HHS Secretary Alex Aazar

House Democrats made it absolutely clear to the nation's top health official, Alex M. Azar II, that the budget the administration put out Monday is dead on arrival. The House doesn't have to vote on the budget. It's purely the president’s wish list and one part of that wish list is particularly troublesome to them: the Medicaid cuts.

Trump’s budget would cut nearly $780 billion from Medicaid over the next 10 years and reduce the growth of the program by $1.4 trillion by repealing the Affordable Care Act and Medicaid expansion and replace that coverage with an inadequate block grant. What is particularly problematic for House Democrats is that the administration is attempting to implement the block grant program with a back door maneuver. The administration has signaled that it will approve waivers to states to replace the current open-ended federal commitment to states with a lump sum of money in the form of a block grant. That would basically cap payments to states, payments that would not keep up with rising costs of health care. That means fewer people would be covered, a reality Azar admitted to in a hearing Monday.

He told lawmakers that under the administration's proposed waivers there is no guarantee that everyone who now has Medicaid would keep it. "You couldn’t make that kind of commitment about any waiver." Rep. G. K. Butterfield (D-NC), said that "block-granting and capping Medicaid would endanger access to care for some of the most vulnerable people"—seniors, children and the disabled. Despite the fact that a Republican Congress rejected that plan in 2017, Azar told the Health, Education, Labor and Pensions (HELP) subcommittee of the House Energy and Commerce Committee that HHS has the ability to grant such waivers to states that want them. "You just wait for the firestorm this will create," Butterfield told Azar, reminding him more that more than 70 million low-income people—more than 20 percent of Americans—get their health care through Medicaid.

The budget proposal to cut more than $800 billion from projected spending on Medicare also drew heat from lawmakers, as did the proposal to cut federal payments to hospitals that primarily serve low-income communities. New York Democratic Rep. Eliot L. Engel said that the $26 billion in cuts over 10 years, would be devastating to these safety net hospitals. Azar dismissed his concerns saying, "I don't believe any of the proposals will impact access to services."

The reality is this administration wants to take health care away from the people Republicans believe are unworthy—the poor, the disabled, the elderly. With the Democratic House, they're going to have a harder time doing that but it's clearly still their primary agenda when it comes to health care.