Health care plays a big role in President Donald Trump's budget released on Monday. While the document serves mostly as a wish list -- Congress controls the federal purse strings -- it does make clear where the president's priorities are concerning the Affordable Care Act (ACA), Medicaid, prescription drugs and opioid abuse.
If Republicans keep control of Congress, legislation mirroring some of these initiatives could become a reality. More immediately, the administration can continue implementing agency rule changes and executive orders that can also affect health care policy.
Here's a checklist of health care budget items and how they affect consumers:
Prescription drug prices
The president has made lowering Rx drug prices a top priority. Polls show the majority of consumers are frustrated with the high cost of medicine. The administration's package to lower drug costs is long and complex, but ultimately doesn't offer a whole lot of relief to consumers.
Changes in how drug company rebates are distributed, how insurance formularies are constructed and how Medicaid and Medicare drug prices are negotiated are all part of the budget. Some experts worry that these changes are just a matter of moving money around and don't address the underlying causes of ever-increasing prescription drug prices.
In an article published Tuesday, former Congressman Henry Waxman, former Health and Human Services Deputy Secretary Bill Corr and former adviser to the Department of Health and Human Services Kristi Marin expressed similar concerns even while praising the overall efforts. "As a package, the proposals could help decrease patient costs for drugs and reduce federal spending … but it's likely that more policies will be needed to control the drivers of drug spending," the trio wrote.
There is some good news.who pay the most for medicines would pay less under the Trump budget. Medicare patients who reach the maximum of $8,418 in total costs would no longer have to pay the 5 percent co-pay on prescription drugs. Other Medicare patients, however, would pay more out of pocket for medicine because manufacturer discounts would no longer be counted toward their total drug spending.
The ACA and Medicaid expansion
Mr. Trump hasn't given up on repealing and replacing Obamacare. The budget supports eliminating ACA premium subsidy payments and Medicaid expansion, and distributing that money to the states in block grants they can use to run their own health care programs. Block grants were the backbone of the plan Republican Sens. Lindsey Graham (South Carolina) and Bill Cassidy (Louisiana) introduced last fall that went nowhere.
Critics of block grants say they'll provide much less money to states for Medicaid. In addition, states would likely no longer be required to uphold ACA standards for individual insurance, including coverage for essential health benefits and equal premiums for people with preexisting conditions.
"The first thing this budget would do is try to repeal the Affordable Care Act again," said Judy Solomon, vice president of health policy at the Center on Budget and Policy Priorities. "It's not likely there's an appetite for that, but it says that it's still an overarching priority for this administration."
Still, the budget has plenty of less sweeping but significant proposed changes and cuts in Medicaid that would directly affect many recipients. Those include denying benefits to people who cannot prove their immigration status, increasing some emergency room co-payments and including the value of a person's property and belongings in addition to income for Medicaid eligibility.
Help for opioid addiction
The Trump budget provides more funding to address the opioid abuse epidemic, including the $3 billion Congress already approved for fiscal year 2018 and $10 billion for fiscal 2019. Although the budget has some back and forth about which government offices will actual oversee efforts to combat opioid abuse, the plan offers other details about how the administration would approach the problem.
Most significant are the proposals to allow government reimbursements for opioid addiction medications, including for the first time methadone and efforts to cut back on prescribing opioids.
Many health care advocates are applauding the news, but others worry that even this seemingly large increase in funding isn't nearly enough. According to some estimates, opioid abuse costs the country as much as $80 billion a year. What's more, proposed cutbacks in Medicaid funding would potentially adversely affect opioid treatment for low-income people.
The Associated Press contributed to this article.