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Blog: Trump adviser now says Medicare and Medicaid changes are on the table

Presumptive GOP presidential nominee Donald Trump Trump Photo by Gage Skidmore
From the start of his race for the Republican presidential primary run last year, Donald Trump repeatedly has promised that unlike other Republican candidates, he would not touch Medicare, Medicaid or Social Security. It's been one of his core appeals to older working- and middle-class voters.

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” he tweeted last May.

As recently as this week, he told Fox Business that “I'm leaving (Medicare) the way it is.”

But as the presumptive GOP nominee has shown over and over again, he's very flexible in his rhetoric and policy positions. On Wednesday, Sam Clovis, Trump's chief policy adviser, signaled to a Washington group that strongly favors a major overhaul of Medicare, Medicaid and Social Security that Trump is open to their agenda. “After the (Trump) administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare,” Clovis said, according to the Wall Street Journal.

That statement came just before Trump met with House Speaker Paul Ryan on Thursday to try to make peace with the top Republican policymaker, who has spearheaded a series of House budget outlines that would dramatically restructure Medicare and Medicaid and sharply reduce federal spending on those two programs. The Wisconsin Republican wants to convert Medicare into a defined-contribution, voucher-style program and change Medicaid into a capped state block grant program. Some experts say the plan would impose significantly higher costs on seniors.

Ryan and other top Republicans reportedly have been distraught over Trump's emphatic promises to voters that he would not cut or change the three popular social insurance programs, and over his criticism of fellow Republicans for seeking such cuts and changes.

“He's so anti-Medicare, Medicaid, Social Security,” Trump said of Ryan last fall. And last week Trump announced that “I am not ready to support Speaker Ryan's agenda.”

Clovis said Wednesday that while a President Trump would not seek any immediate changes in the social insurance programs, “we have to start taking a look not just at Medicare and Social Security but every program we have out there, because the budgetary discipline that we've shown over the last 84 years has been horrible.” The Trump adviser, who's an economist, reportedly suggested that Trump might consider entitlement cuts after a few years of seeing the results of his tax reform plan and other fiscal policies.

But Clovis' statement Wednesday during an event sponsored by the Peter G. Peterson Foundation suggests that Trump and Ryan aren't far apart on restructuring and cutting the entitlement programs after all.

The Trump campaign seemed to quickly recognize the potential political damage from Clovis' comments, given that a Kaiser Family Foundation public poll last year found that 70% opposed Ryan's Medicare restructuring proposal. Shortly after Clovis spoke, a Trump campaign spokeswoman told the Wall Street Journal that Clovis “did not remotely suggest anything having to do with cuts. I read his statements as though we need to examine budgetary discipline to protect programs like Social Security and Medicare.”


Prior to Clovis' statement, there was general agreement among political experts that Trump probably wouldn't say anything during the campaign about entitlement reform, which likely Democratic nominee Hillary Clinton would use as powerful ammunition against him with older voters.

“Trump needs a very large portion of the over-60 vote, and he's not going to go near any change in Social Security or Medicare,” Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said last week. “He has said one of the reasons Mitt Romney lost in 2012 is because he took up Ryan's proposal. He'll say flat out that the Ryan plan isn't where he's going.”

On the other hand, conservative analysts hope Trump would warm to Medicare, Medicaid and Social Security restructuring after winning the election. “Trump is a dealmaker,” Chris Edwards, an economist and budget expert at the libertarian Cato Institute, which favors Ryan-style changes in Medicare and Social Security, said last week. “He might have promised not to cut benefits. But he's clearly the type of person whose opinions change all the time.”

Adding to the pressure to cut entitlement spending would be Trump's proposed tax cuts, Edwards argued. Trump's tax reform package would cost a whopping $9.5 trillion over the first decade and $15 trillion over the second decade, according to the nonpartisan Tax Policy Center.

Democrats likely are salivating over the prospect of running ads warning older voters about the possibility of Trump going after their beloved Medicare and Social Security benefits, and Clovis' comments Wednesday will give them fodder. “If I were a Democrat running for Congress, I would try to make the election about the Ryan plan,” Blendon said.

After Thursday's meeting between Trump and Ryan, the two GOP leaders released a joint statement saying they had “a great conversation” and were “honest” with each other about “our few differences,” and called their meeting a “positive step toward unification.”

Don't be surprised if the issue of restructuring the entitlement programs—which Ryan is passionate about—came up during their talk. Healthcare policy watchers and voters may want to pay close attention to what Trump and his proxies say about Medicare, Medicaid and Social Security from here on out.

“Before you know it, (Trump) will be back saying he will protect these programs,” Blendon said Thursday. “He is courting conservatives this week. But he will be back on message by the general campaign. He has taken a very strong stand on this issue and cannot afford to have anti-Medicare cuts ads in the general election.

That's consistent with the assessment of Trump by former New York Post gossip and celebrity editor Susan Mulcahy, who covered the Manhattan real estate tycoon's exploits for many years and got used to his shifting statements. “He's a carnival barker,” she told NPR on Thursday. “He'll say whatever he needs to say to get you inside his tent. If you get in there and the two-headed dog he promised you isn't there, he's got you inside and he'll find something else.”


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