As the incoming Trump administration seeks to reduce its budget, it may eliminate or reduce several federal health safety nets, including Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutritional Assistance Program (SNAP).

In a media briefing on December 6, hosted by Ethnic Media Services, a panel of experts discussed the potential threats that lie ahead of certain federal health programs. 

Speakers

  • Joan Alker, Executive Director of the Center for Children and Families and Research Professor at the Georgetown McCourt School of Public Policy Foundation
  • Mayra Alvarez, President of the Children’s Partnership
  • Richard Kogan, Senior Fellow, Center on Budget and Policy Priorities

Those three crucial lifelines collectively support 88 million low-income residents in the United States. Notably, CHIP enrolls nearly half of all children in the country, approximately 40 million. Additionally, over 34% of individuals under the age of 65 who identify as Latino are covered by Medicaid. Similarly, 39% of Black people and 35% of Native Hawaiian Pacific Islanders are also covered by Medicaid. Furthermore, approximately 28% of Asian Americans under the age of 65 are also covered by Medicaid, as per data from the Health and Human Services’ Office of Minority Health.

In contrast, President-elect Donald Trump has pledged not to cut Social Security or Medicare, which primarily serve individuals over the age of 65. However, Trump made limited mention of Medicaid, which provides health insurance to low-income adults and children through CHIP.

Medicaid serves as the largest source of federal funds entering state budgets, accounting for an average of 56% of a state’s budget. As Joan Alker aptly put it, “if we do see big cuts to Medicaid, that will affect all areas of states’ budget, not just their health budget.”

Medicaid cuts could occur even before President-elect Donald Trump takes office, as explained by Alker. A new Republican-controlled House and Senate will likely initiate a budget resolution in January. Significant Medicaid cuts would pose substantial challenges for state governments, unable to fill the gap. She emphasized the profound impact these cuts would have on America’s aging population.

The cuts will be phased in over a decade, a strategy employed by Congress to minimize immediate pain. However, new red tape is likely to emerge, delaying enrollment for eligible individuals and their children. Healthcare providers serving low-wage workers, particularly those in rural communities, could face reimbursement cuts. Alker highlighted that these cuts would be challenging for providers to absorb, potentially endangering various groups, including children, seniors, individuals with disabilities, and low-wage workers.

Medicaid enjoys significant voter support, ranking second behind Medicare, one of the federal government’s most popular programs. Alker underscored that voters oppose substantial Medicaid cuts. This election centered on cost concerns for families, and they certainly don’t want to incur higher healthcare expenses.

Several proposals in Project 2025, which is expected to be Trump’s playbook for his second term in office, would cause irreparable harm to the health and well-being of children, according to Mayra Alvarez.

Alvarez emphasized that children require healthcare services and the security that coverage like Medicaid or Medi-Cal in California provides. However, they also need a safety net and access to services that include nutrition, economic support, and more. She highlighted that CHIP, SNAP, and Temporary Assistance for Needy Families (TANF), and even school lunch programs are at risk of being cut or eliminated.

SNAP, also known as food stamps, supports 40 million people and serves as our nation’s first line of defense against hunger, according to Alvarez. She expressed concern that the incoming administration has proposed $4 billion in cuts to the program over five years. This comes at a time when grocery prices have increased by 24% between 2020 and 2023, while wages have not kept pace.

Furthermore, Alvarez expressed concern that the Trump administration will likely end the Low Income Home Energy Assistance Program (LIHEAP), which assists low-income families with their energy bills. She also expressed concern that funding for the Women, Infants, and Children (WIC) program would be reduced.

Families eligible for federal health support are likely to disenroll themselves, as they did during Trump’s first administration, due to the fear of the public charge rule. Trump attempted to invoke this rule during his first term, threatening to deny immigration status adjustments to applicants who had received federal benefits. This created a chilling effect within the immigrant community, as explained by Alvarez.

Another seldom-used process known as impoundment was also discussed. Richard Kogan explained that impoundment allows the President to simply stop the flow of funds already approved by Congress. However, he emphasized that impoundment is unconstitutional.

Trump hinted at his intention to use impoundment during several campaign rallies. He stated, “We’re going to bring back presidential impoundment authority, which nobody knows what it is. But it allows the president to go out and cut things and save a fortune for our country,” as reported by NPR.

Kogan’s research on impoundment began 52 years ago, when former President Richard Nixon used the process to deny funds to social welfare programs. Nixon faced nine lawsuits and lost all of them. In response, Congress approved the Impoundment Control Act in 1974, aiming to limit similar presidential actions.

Kogan clarified that much of the public discussion surrounding impoundment is either confused or incorrect. He emphasized that presidents have never had the general authority to impound funding enacted into law by Congress. In fact, Congress cannot even grant such authority to the President if it chooses to.

Kogan explained that the US Constitution does not grant the President the right to impound funds. Instead, it states that Congress decides what to spend money on and how much, and the President’s role is to ‘take care that the laws be faithfully executed.’

In 1996, Congress passed the Line Item Veto Act, granting Presidents the power to selectively veto specific line items within appropriations bills. This effectively amounted to an impoundment, and it would only take effect unless Congress enacted a new law to prohibit it. However, the Supreme Court ruled in a 6-3 decision that the Act was unconstitutional.

Kogan expressed concerns about the potential cuts that Congress might make, potentially eliminating or reducing funding for essential programs such as healthcare, food assistance, education aid, and housing support for millions of people. Nevertheless, Kogan emphasized that it is Congress’s responsibility to write the budget laws, and the President’s duty is to faithfully adhere to those laws. This is not a matter of choice.

 

Images provided by EMS.