisan Social Security reforms into law in 1983 that are still in the process of being phased-in today, and will be until 2027. Just proposing reforms that don't have a chance of getting through Congress would at least raise awareness that Social Security will be broke by 2035, and other looming entitlement program disasters.
It's never been crystal clear what era "Make America Great Again" harkens back to. But it's clear that America's finances and the long-term liabilities of its entitlement programs are worse than ever before. Trump could make his legacy one of willful ignorance on entitlements. But he also has an opportunity to push for vital reforms of programs that will bankrupt the country if left untouched. He should seize it.