No service cuts but the trust fund took a hit

Protecting Medicare was was one of Trump's earliest campaign pledges. "Save Medicare, Medicaid and Social Security without cuts. Have to do it," he said in his presidential campaign announcement speech.

So far, the promise of Medicare remains in force. There have been no cuts in services or a change in the government's responsibility to fund the program.

That said, Medicare's resources to pay for those services has shrunk, and both Trump and House Republicans have proposed ways to trim Medicare spending over the next decade.

On the resources side, a side effect of the Republican 2017 Tax Cut and Jobs Act was a loss of tax dollars flowing into Medicare's Hospital Insurance Trust Fund. That's the main pot of Medicare money, and the Medicare Trustees forecast in their 2018 report that the fund would run out of money in 2026. A year earlier, they said it would last until 2029.

On Trump's watch, it lost three years of solvency.

In a presentation at the American Enterprise Institute, a market-oriented think tank, the chief actuary at the Centers for Medicare and Medicaid Services, Paul Spitalnic, said two of the lost years were due to lower than expected wage growth.

But the other lost year came from the Republican tax cuts.

"The Tax Cuts and Jobs Act of 2017 decreased individual tax rates and as a result, there is somewhat less income coming into the trust fund," Spitalnic said. "That does have an effect of making depletion of the trust fund a year earlier."

Critics of this analysis counter that the Medicare actuaries made some poor assumptions in 2017, which made 2018 look worse than it really was. On the other hand, both parties have relied on the trustees' forecast for decades.

In terms of budgets, the White House FY 2019 budget plan proposed reducing the growth of Medicare to generate $236 billion in savings by 2028. The administration said it would save money through better negotiations on drugs, shifting some payments away from the trust fund and reducing Medicare fraud.

The House Republicans had their own package of changes that they said would trim spending by $537 billion by 2028.

As ever, the debate is whether slowing the growth of Medicare is the same as cutting it. But the House proposal would make real cuts. It raised the eligibility age from 65 to 67, and increased deductibles. It also turned Medicare into a voucher program. When the Congressional Budget Office scored a similar proposal, it found that people using traditional Medicare would end up paying more.

Still, neither Trump's nor the House Republican plans became law.

For now, benefits remain as they were, but there has been a modest impact on funding that could affect the program in the future.

We rate this as a Compromise.