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.

In addition, the budget also calls for more than $845 billion in reductions for Medicare—practically guaranteed to rile the GOP's senior constituents as 2020 approaches. Trump has repeatedly promised not to cut Medicare, Medicaid or Social Security—and his new budget chops all three. Since this comes as Democrats are touting variations on Medicare for All, Republicans are likely to be in an interesting position as the election approaches.

Democrats are already weighing in on the provisions, with Senator Bernie Sanders, I-VT, commenting about Medicare cuts, “Make no mistake about it: Trump's budget is a massive transfer of wealth from the working class to the wealthiest people and most profitable corporations in America.” According to a Common Dreams report, he's also said of the budget in a statement, “The Trump budget is breathtaking in its degree of cruelty and filled with broken promises.”

Hospital groups are already trumpeting their displeasure with the proposals, with Chip Kahn, president of the Federation of American Hospitals, told Modern Healthcare, “The impact on care for seniors would be devastating. Not to mention that massive reductions would drastically reduce resources critical to care for low-income Americans and cripple efforts to stave off the looming physician shortage.”

Should such proposals actually survive Congressional scrutiny, they too could weigh on the 2020 election, particularly since seniors as a voting block are determined and active.

Another agency taking a hit is the National Institutes of Health, which would see its appropriations cut by nearly $5 billion. The Food and Drug Administration, on the other hand, would see a small increase in funding. And the military gets a massive budget bump.

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Trump budget's steep HHS cuts signal GOP stance for 2020 campaign

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