Medicaid

Americans could be forgiven if they’re unaware that President Trump recently performed one of his most essential tasks and sent his annual budget request to Congress, though months late and stunningly incomplete.

After all, so much else has been dominating the news lately: the Mideast war that Trump promised not to start. Price rises he’d vowed to end. His repeated insults of Pope Leo XIV. His portraying himself as Jesus Christ, then lying about having done so. An incompetent attorney general to fire. And the president’s actual priorities — plans for a $400-million White House ballroom and a massive “Triumphal Arch” nearby!

It’s a lot.

Once again, as in Trump’s first term, the public and press are inattentive to the nation’s fiscal health relative to past years. But that reflects the president’s own disengagement with reconciling spending and revenue — this from a president many Americans voted for based on his purported prowess as a businessman. For decades back to Ronald Reagan’s time, so-called deficit wars in Washington were a big story. Now, even Republicans in Congress complain of Trump’s absence from the fiscal fray as they struggle to belatedly finish this year’s budget work that was due last fall, and to end a weeks-old partial government shutdown, before turning to the budget for the fiscal year starting Oct. 1.

Yet it’s worth paying attention to U.S. budgets even if Trump won’t, for the sake of our children and grandchildren who’ll inherit the bills. In one document, a federal budget reflects the nation’s priorities. And these days, in the perennial guns-versus-butter debate, Trump has made his feelings all too plain.

“We’re fighting wars,” he told a group at the White House on April Fools’ Day. “We can’t take care of day care … Medicaid, Medicare, all these individual things.”

Forget that Trump swore to end wars. Or that last year, long before he went to war against Iran, he cut $1 trillion over 10 years from Medicaid and other healthcare programs in his misnamed “One Big Beautiful Bill.”

Yes, budgets can be boring, especially to a president with a famously short attention span. Trump and many of us Americans are distracted constantly by all the shiny objects he throws at the national consciousness by his words, acts and social media postings at all hours.

Yet the budgetary trend is clear to anyone bothering to look: As president, Trump is once again exacerbating the nation’s unsustainable course of piling up debt. According to the nonpartisan Congressional Budget Office, among other credible sources, debt is now approaching the highest level in U.S. history, which was reached during World War II. It already surpasses the size of the entire economy and threatens higher borrowing costs and reduced investments.

For all the achievements Trump likes to claim — ending eight wars in a year! — here’s one that’s real: He is on a path to break his own record for the most debt in a single presidential term, $8.4 trillion in Trump 1.0, which was nearly double the increase under President Biden.

Need further proof of Trump’s brazen mendacity? Of course you don’t, but here it is: In the face of the well-documented budget record, Trump declared both this year and last year to a joint session of Congress, on national television, that he would balance the federal budget —“overnight,” he said in February.

The inequitable tax cuts and big spending increases for the military and immigration crackdowns that Trump and the Republican-controlled Congress enacted last year are significantly greater than in his first term, and are driving up the debt despite Republicans’ deep healthcare cuts. Just months after Trump took office, the ratings firm Moody’s downgraded the nation’s sterling credit rating for the first time in more than a century.

And now, in his new budget request, Trump seeks to inflate military spending from under $1 trillion when he regained office to $1.5 trillion, for the biggest year-to-year increase in military budgets since World War II.

This fiscal irresponsibility is happening at the worst possible time. For the last quarter of the 20th century, presidents and Congresses of both parties annually debated how to reduce deficits and several times reached consequential multi-year deals, culminating during the second Clinton term in four straight years of surpluses. (Those surpluses ended — wait for it — with Republicans’ tax cuts and war spending during the George W. Bush administration.)

Politicians back then were moved not just by the deficits of their time — deficits that, as a share of the economy, were less than half what they are now. They also were responding to experts’ warnings of a demographic tsunami by the 2020s: With the aging of the huge baby-boomer population, spending for Social Security, Medicare and Medicaid would greatly increase even as the workforce whose payroll taxes support those programs shrank. Today the number of people 65 or older is almost three times what it was 50 years ago, and rising.

This reckoning is upon us, though you wouldn’t know it as Trump keeps calling for cutting revenue and spending more for lawless wars, immigration raids and monuments to himself. Barring bipartisan action, in 2033 Social Security’s retirement fund and Medicare’s hospital fund will no longer be able to cover beneficiaries’ full claims, according to their trustees’ annual report, necessitating reduced benefits or shifts of money from other worthy programs.

Trump did put Vice President JD Vance in charge of a “war on fraud.” But that holds about as much promise as Elon Musk’s fiscal fiasco — remember DOGE? — that cost money instead of cutting $2 trillion as promised.

Like other problems, Trump likely will leave the fiscal follies to his successor, who, should he or she win two terms, would preside as Social Security and Medicare become insolvent. I’ve yet to hear any of the early 2028 presidential aspirants — or Trump — address or be asked about that.

Let the debate, belatedly, begin.

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Governing, the political sages tell us, is all about making choices, particularly when leadership faces finite resources and the choices are between war and peace; this is the “guns or butter” balancing raised by Lyndon Johnson’s pursuit of the Vietnam War and, appropriately, by President Trump’s Iran war.

Thus far, according to budget experts and the Trump administration itself, the war has cost Americans about $25 billion, with the White House reportedly preparing to seek $200 billion more in military funding. That points to the obvious question of what the U.S. could buy if it stopped spending on the Iran adventure.

Here’s the short answer: Medicaid coverage, free school lunches, and housing, child care and community college assistance for tens of millions of Americans. Those estimates come from Bobby Kogan, senior director for federal budget policy at the liberal Center for American Progress.

Kogan is not alone in doing the math. Similar estimates have been published by the Century Foundation and Mother Jones.

Democrats in Congress have offered their own juxtapositions: “$11.3 billion would have fully funded the training of 100,000 new nurses to solve our staffing crisis,” Rep. Diana DeGette (D-Colo.) observed on social media. “Instead, it was spent in just six days on an illegal war with no endgame.” (She wrote when that was the government’s estimate on spending in only the first week of the Iran war.)

Details will follow. But first, a reminder that the “peace dividend” — that is, the surge of available resources for socially beneficial spending after the cessation of hostilities — has always been an elusive concept.

In part that’s because it invariably gets tied up in conflicts over precisely what peacetime programs political leaders wish to fund, and that often involves tougher decisions than whether to mount a bombing campaign against a perceived adversary.

“What happened to the peace dividend?” economist Augusto Lopez-Claros asked last year, referring to the supposed surfeit of funds that was to flow after the end of the Cold War. His answer was that there were always alternatives, many of them militaristic in nature, in the wings to suck up the funds that had been spent in the past.

The issue has especially acute significance today, not merely because of the Iran war. The Trump administration and Republicans in Congress have been campaigning to cut federal spending, almost entirely on social programs such as Medicaid and on Social Security and Medicare benefits, ostensibly because they contribute heavily to our “unaffordable” federal budget deficits.

Never mind that the largest single contributor to the deficit is the massive tax cut enacted by Republicans in 2017, during the first Trump term, which were made permanent by the GOP’s budget bill last year.

Placing military spending in the context of alternatives is typically shunned by Republicans and conservatives. The Wall Street Journal editorial board derided the exercise as “dorm room politics,” referring specifically to an estimate by Rep. Ro Khanna (D-Fremont) that the $200 billion reportedly sought by the White House “would pay for free college for every American,” and more.

That doesn’t mean the exercise isn’t worthwhile, however. Kogan acknowledges that it wouldn’t be up to the Pentagon to redirect its budget to the social programs that could be funded with its funding request, but his point in making the comparisons is “to get a sense of scale.”

So let’s dive in, starting with Kogan’s work. He matched the cost of several social services against the $25 billion estimated to be spent on the war through the end of this week and the $200-billion new request. He also broke down some of the spending by ordnance. The price of one Tomahawk missile, invoiced about $3.5 million each, could cover Medicaid for a year for 275 people, for example; the U.S. has fired an estimated 300 of them in the Iran war so far, for more than $1 billion.

Kogan calculated that more than 3.1 million people could be covered by Medicaid for $25 billion, and 24.8 million could be covered for $200 billion. He based this estimate on the Congressional Budget Office’s finding that the federal share of Medicaid came last year to $668 billion to cover about 82 million adult and child enrollees, or about $8,048 per person annually.

Then there’s free school lunches, which the government has pegged at up to $4.69 per day for about 30 million children receiving meals in school. If they all received free lunch, that would come to a little over $25 billion, based on a 180-day school year. (Only about two-thirds of those children receive free meals, with the rest receiving cut-price meals or paying full price.)

Child care isn’t typically a governmental responsibility (though it should be); Kogan uses an estimate from the nonprofit organization Child Care Aware that care cost Americans about $13,128 on average in 2024; inflating that to a 2026 figure yields an average of $14,048, meaning that 1.78 million households could be covered for about $25 billion, and about 14.2 million for $200 billion.

Tuition for a two-year path to an associate degree in community college, that portal to higher education for millions of Americans, will cost an average of $8,700 this year by Kogan’s reckoning, based on the College Board’s estimate of $8,300 for 2025. That means that about 2.87 million Americans could have their tuition fully covered for about $25 billion, and nearly 23 million students could be covered for $200 billion.

The progressive Century Foundation contributed estimates of how much in social program spending could be accommodated for $200 billion. Its roster includes the cancellation of all medical debt for the 100 million Americans shouldering about $194 billion in medical debt. The enhanced Affordable Care Act premium subsidies that expired this year could be continued for almost six years for about $200 billion, extrapolating from the 10-year, $350-billion estimate produced by the CBO. “Ensuring health coverage for all Americans,” the foundation noted, “could save an estimated 68,000 lives per year.”

The foundation also notes that $200 billion could ameliorate the draconian cuts in Medicaid imposed by the preposterously named One Big Beautiful Bill that the GOP enacted as a budget measure in July. The work requirement in that bill is estimated to reduce Medicaid spending by $326 billion over 10 years, according to the CBO, mostly by throwing enrollees out of the program. The work rules, which as I’ve reported do nothing to enhance employment, could be deferred for six years, preventing the loss of coverage for about 5.2 million Americans.

Mother Jones reported soberly that $200 billion would cover the wages of 2.8 million public school teachers, based on an average salary of $72,030, as reported by the National Education Assn.

The publication took a rather more fanciful approach for some calculations. It reported that $200 billion would pay for 2,666 sequels to the “Melania” documentary, based on the $75-million reported cost of its production and marketing by Amazon, its sponsor. And 500 more White House ballrooms, based on the latest projection of $400 million for just one.

Obviously all these calculations are somewhat chimerical. No one really believes that if Congress rejects the $200-billion ask, that money would be redeployed for any of these social programs, at least while the GOP remains in control of the government purse strings. The basic arithmetic itself is subject to cavils resulting from the murkiness of some of the cost calculations and projections.

But they’re not far wide off the mark in terms of orders of magnitude. Millions of dollars in social spending could be covered by billions of dollars in military spending, and much more productive investments could be made in the years and decades to come.

The lost “peace dividend” encompasses not just domestic needs, but also “the potentially catastrophic risks that we are taking on in the future because we are misallocating resources now,” Lopez-Claros observed — “spending massively on defense while leaving unattended climate change mitigation, pandemic preparedness, the shamefully high levels of malnourishment in the world, among others. We may well come to regret this and by then, unfortunately, it might be too late.”

Even before the first bombs fell on Iran, after all, the U.S. was shortchanging all those imperatives. “Just last July, Trump signed into law the biggest cuts to the social safety net in all U.S. history,” Kogan says, including “the biggest cuts to Medicaid ever, and the biggest cuts to SNAP, ever.” (The GOP budget bill cut SNAP, the food stamp program, by $186 billion, leaving “nearly 3 million young adults ages 18 to 24 who receive SNAP vulnerable to losing that assistance,” the Urban Institute estimated after the bill was signed.

At their heart, these calculations are not really about dollars and cents. The financial figures just help us keep score of the choices that define us as a nation.