On February 10, the White House released President Trump’s fiscal year 2021 budget.1 Budgets are often described as statements of priorities. This budget attempts to obscure what remains atop the Trump administration’s health policy priority list: eliminating the coverage expansions implemented by the Patient Protection and Affordable Care Act (ACA).
For the last 2 years, the budget has directly demonstrated the administration’s commitment to eliminating the ACA’s coverage programs. Those budgets featured proposals modeled on the Graham-Cassidy-Heller-Johnson proposal that the Senate debated and failed to pass in 2017.2 Those proposals would have repealed the ACA’s Medicaid expansion and Marketplace subsidies and replaced them with much stingier block grants to states while also cutting funding for states’ pre-ACA Medicaid programs via a per capita cap or block grant. States would also have been allowed to eliminate ACA insurance market rules that bar insurers from charging more or denying coverage on the basis of pre-existing conditions.
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