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President Trump sent Congress a $4.4 trillion budget proposal on Monday outlining steep cuts to domestic programs, large increases in military spending and a ballooning federal deficit that illustrates how far Republicans have strayed from their longtime embrace of balanced budgets. The blueprint has little to no chance of being enacted as written and amounts to a vision statement by Mr. Trump, who as a businessman once called himself the “king of debt” and has overseen a federal spending spree that will earn him that title in an entirely different arena. (Davis, 2/12)

Trump's budget revived his calls for big cuts to domestic programs that benefit the poor and middle class, such as food stamps, housing subsidies and student loans. Retirement benefits would remain mostly untouched by Trump's plan, as he has pledged, though Medicare providers would absorb about $500 billion in cuts — a nearly 6 percent reduction. Some beneficiaries in Social Security's disability program would have to re-enter the workforce under proposed changes to eligibility rules. (Taylor and Crutsinger, 2/13)

Some Medicare beneficiaries would face higher prescription drug costs under President Donald Trump's budget even as the sickest patients save thousands of dollars, a complex trade-off that may make it harder to sell Congress on the plan in an election year. In budget documents, the administration said its proposals strike a balance between improving the popular "Part D" prescription benefit for the 42 million seniors enrolled, while correcting design flaws that increase program costs for taxpayers. Health and Human Services Secretary Alex Azar is expected to testify on the proposal later this week in Congress. (Alonso-Zaldivar, 2/13)

On the surface, the plans to lower drug prices in the Trump Administration’s 2019 budget shouldn’t cause much pain to the health-care industry. A closer look shows where policymakers are hoping to get deeper cost savings. In the 2019 budget released Monday, the White House unveiled a series of plans to lower drug prices, including making certain generic drugs free and capping out of pocket spending for Medicare beneficiaries. (Grant, 2/12)

Kaiser Health News: Trump’s Budget Proposal Swings At Drug Prices With A Glancing Blow

President Donald Trump’s new budget proposal flirts with combating high prescription drug prices, but industry watchers say the tweaks to Medicare and Medicaid do little more than dance around the edges of lowering the actual prices of drugs. The White House’s proposal, which comes after Congress passed a two-year spending deal last week, though, sets the tone for the administration’s focus on prescription drugs. (Tribble, 2/12)

OMB couldn't calculate the budgetary impact of some ideas, such as a proposal to establish an inflation limit for reimbursement of physician-administered drugs in Medicare Part B. The administration says this would address "abusive" pricing by manufacturers. (Karlin-Smith, 2/12)

The spending plan reaches beyond the White House’s own power over the government social safety net and presumes lawmakers will overhaul long-standing entitlement programs for the poor in ways beyond what Congress so far has been willing to do. The changes call on lawmakers to eliminate the expansion of Medicaid under the Affordable Care Act and transform the rest of that program into a system of capped payments to states; convert food assistance into a hybrid of commodity deliveries and traditional cash benefits; and expand requirements that low-income people work to qualify for federal assistance. (Jan, Dewey, Goldstein and Stein, 2/12)

The White House budget for fiscal 2019 seeks major savings by repealing ObamaCare and endorsed a Senate GOP bill as the best way to do so. “The Budget supports a two-part approach to repealing and replacing Obamacare, starting with enactment of legislation modeled closely after the Graham-Cassidy-Heller-Johnson (GCHJ) bill as soon as possible,” the White House said in its budget request. (Weixel, 2/12)

His budget would slash almost $700 billion in federal healthcare spending that helps low- and moderate-income Americans who rely on insurance marketplaces created by the 2010 healthcare law. As Republicans proposed last year, the plan would replace much existing healthcare spending with grants to states, allowing each one to craft its own health program. Similar proposals last year failed in the Senate, and Senate Majority Leader Mitch McConnell (R-Ky.) has indicated that the chamber won't consider another run at Obamacare this year. (Parsons, 2/12)

The president’s budget singles out abortion providers and would prohibit Health and Human Services funding, including money used for family planning, from going to any clinic or health care facility that also offers abortion services. Though the language is broadly written, its intended target is Planned Parenthood, which relies on government funding to offer a variety of services to women other than abortion. The budget would help achieve the longstanding goal of social conservatives to cut off Planned Parenthood from federal assistance. (2/12)

President Trump’s budget is proposing moving two grants out of the anti-drug office, a major change that’s already sparked a backlash from lawmakers and more than 150 advocacy organizations. The administration has justified the proposal in its budget, saying it “will enable ONDCP to focus resources on its core mission: to reduce drug use and its consequences by leading and coordinating the development, implementation and assessment of U.S. drug policy.” (Roubein, 2/12)

Congress' decision to delay Medicaid disproportionate-share hospital payment cuts has the double benefit of sprucing up the credit quality of safety-net hospitals and local governments, Moody's Investors Service said Monday. The budget deal passed Friday includes a two-year delay in the cuts, which would have amounted to $2 billion in fiscal 2018. Although the cuts technically took effect Oct. 1, 2017, the beginning of the federal fiscal 2018, hospitals had not yet felt the effects. The move will be credit-positive for safety-net hospitals, which treat large numbers of indigent patients and often rely on supplemental payments or government subsidies, according to a Moody's credit outlook report released Monday. (Bannow, 2/12)

Many of the cuts in the plan are unlikely to become reality: Congress just increased spending limits last week, and it rarely dares to change entitlement programs. But the budget is an important signal of the administration’s priorities. (2/12)

The blueprint underscores what has become clear in recent months: that the budget austerity Republicans pursued in 2011 has ended. GOP lawmakers and Mr. Trump are now pursuing fiscal policies that tolerate wider deficits in a bid to ramp up economic growth. (Davidson, 2/12)

“Does it balance? No, it doesn’t,” White House Office of Management and Budget Director Mick Mulvaney told reporters Monday. “I probably could have made it balance, but you all would have rightly absolutely excoriated us for using funny numbers because it would have taken funny numbers do to it.” (Paletta and Werner, 2/12)

It was hailed as the long-overdue compromise. With a six-week funding extension, $300 billion for the military, and a promise for $6 billion in opioid prevention funds – last week’s federal spending deal drew bipartisan praise. But some New Hampshire nursing homes aren’t celebrating. Tucked into the 600-page bill is a series of cuts to long-term health services. According to an analysis by the Congressional Budget Office, the new legislation reduces direct Medicare funding for nursing homes by $1.9 billion over 10 years – or $140 million starting in October. (DeWitt, 2/12)