Trump Is Trying to Shift the Entire Budget Conversation to the Right. Don't Let Him.

The initial response to President Donald Trump’s budget has rightfully focused on the outrageousness of its worst spending cuts, such as huge reductions in affordable housing, medical research, infrastructure, and even Meals on Wheels. But even if Congress rejects some of these extreme cuts, President Trump’s budget may still set the stage for working families to get a raw deal.

The president’s budget doesn’t have the final say on how much money is spent on each agency and program—that’s Congress’s job. But it does frame the debate around government spending for the year. By putting out a budget that includes draconian cuts to the programs that Americans rely on, President Trump is trying to lower the standards for an acceptable outcome from Congress—and shift the entire conversation about federal spending to the right.

Even without the Trump budget’s $54 billion in cuts, next year’s spending levels are already too low due to the sequestration caps imposed by the Budget Control Act of 2011. Congress actually designed these caps to be terrible; the threat of sequestration was meant to force Republicans and Democrats to compromise on a “grand bargain” to reduce deficits. They never made that compromise, so lawmakers have been using short-term budget deals to mitigate sequestration’s worst impacts—but now Trump’s budget could make sequestration look reasonable by comparison.

As a reminder—because memories can be painfully short in politics—sequestration is not reasonable. In fiscal year 2018, it will limit nondefense discretionary spending—the same part of the budget targeted for cuts by President Trump—to roughly match its lowest level ever as a share of the economy since the federal government began tracking this category of spending in 1962.

The only way to get a good deal for working families is to increase the spending caps above sequestration levels. Otherwise, Congress will continue to underfund programs that support basic living standards and invest in the middle-class, while rigging the system even further for wealthy and corporate elites.

Sequestration is not reasonable.

Two years ago, Congress demonstrated what sequestration would mean for jobs and working families when they tried to use those caps to write spending bills for FY 2016. Like President Trump’s budget, these bills took money out of the Pell grants that help students afford college. The House of Representatives proposed huge cuts that nearly eliminated infrastructure grants funded by the Transportation Investment Generating Economic Recovery (TIGER) program—which President Trump’s budget proposed eliminating completely. Similarly, huge cuts in a Senate spending bill would have nearly eliminated the HOME investment partnerships program to support affordable housing—another program targeted for elimination by the Trump budget.

In FY 2018, the sequestration caps in current law would cut nondefense discretionary spending by $3 billion. A $3 billion cut may seem insignificant next to the Trump budget, but even flat funding would be grossly inadequate for many nondefense discretionary programs. Lawmakers have already provided a $3.1 billion increase for the Department of Veterans Affairs in FY 2018, since they fund veterans’ medical programs a year in advance. Accommodating this increase will require deeper cuts to other programs, where funding requirements are also generally increasing because of inflation and population growth. For example, flat funding for rental assistance programs could cause 100,000 families to lose their housing vouchers.

Sequestration doesn’t just cut programs that are essential to average Americans—it actively hollows out safeguards that are meant to level the playing field, giving even more power to corporations and helping the rich get richer. The Environmental Protection Agency (EPA) and Internal Revenue Service (IRS) were targeted for cuts in both the Trump budget and the FY 2016 sequestration spending bills. Preventing the EPA and other agencies from enforcing environmental laws is great news for big polluters who can increase profits by cutting corners without getting caught, but it leaves ordinary Americans to live with the consequences of unsafe water, toxic air, and catastrophes such as chemical explosions. And cutting the IRS budget makes its customer service even worse for ordinary Americans, as seen with the particularly “abysmal” problems caused by lack of funding in 2015. At the same time, IRS budget cuts also make it easier for wealthy households and big corporations to use complex accounting maneuvers to overwhelm the IRS and avoid paying their fair share.

The Trump budget provides a stark illustration of what steep cuts to domestic programs mean for working families. But it should not lower the standards for an acceptable budget deal. To the contrary, after seeing President Trump’s plans to attack programs that help maintain basic living standards and create ladders into the middle-class, it is more important than ever for Congress to support a budget that adequately funds these programs.

Failing to lift the sequestration caps would mean starting down the same path outlined in the Trump budget, and working families deserve better than that.

Last week, White House budget director Mick Mulvaney defended the Trump administration’s proposal to cut funding for Meals on Wheels by arguing that the program is “just not showing any results.”

That claim is objectively false.

Meals on Wheels serves more than 2 million seniors every year who aren’t able to shop and cook for themselves. Research on home-delivered meal programs shows that they improve diet, nutrition, and quality of life, and reduce food insecurity among participants. In short, when seniors get meals, they’re healthier. My casual field research—otherwise known as every conversation I’ve ever had with my grandparents—also backs this up. If you don’t feel well, you should eat something.

I’m guessing, based on Mulvaney’s argument that cutting the program’s funding is the “compassionate” thing to do, that he hasn’t watched someone nearly die from malnutrition. But I have.

My grandmother had the dubious honor of being the only person to check into her hospice house two separate times.

The second time she was admitted, she spent a month fighting off the beleaguered staff’s attempts at kindness while she settled into an uncharacteristically peaceful death. She wasn’t an easy woman to care for during her life, and she wasn’t any different when she was dying. Once, when a hospice worker took her outside to spend some time in the sun, she dismissed the house’s small garden as “prissy bullshit.” When a volunteer dropped a curler during an attempt to wash and set her hair, she snapped that she “didn’t have that much time left, and didn’t want to waste it fumbling around.” When a grief counselor asked her what she’d miss about her life, she answered “gimlets and a fucking cigarette.”

We held her memorial service in the same room that she died in—another first for the house’s staff. When the nurse leading the service offered us the opportunity to share a warm memory about her life, we all shifted uncomfortably in our seats as we struggled to think of one. My aunt finally broke the silence with a long story about my grandmother’s legendarily mean tortoiseshell cat, Cleo, who lashed out at anyone within striking distance.

My aunt didn’t mention her plan to have Cleo euthanized shortly after the service.

I hope Meals on Wheels would have been there to show a mean old lady some compassion.

Two years earlier, when my grandmother was admitted to that hospice the first time, she only stayed for two weeks. What we had been convinced were signs that she was nearing death—exhaustion, weakness, confusion—turned out to be malnutrition. After a few healthy meals, they sent her back home, and we made sure someone went to her trailer at least once a day to check that she ate and to ration out just enough scotch to keep her withdrawal tremors at bay.

My grandma survived those two years between hospice stays because my aunts split up the responsibility of taking care of her. If they hadn’t been able to do that, I can only hope that Meals on Wheels would have been around to help her before she slipped back to the place where hunger made it impossible to finish a sentence, or stand up from the kitchen table, or put in her dentures.

In other words, I hope Meals on Wheels would have been there to show a mean old lady some compassion.

What if you had to make a choice between hunger or deportation?

As the Trump era unfolds in California, fear of an Immigration and Customs Enforcement crackdown is disrupting the daily lives of immigrants and their families. In a state with 5.4 million non-citizen residents—and where nearly half of all children have at least one immigrant parent—the president’s promise to increase deportations may already be affecting the health and livelihoods of families, even those here legally, by discouraging them from turning to public-assistance programs or from working.

At the Alameda County Community Food Bank in the San Francisco Bay area, 40 families recently requested that their food stamps be cancelled, according to Liz Gomez, ACCFB’s associate director of client services. Another 54 Spanish-speaking households that pre-qualified for the Supplemental Nutrition Assistance Program turned down the opportunity to apply. Gomez says that the combination of a leaked draft executive order suggesting that legal immigrants could be deported for turning to public assistance within their first five years of arrival, as well as local ICE sweeps—and stories about raids and arrests elsewhere—are making immigrants afraid to give their information to service providers.

ACCFB has one of the largest SNAP outreach programs among food banks nationwide. It also provides enough food for 580,000 meals each week through food pantries, soup kitchens, child-care centers, senior centers, after-school programs, and other community-based organizations.

“We are concerned that some people are hesitant to visit a food pantry out of fear that ICE could show up,” said Gomez.

Indeed, Heidi McHugh, community education and outreach coordinator at Food for People in Humboldt County, says they have seen a decline in Latino clients at some sites. The organization runs 14 community food programs including meals for seniors, food pantries, school meal programs, and a mobile produce pantry that travels throughout the county to distribute vegetables. This month, when it stopped in a community that historically turns out 20 or 30 Latino households, only five Latino households showed up.

“We had previous customers drive by without stopping,” said McHugh. “Our pantries in the communities with high proportions of Latino residents say that they are seeing fewer people coming for food.”

At a food bank in the San Francisco Bay Area, 40 families recently requested that their food stamps be cancelled.

Qualifying for Medicaid, SNAP, or WIC can’t currently be used as legal cause for deportation or denying someone citizenship. But people are still afraid, Gomez said, even immigrants with legal status. Given the leaked draft executive order, providing personal information feels risky, at best. “They fear it will be shared,” said Gomez. “But it’s important for people to know that information like immigration status is not collected by pantries or meal programs—they’re simply there to help people who need food.”

About 45 percent of immigrant-headed families with children use food assistance programs. While undocumented immigrants are not eligible for food stamps, many families include children who are US citizens, and parents may apply on their behalf. Immigrants are more likely to be poor and to experience food insecurity than other groups of Americans; still, there is evidence that they’re already less likely to use public assistance than native-born citizens.

The economic impacts of forgoing benefits ripple to the surrounding community: Gomez said that the 40 households that canceled SNAP benefits and the 54 households that didn’t apply adds up to $630,000 annually in lost stimulus to the local economy. “And that’s just one example from our own work,” she said. “What’s the economic impact in communities across the country?”

Given recent ICE activity around the country, it’s not hard to see why immigrants might worry about the risks of using social support programs. Recently, ICE agents entered a courthouse in El Paso County, Texas and arrested a domestic violence victim who was trying to get a restraining order against her alleged abuser. In Alexandria, Virginia, there was a report of homeless people being interrogated by ICE at a church where they’d taken shelter from the cold. And in Los Angeles, a father was arrested by ICE immediately after dropping off his 12-year-old daughter at school.

Last month, two California state legislators sent a Freedom of Information Act request to the federal government seeking information about reported ICE activities in “sensitive locations” like “schools, hospitals, medical clinics, community centers, courts, government offices or churches.” Assembly Speaker Anthony Rendon and Senate President Senate President pro Tem Kevin de León wrote that “the fear of possible ICE enforcement activity in sensitive spaces prevents Californians from accessing services, including educational, medical, and law enforcement assistance.”

At a recent press conference in Fortuna, a small northern California city where nearly 20 percent of residents are Latino, members of the community talked about how the presence of ICE agents had disrupted their lives, including their ability to work. Jorge Matias, a community health worker, said there are parents who are “afraid to leave their homes to go to work or to go to their children’s schools for fear of being deported.” A woman named Karina Coronel said her children, ages four and six, have recently been bullied at school by students and a teacher, and that she has been shoved in stores and repeatedly told to “Go back to Mexico.” Coronel said, “Right now I am very fearful to even leave my home.”

“What gets me is that our people were already struggling,” said Gomez, noting that a 2014 study conducted by ACCFB showed that half of the food bank’s clients were already forced to make impossible choices between food and things like rent, utilities, transportation, and medicine. “People are literally now making the choice not to eat or to sacrifice their health because they are so invested in being an American,” said Gomez.

Author’s note: Join millions of people around the nation to protect immigrants and refugees and stand up for the values of love, compassion, and family in the #HereToStay campaign.

This article was originally published on The Nation.

When Dr. Ben Carson was nominated to be Secretary of the Department of Housing and Urban Development, many progressives were distraught. Dr. Carson’s lack of experience with housing policy, paired with his limited interest in running a federal agency, did not inspire much faith in his ability to manage an agency with a $47 billion budget that is tasked with supporting 31 million Americans.

By the time Carson was confirmed last month, there had been a shift. Media coverage softened, as some newspapers moved from being incredulous about his qualifications to arguing that his health background made him uniquely suited to running the department. During his confirmation hearing, Carson made that case himself by noting “good health has a lot to do with a good environment.” Some housing advocates, in turn, were hopeful he could be a good partner to their communities.

Less than a month into his tenure as HUD secretary, Carson is already beginning to undercut this argument. The Trump administration’s FY 18 budget, released today, proposes a $6.2 billion cut to the HUD budget—targeting programs that keep families housed and healthy.

Today’s “skinny budget” was light on detail, so it didn’t account for all of the resources that would be slashed as a result of the 13.2 percent cut to HUD’s funding. According to earlier documents, about $1.5 billion of the cuts would come from the funds local governments rely on to clear public housing of mold and lead. That would add to the backlog of major repairs needed for public housing, which already stands at $26 billion. The budget does propose a $20 million increase in funding specifically for lead remediation, but that restores less than 1 percent of what is being cut.

The budget also cuts programs that help prevent and alleviate homelessness, which is associated with health problems due to weather exposure, untreated conditions, and inconsistent medical care. About 200,000 low-income households could lose the rental assistance they need to afford housing, and the development funds that local governments use to prevent homelessness stand to be gutted. These programs have reduced homelessness by 10 percent since 2010— including a 15 percent reduction in family homelessness, and a 33 percent reduction in veteran homelessness.

The cuts also eliminate programs that support entire communities in their effort to provide a healthy environment for children. Community Development Block Grants (CDBG) and Home Investment Partnership (HOME) grants build and fix affordable housing, finance health care centers, and create community centers that give children safe places to play. In 2013 alone, 9.8 million people lived in areas that benefited from CDBG-funded projects, and HOME grants have helped build or saved 1.2 million affordable homes since the program was created in 1990.

Sec. Carson knows that living in poverty makes children sick.

Sec. Carson knows that living in poverty makes children sick. Living in structurally unsafe, substandard housing places children and families at a higher risk for fire-related injuries, asthma, and lead poisoning. It is also responsible for more than 18,000 preventable deaths each year. Carson has acknowledged this time and time and time again over the years. And, in one of Sec. Carson’s first messages to staff and the housing community last week, he pledged to “use every fiber of [his] being to work to improve America’s neighborhoods.” So, where is he this week when communities and families need him to defend the vital dollars they rely on?

During his confirmation hearing, Carson told U.S. senators, under oath, that he no longer supported the extreme cuts he had once campaigned on for President. He called such cuts “cruel and unusual punishment.” His support of this budget breaks his oath to Congress, and it calls into question the ethical oath he swore to live by when he became a physician: to do no harm.

Carson’s decision to support the current budget would dishonor his lifetime Hippocratic creed to uphold the human dignity of the people he serves—the people, families, and communities that rely on HUD. They deserve housing that keeps them safe from winter storms and summer heat. They deserve roofs without leaks, paint without lead, and walls that aren’t bubbling with black mold. They deserve to be able to turn the stove on without worrying if the apartment will catch fire.

They deserve to be healthy.

As House Republicans deliberate over their efforts to ram through a repeal of the Affordable Care Act that slashes $880 billion from Medicaid, one might be forgiven for believing that the only threat to the health care of low-income Americans and people with disabilities is coming from Congress.

No such luck.

Tuesday night, Secretary of Health and Human Services (HHS) Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma issued a letter to the nation’s governors laying out their vision for Medicaid. In the letter, they indicate a willingness to waive longstanding rules that are designed to protect low-income Americans from coercion, poverty, and exploitation.

Price and Verma assert that “rigid and outdated implementation and interpretation of federal rules” hinder the Medicaid program from accomplishing its goals. They reiterate a popular (and false) conservative talking point that by providing states additional funds to expand Medicaid, the Affordable Care Act discouraged them from addressing the needs of people with disabilities on traditional Medicaid. Finally, they lay out HHS’s willingness to grant almost every ill-advised “flexibility” request in the right wing’s wish list on Medicaid—many of which place people with disabilities, seniors, and low-income Americans at extraordinary risk.

Making Medicaid Harder to Access

The letter indicates the Trump administration would be willing to let states introduce premiums and higher cost-sharing for Medicaid beneficiaries. These measures were rejected under the Obama administration, since they interfere with the program’s ability to serve low-income people. But based on Price’s letter, they now look likely to sail through.

In particular, Price and Verma suggest states may wish to apply for permission to allow “emergency room copayments to encourage the use of primary and other non-emergency providers for non-emergency medical care.” It’s a laudable goal, but in rural areas where there is a shortage of clinicians who accept Medicaid patients—a common problem due to the program’s low reimbursement rates—emergency rooms are often the only practical option for low-income people. Policies that make emergency room visits more expensive are likely to simply discourage people from seeking necessary care.

Price and Verma also suggest states explore charging Medicaid beneficiaries premiums. Such measures ignore the underlying reality that Medicaid serves the deeply poor, who cannot sustain these costs by definition. Still, the suggestion is familiar to Verma—under her leadership as a health policy adviser to then-Governor Mike Pence, Indiana introduced monthly premiums in 2015. Failure to pay them was grounds for losing coverage, or having less access to vital health care services.

This newfound flexibility would make it possible for states to enact damaging policies

This newfound flexibility would also make it possible for states to enact damaging policies that they have been requesting for years. Arizona, Indiana, Kentucky, Montana, and Arkansas have all previously requested permission from the federal government to impose work requirements on Medicaid, which would deny people access to the program unless they are employed.

Arizona is also pursuing a five-year cap on Medicaid benefits. Under the plan, an individual must either be working full time or be receiving disability benefits from the Supplemental Security Income (SSI) or Social Security Disability program in order to keep Medicaid benefits past the five-year cap.

Both work requirements and time limits are likely to disproportionately impact people with disabilities. Even though the time limit proposals provide exemptions for people who are receiving benefits through SSI, many disabled adults qualify for Medicaid on the basis of their income—not their disability status with the Social Security Administration. That’s because many disabled people are unable to navigate the Social Security Administration’s complex bureaucracy or, particularly among people with psychiatric disabilities, may not be fully aware of their own disability. As of 2009, 1 in 5 adults eligible for Medicaid on a basis other than disability (2.3 million people) and 1 in 10 children eligible on a basis other than disability or child welfare assistance (about 3 million children) had a mental health diagnosis.

As for work requirements, people with disabilities are more likely than other Medicaid recipients to be unemployed. These measures would place them at risk of losing the health care coverage that would help them enter or return to the workforce. Indeed, where Medicaid has been expanded, research has shown that participation in the workforce for disabled adults has increased.

Weakening Protections Against Institutionalization

In their letter, Price and Verma also indicate an intent to weaken vital Obama administration protections for seniors and people with disabilities.

In 2014, the Obama administration issued a rule designed to protect seniors and people with disabilities who receive home and community based services. The Home and Community Based Settings Rule helps ensure that when states fund community services for people with disabilities, they do so in a manner that promotes integration instead of replicating the isolation and control of institutional environments.

The Settings rule requires every state to ensure that those receiving community supports have the right to do basic things like invite visitors into their own home, choose when they eat or what they do during the day, have legally enforceable rights under a lease, and possess options as to where to live other than group homes and other ‘disability-specific settings.’ States have until 2019 to comply with the Settings rule, and a broad range of flexibility to implement it in a way that best meets the needs of their residents.

The rule is designed to protect individual liberty, so that Americans will not lose control over their most basic choices by virtue of old age or disability. Prior to the Settings rule, states were moving to fund community-based services on the grounds of old institutions or by organizing segregated villages “clustering” adults with intellectual disabilities all in one place, limiting contact with the broader society. The Obama administration rightly recognized that these “gated communities” grouping people with disabilities together to get services were institutions by another name, so it limited states’ ability to fund them with scarce community services dollars.

Their letter places individuals with disabilities at greater risk of warehousing

But Price and Verma intend to move the implementation date from 2019 to an unspecified period in the future. Beyond that, their letter also calls for rolling back federal oversight, placing individuals with disabilities at greater risk of warehousing by state governments that are too often willing to defer to service providers about the level of rights their disabled residents should be afforded.

Elsewhere in the letter, Price and Verma express interest in revisiting 2016 Obama administration regulations governing how and under what circumstances states can contract out the operation of their Medicaid programs to private insurance companies, while fast tracking further state requests for “flexibility” in Medicaid.

Advocates at the state level must seek to organize in order to stop the worst of these ill-advised “flexibility” requests that are emerging from state legislatures and state Medicaid agencies. And governors in both parties must be told in no uncertain terms that taking advantage of the Trump administration’s offer to allow the gutting of Medicaid will not be viewed kindly by their voters.

Though this administration fails to recognize it, the rights of people with disabilities deserve federal protection. Just as states frequently fail to protect the rights of racial and ethnic minorities, women, and the LGBTQ community (all constituencies who are also under attack by the Trump administration), so too are state governments frequently willing to compromise the rights of disabled Americans for the sake of cost, convenience, or prejudice.

We can’t afford to be flexible when it comes to freedom and basic access to health care for every American.

Trump Is Trying to Shift the Entire Budget Conversation to the Right. Don’t Let Him.

The Trump Administration Is Confused About Meals on Wheels. My Grandma Could Teach Them A Thing or Two.

Why Immigrants in California Are Canceling Their Food Stamps

Why Won’t Ben Carson Speak Out Against HUD’s Budget Cuts?

HHS Secretary Tom Price Invited Governors to Gut Medicaid Protections

Making Medicaid Harder to Access

Weakening Protections Against Institutionalization

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Making Medicaid Harder to Access

Weakening Protections Against Institutionalization

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