WASHINGTON - A new proposal from President Donald Trump to slash Medicare spending puts Republicans in a political bind ahead of the 2020 election as Democrats are pitching an expansion of the popular health care program for all Americans.
Trump's 10-year budget unveiled Monday calls for more than $845 billion in reductions for Medicare, aiming to cut "waste, fraud and abuse" in the federal program that gives insurance to older Americans. It's part of a broader proposed belt-tightening effort after deficits soared during the president's first two years in office in part due to massive tax cuts for the wealthy.
The move immediately tees up a potential messaging battle between Democratic proposals for "Medicare-for-all" - castigated by Republicans as a socialist boondoggle - and a kind of Medicare-for-less approach focused on cutting back on spending, from the GOP.
Video: With several Democratic presidential candidates supporting "Medicare-for-All" and more than half the country backing some form of a national health plan, details get murky. (Jenny Starrs, Sarah Hashemi/The Washington Post)
Democrats, including some seeking to challenge Trump in 2020, seized on the proposed Medicare cuts Monday as an example of the GOP seeking to balance the budget on the backs of the elderly and the poor after giving broad tax breaks to the wealthy.
"Make no mistake about it: Trump's budget is a massive transfer of wealth from the working class to the wealthiest people and most profitable corporations in America," Sen. Bernie Sanders, I-Vt., a Democratic presidential candidate, said in a Monday tweet that highlighted Medicare cuts.
During his 2016 campaign, Trump broke from Republican orthodoxy by promising not to cut Medicare, Medicaid or Social Security. His budget, by contrast, calls for scaling back all three programs.
In states with large senior populations, such as Florida, political attacks over Medicare cuts have proved so effective that both parties have used them. Sen. Rick Scott, R-Fla., won his seat after running ads last year accusing then-incumbent Democrat Bill Nelson of voting to cut Medicare.
Trump probably needs to win Florida, Arizona, Pennsylvania and other states with large numbers of seniors if he is to secure re-election in 2020. Older Americans consistently vote at higher rates than younger Americans.
Since taking office, Trump has largely left untouched Medicare and other programs heavily used by seniors. Republicans have followed his lead, ditching previous proposals to raise the retirement age or impose other restrictions to save costs and reduce the $22 trillion national debt.
While announcing his presidential bid in June 2015, Trump said he would "save Medicare, Medicaid and Social Security without cuts." He added that it was "not fair" to make cuts to a program that people had been paying into for many years, and that he would save it "by making us rich again" and cutting waste, fraud and abuse.
The White House said Monday that Trump's budget, which calls for changing hospital reimbursement rates and finding savings on drug prices, does not amount to cuts for Medicare or change the program structurally.
"He's not cutting Medicare in this budget," Russell Vought, the acting director of the Office of Management and Budget, told reporters Monday at the White House. "Medicare spending will go up every single year by healthy margins, and there are no structural changes for Medicare beneficiaries."
But Trump's proposed Medicare savings are more than three times as large as those in his previous budget, and industry lobbying groups said the reductions would hurt hospitals and seniors.
"The impact on care for seniors would be devastating," Chip Kahn, president and CEO of the Federation of American Hospitals, said in a statement. "Hospitals are less and less able to cover the cost of care for Medicare patients; it is no time to gut Medicare."
Many prominent Democratic presidential candidates have embraced some version of a Medicare-for-all system, which would allow most Americans to be covered under the federal program.
Trump and his Republican allies had been on the offensive on health care in recent months, after several Democratic candidates struggled to answer questions about how they would pay for universal coverage and whether they would allow Americans to keep their private insurance.
"Just this week, more than 100 Democrats in Congress signed up for a socialist takeover of American health care," Trump said earlier this month at the Conservative Political Action Conference, claiming that a Medicare-for-all plan would "take away private coverage from over 180 million Americans."
Democratic strategists and officials argued Monday that Trump's budget proposal exposed how little credibility Republicans have in debating health care, and they showed signs of confidence that it would sharpen the contrast Democrats are seeking to make in the run-up to the 2020 election.
"It totally eviscerates any integrity to their already pretty flimsy attack," Sen. Richard Blumenthal, D-Conn., said. "This assault on Medicare lays bare the real Republican agenda, which is to destroy the health care safety net. They have no shred of intellectual underpinning or integrity to their attack on Democrats if they make this kind of proposal."
Republicans and fiscal conservatives offered tepid praise for the president's proposal, which would not balance the federal budget until 2034. Republicans have long called for more significant changes to Medicare and other mandatory spending programs that are the biggest drivers of the national debt.
"President Trump has the right mindset regarding his proposed budget," said Adam Brandon, president of FreedomWorks, a conservative group. "Congress, however, needs to make entitlement reform a priority if we are to address the nation's burgeoning national debt in the long term."
In last year's midterm elections, Democrats campaigned aggressively on health care, attacking Republicans over their failed effort to repeal and replace the Affordable Care Act. The dynamic marked a shift from the two previous midterm elections, during which the GOP was the party mainly going on offense on health care, slamming Democrats over the creation of the ACA, also known as Obamacare.
"On one hand, you don't like handing the other side a potential campaign message at any point, and Democrats will inevitably try to make this into a 'Trump wants to cut your Medicare' argument," Republican pollster Chris Wilson said. But Wilson argued that the plan probably would not reverberate as the ACA repeal push did. "A proposed cut to entitlements in a budget proposal that has no chance of passing the House just isn't going to enter the public consciousness in the same way," he added.
The latest discussions about Medicare mark a new chapter in the partisan debate. Many Democrats are eager to continue putting health care at the forefront of the national conversation. Democratic presidential candidates "should be raising this issue morning, noon and night," said Blumenthal, who co-sponsored a Medicare-for-all proposal in the last Congress.
Democratic presidential candidates seized on Trump's budget framework Monday, singling out the Medicare cuts.
"This budget says a lot about the President's priorities: cut $845 billion from Medicare, while spending billions on his vanity project, the wall," Sen. Kamala Harris, D-Calif., tweeted, referring to Trump's request for border wall funding. "This would hurt our seniors and is yet another piece of evidence for why we need a new president."
Trump's proposed Medicare cuts amounted to a "huge gift for Democrats," said Dan Pfeiffer, who served as White House communications director under President Barack Obama.
"It's a political fumble on the Republican part in the sense that this budget is going nowhere," he said. "The argument prior to this was the Democrats' plan versus the status quo. And now it's the Democrats' plan versus the Republican plan to cut Medicare."
Sen. Brian Schatz, D-Hawaii, tweeted: "One party wants to expand Medicare and Medicaid and the other wants to cut them. That's the end of my tweet."
This article was written by Toluse "Tolu" Olorunnipa and Sean Sullivan, reporters for The Washington Post.