The President’s budget, with greater detail later today or this week does reveal enough to demonstrate that the Administration is going a third round on some past budget cuts that went nowhere in a Congress run by his own party. The general descriptions provided included in the Budget for a Better America outline, proposes cuts in mandatory and discretionary spending by:

• Converting Medicaid into a per capita cap block grant
• Creating an optional state block grant of child welfare foster care funding through a waiver process
• Elimination of the Social Services Block Grant (SSBG);
• Elimination of the Community Services Block Grant (HHS);
• Elimination of the Community Development Block Grant (HUD);
• Cutting $1 billion plus the elimination of the $600 million contingency fund in TANF;
• Elimination of the 21st Century Afterschool program (Education); and
• The elimination of the Low-Income Home Energy Assistance Program (LIHEAP) to name some but not all cuts

The block grants are attacked as not demonstrating effectiveness or strong enough outcome measures which does not appear to be a concern in allowing a block grant of foster care funding or creating a “per capita cap” (a complex formula-based block grant) for Medicaid.

While many will label the budget as “doa” or dead on arrival, several will be pursued through administrative action and many will become part of an ongoing agenda.

One prime example of a budget proposal that will be pursued administratively are the work requirements across a range of programs including Medicaid, nutrition programs and housing programs. The Medicaid work requirements would be much more expansive then last year’s efforts in that they would not be limited to the Medicaid expansions under the ACA. Instead they are seeking Medicaid work penalties across the health care program. An initial analysis of the Administration’s Medicaid work requirements by outside think tanks suggests that they would remove over a million and a half people off health insurance each year.

This proposal caused some fireworks last week when HHS Secretary Alex Azar went before the House Energy and Commerce Health Subcommittee. Secretary Azar was asked during the hearing why the state of Arkansas work requirements have removed nearly 20,000 people from health care coverage. Secretary Azar indicated that he did not know the reason. That response caused Congressman Joseph Kennedy III (D-MA) to engage the Secretary over the Medicaid work requirements as Kennedy asked how the Administration could propose an expansion of the work requirements across the fifty states when it doesn’t understand the implications in one state. He asked the secretary, “What’s the logic in that?