Trump's budget offers few clues about administration's Medicare, Medicaid priorities

White House
President Donald Trump's budget contains only vague language about the administration's priorities for Medicare and Medicaid.

Though President Donald Trump’s budget proposal has gained attention for its cuts to the Department of Health and Human Services, the document says little about two major government healthcare programs, Medicare and Medicaid.

However, what is left out of the budget proposal may say more than what’s in it, experts told FierceHealthcare.

In the proposal, the administration says it “supports efficient operations for Medicare, Medicaid and the Children’s Health Insurance Program and focuses spending on the highest priority activities necessary to effectively operate these programs."

To Jeff Goldsmith, national policy adviser for the consulting firm Navigant, that language offers little clue as to what Trump’s priorities are for the two programs, though he noted that because Medicare is an entitlement program, funding for it generally isn't appropriated through the federal budget.

“I think that’s complete boilerplate; I don’t know what that means,” he said,

But that vagueness isn’t necessarily surprising, said Michael Abrams, a partner at Numerof & Associates.

“I do get the impression that there will be perhaps more context on where the administration wants to go with regard to Medicare and Medicaid down the road,” he said. As Trump is currently pushing Congress to pass the American Health Care Act, “I think understandably, he doesn’t want to have two policy statements out there at the same time,” he added.

The budget proposal does go into more specifics about healthcare fraud enforcement, proposing to give the Health Care Fraud and Abuse Control program an additional $70 million in discretionary funding in fiscal year 2018.

However, “a lot of us have been wondering,” Goldsmith said, about whether the budget was going to be the vehicle for undoing some aspects of the Affordable Care Act that aren’t mentioned in the American Health Care Act, such as the Independent Payment Advisory Board, or the Center for Medicare and Medicaid Innovation (CMMI).

Abrams agreed that “it’s interesting that nothing yet has been said on the future of CMMI.” The fact that neither Congress nor the Trump administration has suggested cutting funding for the agency leads him to believe that the trend of furthering value-based reimbursement has a good chance of continuing.

To Abrams, that’s good news for the future of healthcare reform. “Because honestly, if they don’t continue on that path, I’m not sure what mechanism they’re going to use to lower the cost of care,” he said.

That doesn’t necessarily mean CMMI won’t see changes under the Trump administration, however. A coalition of healthcare industry groups has already sent HHS Secretary Tom Price an outline of requested reforms, such as requiring Congress to approve any demonstration model expansions and related changes to Medicare and Medicaid.

In the past, the Centers for Medicare & Medicaid Services faced considerable pushback from both industry groups and politicians when CMMI proposed testing a sweeping new Medicare Part B reimbursement model. It later scrapped the demonstration.

For his part, Price said that while he supports innovation, he’s “adamantly opposed” to the mandatory way the CMMI has approached some demonstrations.

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