Trump's budget and cuts to health care come as Democrats are touting variations on Medicare for All, putting Republicans in an interesting position as the election approaches. (Photo: Shutterstock)

The new Trump budget could lead to a battle royal in 2020, with some $2.7 trillion in spending cuts that would hit the Department of Health and Human Services with a 12 percent cut and Medicaid spending to the tune of some $1.5 trillion from 2020 to 2029.

Other actions sure to be less than popular with those who need health care are a push to change overall funding for Medicaid to a block grant or to per capita caps for states and rolling back the Affordable Care Act's expansion of the program.

And although Axios reports that the proposed budget also targets seniors' out-of-pocket drug costs—which wouldn't be a bad thing—other provisions in the budget won't make seniors happy at all. The budget targets “silver loading,” says Modern Healthcare, which allows insurers in most states to load the cost of cost-sharing reductions onto silver benchmark plans. CSRs help to offset higher out-of-pocket costs for low-income exchange customers, but the original CSR payments were terminated by Trump in October of 2017.