WASHINGTON -- Health policy scholars offered conflicting predictions for President Trump's proposed budget bill, which is expected to be released on Monday.
Most, but not all, of the experts ľֱ interviewed said they do not expect the new FY 2019 budget plan to include mention of Affordable Care Act (ACA) repeal.
Bob Greenstein, president of the left-leaning Center on Budget and Policy Priorities (CBPP), seemed less certain that his repeal fears have passed.
"My guess, which I hope is wrong, is that we will once again see proposals to repeal the Affordable Care Act, particularly the subsidies and the Medicaid expansion and major Medicaid cuts on top of that," he said.
"It seems like this administration tries to stick closely to the arch conservative part of it's base, which has been ginned up to demand ACA repeal." Also, he noted, that the administration will probably try to claim that the proposals balances the budget. "If that's the case then the budget will probably assume massive savings in Medicaid and other health-related areas."
Greenstein noted that the White House and key Republican lawmakers still agree on this issue. "House Speaker Paul Ryan (R-Wisc.) continues to say that legislation making large changes in low-income assistance programs is one of his top priority for 2018," he added.
The CBPP released a report on Friday touting
"The president's budget is irrelevant the moment it arrives," said Doug Holtz-Eakin, PhD, president of the American Action Forum, a conservative think tank, taking a different tack. The questions it would typically answer, such as how much non-defense spending to expect, were already answered by the spending bill that the president signed Friday morning, he said. Regarding ACA repeal, he added, "nothing is going to happen on that front."
Asked whether there would be cuts to Medicaid, Holtz-Eakin doubted it.
"It doesn't matter whether it's in the budget or not. It's not going to happen," said Gail Wilensky, PhD, who served as administrator of what is now the Centers for Medicare & Medicaid Services under President George H.W. Bush, regarding such cuts. Wilensky is now a senior fellow at Project HOPE, in Bethesda, Md.
She said she doesn't anticipate an ACA repeal mention either, but warned that the plan "may include savings which [the administration] actually doesn't think would ever happen." And added, "Administrations both Republican and Democrat have done that."
On this point, she and Greenstein agreed. The CBPP also warned of "rosy" and "unrealistic economic assumptions" and other budget gimmicks that might be used to sweep the nation's fiscal challenges under the rug.
Echoing Holtz-Eakin, Tom Miller, a resident fellow at the right-leaning American Enterprise Institute, called the executive budget proposal a "one-day show" and "arm waving." "The hard thing is to see tangible policies that are going somewhere that would have the votes to approve them," he said.
One potential concrete policy change might be an idea a senior administration official leaked to the involving lowering drug prices by compelling drug companies to share the rebates they normally extend to insurers and pharmacy benefit managers with Medicare beneficiaries.
Doug Badger, a senior fellow at the Galen Institute, said, "I would like to see some provision that would address victims of Obamacare."
Whether it's framed as "repeal and replace" or "healthcare reform" isn't important he said, but the federal government needs to fix the problems created by the ACA. He also stated that he does expect to see some type of repeal of the ACA mention in the bill.
Badger also said he hopes to see a "thoughtful" approach to drug prices.
"I don't want to come to this issue with green eye shades looking at how we can slash spending or slash prices ... without regard to the long-term consequences."
As for the ideas on drug pricing included in recent media reports, Badger said he would need to see more details.
"I get suspicious when two lobbies come out against one another and each accuse the other of gouging the public."
Kavita Patel, MD, MPH, a nonresident fellow in economic studies at the left-leaning Brookings Institution, and a primary care internist at Johns Hopkins University, said the idea came from a just-released
While the idea may be "great on paper, it's difficult to do in practice," she told ľֱ in a phone call. "It still seems like it's not holding the manufacturer responsible for the price."
Patel, who also doesn't expect to see any mention of the ACA or Medicaid cuts in the proposed budget, said what she'd like to see is "meaningful funding" for prevention and public health.
It's not a good sign that the spending bill that passed on Friday cut $5 billion from the Prevention and Public Health Fund.
Patel would also like to see more funding for Health IT, which both the Obama administration and the Trump administration have left "bare-boned."
"There's a lot more we need in information technology including data sharing, which doesn't really exist right now."
But she conceded, "The things I want are probably not going to happen."