Donald Trump, at the time president of the United States, listens to then-Office of Management and Budget Acting Director Russ Vought deliver remarks prior to Trump signing executive orders on Oct. 9, 2019, in the Roosevelt Room of the White House. (Official White House Photo by Shealah Craighead)

WASHINGTON — Incoming White House budget director Russ Vought has spent much of his career learning the detailed, often convoluted mechanisms that make up the Office of Management and Budget.

The agency, little known outside Washington, D.C., is relatively small compared to the rest of the federal government, but it acts like a nucleus for the executive branch and holds significant power.

OMB is responsible for releasing the president’s budget request every year, but also manages much of the executive branch by overseeing departments’ performance, reviewing the vast majority of federal regulations and coordinating how the various agencies communicate with Congress. 

Vought was deputy director, acting director and then director at OMB during Trump’s first term.

Before that Vought worked as vice president of Heritage Action for America, policy director for the U.S. House Republican Conference, executive director of the Republican Study Committee and a legislative assistant for former Texas Republican Sen. Phil Gramm. He has an undergraduate degree from Wheaton College and a law degree from George Washington University Law School.

Following Trump’s first term in office, Vought founded the right-leaning Center for Renewing America. The group’s mission is “to renew a consensus of America as a nation under God with unique interests worthy of defending that flow from its people, institutions, and history, where individuals’ enjoyment of freedom is predicated on just laws and healthy communities.”

Cutting government spending

Vought outlined his agenda for the next four years in Project 2025, a 922-page document from the conservative-leaning Heritage Foundation that led to speculation during the presidential campaign about what Trump would seek to do without Congress, including in areas that constitutionally fall within the legislative branch, like government spending.

The Democratic presidential nominee, Vice President Kamala Harris, repeatedly tried to tie Project 2025 to Trump and his campaign, and they sought to distance themselves from its proposals. But Trump has since nominated some of its authors or contributors to run federal departments and agencies.

Vought, in a 26-page chapter on the executive office of the president, wrote the OMB director “must ensure the appointment of a General Counsel who is respected yet creative and fearless in his or her ability to challenge legal precedents that serve to protect the status quo.”

Trump, Vought and many others are bullish about cutting government spending, but will likely run into legal challenges if they try to spend more or considerably less than lawmakers approve in the dozen annual government funding bills. 

Budget request

One of Vought’s most visible responsibilities will be releasing the president’s annual budget request, a sweeping document that lays out the commander-in-chief’s proposal for the federal government’s tax and spending policy.

The president’s budget, however, is just a request since Congress has the constitutional authority to establish tax and spending policy.

Lawmakers on Capitol Hill write the dozen annual government funding bills that account for about one-third of annual federal spending. The rest of the federal government’s spending comes from Social Security, Medicare and Medicaid, which are classified as mandatory programs and mostly run on autopilot unless Congress approves changes and the president signs off on a new law.

That separation of powers led to frustration during Trump’s first term in office and will likely do so again, since he spoke during the 2024 campaign about using “impoundment” to prevent the federal government from spending money Congress has approved.

Trump withheld security assistance funding from Ukraine during his first term in office, leading to one of his two impeachments and a ruling from the Government Accountability Office —a nonpartisan government watchdog — that he had violated the law.

“Faithful execution of the law does not permit the President to substitute his own policy priorities for those that Congress has enacted into law,” GAO wrote. “OMB withheld funds for a policy reason, which is not permitted under the Impoundment Control Act (ICA). The withholding was not a programmatic delay. Therefore, we conclude that OMB violated the ICA.”

Trump spoke on the campaign trail about using “impoundment” to drastically cut government spending, but that would likely lead to lawsuits and a Supreme Court ruling. 

Vought’s think tank, Center for Renewing America, published analysis of presidents using impoundment throughout the country’s history, with the authors concluding the Impoundment Control Act is unconstitutional.

‘Every possible tool’

Vought sought to defend the president’s budget request in his chapter in Project 2025, writing that though “some mistakenly regard it as a mere paper-pushing exercise, the President’s budget is in fact a powerful mechanism for setting and enforcing public policy at federal agencies.”

He signaled the second Trump administration would be more nuanced in its interpretation of presidential authority.

“The President should use every possible tool to propose and impose fiscal discipline on the federal government.” Vought wrote. “Anything short of that would constitute abject failure.”

Vought also wrote about the management aspect of OMB’s portfolio, pressing for political appointees to have more authority and influence than career staff.

“It is vital that the Director and his political staff, not the careerists, drive these offices in pursuit of the President’s actual priorities and not let them set their own agenda based on the wishes of the sprawling ‘good government’ management community in and outside of government,” Vought wrote. “Many Directors do not properly prioritize the management portfolio, leaving it to the Deputy for Management, but such neglect creates purposeless bureaucracy that impedes a President’s agenda—an ‘M Train to Nowhere.’”

How to address projected shortfalls for both the Social Security and Medicare trust funds will become an increasingly important topic for the president and Congress during the next decade. (Photo by Getty Images)

This is one in a series of States Newsroom reports on the major policy issues in the presidential race.

WASHINGTON — The presidential debate in early September included just one mention of Social Security and three references to Medicare, making the safety net programs a minuscule part of the policy discussion, despite their importance to tens of millions of Americans.

Democratic nominee Kamala Harris and Republican candidate Donald Trump have both mentioned the programs numerous times during appearances, though neither campaign has sought to elevate the financial stability of the two programs as a core issue.

More often than not, Harris and Trump rebuke their opponent, while committing to “save” Social Security and Medicare — skipping over the details or the role Congress must play in the discussion.

How to address projected shortfalls for both the Social Security and Medicare trust funds will become an increasingly important topic for the president and Congress during the next decade.

The latest Social Security trustees report expects the Old-Age and Survivors Insurance and the Disability Insurance trust funds will be able to pay full benefits until 2035, after which, without action by lawmakers, benefits would drop to about 83%.

The trustee report for Medicare shows the funding stream for the hospital insurance trust fund can cover all of its bills through 2036 before it would only be able to cover 89% of costs.

There are currently 67.5 million people enrolled in Medicare, which provides health insurance and prescription drug coverage for people over the age of 65 as well as younger people who have certain severe illnesses or disabilities.

Nearly 68 million people receive some level of benefit from Social Security each month, accounting for about $1.5 trillion in spending by the federal government annually, according to a fact sheet.

While the issue is somewhat less pressing for Trump, who would be term limited to another four years, Harris could theoretically spend the next eight years in the Oval Office, making the solvency of the trust funds an issue she would likely need to address with Congress.

Protecting seniors

During the September debate, Harris brought up Social Security and Medicare following a question about how her policy beliefs on fracking, assault weapons and border security have changed over time.

“My work that is about protecting Social Security and Medicare is based on long-standing work that I have done. Protecting seniors from scams,” Harris said as part of a longer answer. “My values have not changed. And what is important is that there is a president who actually brings values and a perspective that is about lifting people up and not beating people down and name-calling.”

Harris later brought up Medicare again, noting that legislation Congress approved during Biden’s term in office allowed program administrators to negotiate certain prescription drug prices for the first time. That law, known as the Inflation Reduction Act, also capped the cost of insulin for Medicare enrollees at $35 per month.

Trump didn’t broach the subject of Social Security or Medicare during the September debate with Harris, but he did speak about the two programs during an earlier summer debate with President Joe Biden, before he stepped aside as the Democratic nominee.

During that debate, Trump claimed the Biden administration was going to “destroy” the two programs by allowing noncitizens to draw down benefits.

FactCheck notes on its website that comments and viral posts about noncitizens receiving Social Security benefits don’t always represent reality and sometimes confuse different programs.

“Immigrants who are lawfully living or authorized to work in the U.S. are eligible for a Social Security number and, in some cases, Social Security benefits. But viral posts make the false claim that ‘illegal immigrants’ can receive Social Security numbers and retirement benefits, and they confuse two programs managed by the Social Security Administration.”

KFF writes on its website that whether legal immigrants are eligible for Medicare depends on several factors, including how long they’ve paid into the system.

“New immigrants are not eligible for Medicare regardless of their age. Once immigrants meet the residency requirements, eligibility and enrollment work the same as they do for others.”

Trump on entitlement programs

Trump’s comments on entitlement programs haven’t always been consistent or entirely clear, but his campaign and he both maintain they will “save” the program.

During an interview with CNBC in March, Trump said that there are numerous things lawmakers could do to address solvency.

“There is a lot you can do in terms of entitlements, in terms of cutting and in terms of also the theft and the bad management of entitlements,” Trump said, declining to list any of those policy proposals.

Trump’s campaign website posted a video of him back in January 2023, saying Republicans “should not cut a penny” from Medicare or Social Security to pay for other legislation.

The problems facing Social Security and Medicare aren’t related to Congress reducing the amount of tax dollars flowing into the programs. Rather it is the structure for the programs lawmakers set up previously.

Without action by Congress, the trust funds won’t be able to account for benefit payments in the long term.

So the challenge for the next president won’t be preventing lawmakers from taking action related to Social Security and Medicare, but helping find a bipartisan path forward on legislation to change revenue, spending, or both.

Trump does want to end taxes on Social Security benefits, writing on social media in July that “SENIORS SHOULD NOT PAY TAX ON SOCIAL SECURITY!”

Henry Aaron, the Bruce and Virginia MacLaury Chair and senior fellow in the Economic Studies Program at the Brookings Institution, wrote in a detailed analysis of the platform that Trump’s proposal to end income tax on Social Security benefits “would accelerate trust fund depletion by about two years and deepen the long-run funding gap by more than 7%.”

Harris policies

Harris’ campaign website says she would “protect Social Security and Medicare against relentless attacks from Donald Trump and his extreme allies.”

“She will strengthen Social Security and Medicare for the long haul by making millionaires and billionaires pay their fair share in taxes,” the policy page states. “She will always fight to ensure that Americans can count on getting the benefits they earned.”

Harris announced in early October during an appearance on “The View” that if elected she would work toward including long-term home care for seniors enrolled in Medicare.

“There are so many people in our country who are right in the middle: They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said during the live interview. “We’re finding that so many are then having to leave their job, which means losing a source of income, not to mention the emotional stress.”

The proposals would likely need partial, if not complete, buy-in from Congress to move forward and could come with a $40 billion annual price tag, though the campaign noted in a fact sheet that there are pay-fors.

“These new benefits will be fully paid for and extend the life of the Medicare Trust Fund by expanding Medicare drug price negotiations, increasing the discounts drug manufacturers cover for certain brand-name drugs in Medicare and addressing Medicare fraud,” it states.

A Harris administration would also “crack down on pharmaceutical benefit managers (PBMs) to increase transparency, disclose more information on cost, and regulate other practices that raise prices” and “implement international tax reform” to pay for the changes.

Concerns about nursing home ownership and Vice President Kamala Harris' proposal to allow Medicare to cover home health care both reflect the political relevance of concerns that older Americans have, advocates say. (Getty Images)

Caregiving, especially for the elderly, is emerging as an important issue in the November election.

On the same day Democratic presidential candidate Kamala Harris rolled out a plan to extend Medicare coverage to include home care for the elderly, advocates held a press conference to discuss the results of a poll asking Wisconsin voters about their views on long-term care.

“I feel like the issue of long-term care in particular has been this kind of sleeping giant ready to be awoken,” said George Goehl, a community organizer with Addition Action, an advocacy group that focuses on small towns and rural communities around the country.

In Wisconsin, Addition Action has been working with community groups organizing to oppose the sale of county-owned nursing homes to private investors.

In Sauk County, a county home was recently sold to a corporation with several Milwaukee homes over the objections of local residents. In Lincoln County, the sale of a county home to a private investor was halted after community residents mustered widespread opposition.

The poll that Addition Action commissioned included a statewide sample of 400 people age 55 and older, as well as an oversample of 400 rural and small community residents.

Overall, 86% of those surveyed said long-term care costs, including nursing homes and assisted living, were unreasonable, including 57% who called those costs “very unreasonable.” Asked whether the government was doing enough to ensure access to quality, affordable long-term care, 68% said government should do more and 12% said it should do less, while 19% said the government was doing the right amount.

The survey participants gave a mixed assessment when considering private ownership and public ownership of nursing homes.

Public county-owned homes were trusted more by 16% while 35% trusted privately owned homes more. Both groups together, however, accounted for just over half of the survey group.

The remaining 49% were divided nearly equally between people who said they weren’t sure and people who said they trusted — or mistrusted — both kinds of owners equally.

But 64% of people in the survey opposed the sale of public, county-owned nursing homes to private companies, while 33% favored such sales — a margin of 2 to 1.

The survey results are largely bipartisan, according to the polling firm, Hart Research. Majorities of Republicans, independent voters and Democrats said they favored policies including high wages for long-term care workers, eviction protections for nursing home and assisted living residents, expanded access to Medicaid to enable more elderly to obtain long-term care and federal support for public nursing homes.

“Nursing homes are an important part of long-term care, but they are just one part of the care infrastructure we need,” said Judy Brey, who is part of a community campaign that opposed Sauk County’s sale of its public nursing home. Brey spoke on a Zoom call Tuesday to discuss the poll findings.

“This poll tells us that today, most seniors in rural communities like mine don’t believe there is enough affordable, quality long-term care, so the need for long-term care is only going to grow,” Brey said.

Also on the call was Dora Gorski, who has been part of a group in Lincoln County that successfully opposed the sale of a public home there a few years ago. “We know that more can be done to support seniors, especially since we’re growing in numbers in this community and throughout the United States,” Gorski said.

Majorities in the poll also told surveyors that they would view political candidates more favorably who have a plan “to protect public, county-owned nursing homes” from being sold to for-profit corporations.

According to Goehl, in three April 2024 county board elections board members in Sauk, Lincoln and Portage counties who had led efforts to sell county-owned homes to private firms were defeated by candidates opposed to such sales.

“This issue had stirred up a hornet’s nest,” Goehl said in an interview Tuesday.

The poll’s release came on the same day that Vice President Kamala Harris, campaigning for president, announced a proposal to allow the federal Medicare program to cover in-home health care.

Appearing on the television talk show The View, Harris said the expansion would be funded in part by savings that Medicare would receive as a result of negotiating prescription drug prices with pharmaceutical manufacturers.

Harris described the proposal as an effort to meet the needs of “the sandwich generation” — adults who bear the dual responsibilities of raising children and assisting aging parents who are no longer able to live on their own.

Currently, most people who cannot afford to pay for long-term care home services out of pocket can only get that covered through Medicaid — and then they have to divest themselves of most of their assets.

“They have to make themselves poor,” said Haeyoung Yoon, policy director at the National Domestic Workers Alliance (NDWA) a nonpartisan nonprofit for domestic workers including nannies, house cleaners, and home health workers that represents about 400,000 people across the country through local and state affiliate groups.

Home health workers are part of “the fastest- and largest growing occupation in our economy,” Yoon told the Wisconsin Examiner. “We’re going through the  graying of America — baby boomers are aging.”

Yoon said stronger public investment in care, including home health care, is needed so the work pays family-sustaining wages while being affordable to the general public. Currently the average annual wage in the field is less than $22,000 she said, and employees, if they have health care, are likely to be on Medicaid.

Yoon also is part of Care In Action — a separate organization that engages in political advocacy on behalf of the domestic workforce. Speaking in her role as a political advocate, she said the Harris proposal represented an important policy advance.

“It’s a historic and really big deal to say this is something that she wants to do when she’s elected,” Yoon said. 

The Democratic presidential nominee, Vice President Kamala Harris, on Tuesday announced a proposal on long-term care under Medicare focused on the “sandwich generation,” which refers to Americans who are caring for their children while also caring for aging parents. (Photo by Getty Images)

Vice President Kamala Harris unveiled a plan Tuesday that would strengthen Medicare coverage to include long-term care for seniors in their homes, tackling one of the biggest challenges in U.S. health care.

The Democratic presidential nominee revealed the proposal while on “The View” — one of several high-profile media appearances this week as she and the GOP presidential nominee, former President Donald Trump, sprint to the November finish line.

“There are so many people in our country who are right in the middle: They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said during the live interview. “We’re finding that so many are then having to leave their job, which means losing a source of income, not to mention the emotional stress.”

Harris is focusing on the “sandwich generation,” which refers to Americans who are caring for their children while also caring for aging parents.

Under the plan, Medicare — the nation’s health insurance program for people 65 and older and some under 65 with certain disabilities or conditions — would cover an at-home health benefit for those enrolled in the program, as well as hearing and vision benefits, according to her campaign in a Tuesday fact sheet.

Medicare for the most part now does not cover long-term care services like home health aides.

The benefits would be funded by “expanding Medicare drug price negotiations, increasing the discounts drug manufacturers cover for certain brand-name drugs in Medicare, and addressing Medicare fraud,” per her campaign.

Harris also plans to “crack down on pharmaceutical benefit managers (PBMs) to increase transparency, disclose more information on costs, and regulate other practices that raise prices,” according to her campaign, which said she will also “implement international tax reform.”

The campaign did not cite a price tag but noted similar plans have been estimated to cost $40 billion annually, “before considering ​​savings from avoiding hospitalizations and more expensive institutional care, or the additional revenues that would generate from more unpaid family caregivers going back to work if they need to.”

The proposal comes along with the nominee’s sweeping economic plan, part of which involves cutting taxes for more than 100 million Americans, including $6,000 in tax relief for new parents in the first year of their child’s life.

Trump responds

In response to the proposal, the Trump campaign said the former president “will always fight for America’s senior citizens — who have been left behind by Kamala Harris,” per a Tuesday news release.

The campaign also cited Medicare Advantage policies extended by the Centers for Medicare and Medicaid Services in Trump’s first term.

The campaign reiterated the 2024 GOP platform’s chapter on protecting seniors, saying Trump will “prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages, and supporting unpaid family caregivers through tax credits and reduced red tape.”

Harris and Howard Stern

While appearing live on “The Howard Stern Show” on Tuesday shortly after “The View,” Harris dubbed Trump an “unserious man,” saying the consequences of him serving another term are “brutally serious.”

She also again criticized Trump for nominating three of the five members to the U.S. Supreme Court who voted to overturn Roe v. Wade in June 2022 — a reversal that ended nearly half a century of the constitutional right to abortion.

“And it’s not about abortion, you have basically now a system that says you as an individual do not have the right to make a decision about your own body. The government has the right to make that decision for you,” she said.

Harris, who said she would appoint a Republican to her Cabinet if elected, was asked whether she would choose former Wyoming Rep. Liz Cheney.

Cheney was the vice chair of the U.S. House Jan. 6 committee tasked with investigating the 2021 attack on the U.S. Capitol.

Harris did not disclose a preference, but said Cheney is “smart,” “remarkable” and a “dedicated public servant.”

Cheney is among some prominent Republicans to endorse Harris. She campaigned with the veep in Ripon, Wisconsin — the birthplace of the Republican Party — just last week.

Trump talks with Ben Shapiro

Meanwhile, Trump said Harris is “grossly incompetent” during an interview that aired Tuesday on “The Ben Shapiro Show.”

“Biden was incompetent, she is equally incompetent and in a certain way, she’s more incompetent,” Trump told Shapiro, a conservative political commentator and co-founder of The Daily Wire, referring to President Joe Biden.

Trump also criticized Harris’ Monday interview on CBS News’ “60 Minutes,” saying the veep “answers questions like a child.”

“She’s answering questions in the most basic way and getting killed over it,” Trump added.

Look ahead for Harris, Trump campaigns

Harris was also set to also appear on CBS’ “The Late Show with Stephen Colbert” on Tuesday night. She will also appear at a Univision town hall in Las Vegas, Nevada, that airs Thursday.

Trump was slated to participate in a roundtable with Latino leaders and a Univision town hall on Tuesday in Miami, but both events were postponed due to Hurricane Milton.

Trump is set to give remarks Wednesday in Scranton, Pennsylvania. Later that day, he will continue campaigning in the Keystone State with a rally in Reading.

Wisconsin Watch partners with Gigafact to produce fact briefs — bite-sized fact checks of trending claims. Read our methodology to learn how we check claims.

No.

Former President Donald Trump has repeatedly said during his 2024 presidential campaign that he would not cut Medicare, which is health insurance mainly for people age 65 and over.

January 2023: “Under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security.”

March 2024: “I will never do anything that will jeopardize or hurt Social Security or Medicare.” That seemed to walk back comments Trump made a day earlier: “There is a lot you can do in terms of entitlements, in terms of cutting and in terms of also the theft and the bad management of entitlements.”

July 2024: Trump and the Republican Party in its platform pledged “no cuts” to Medicare.

The slash claim was made Aug. 19, 2024, by Wisconsin Lt. Gov. Sara Rodriguez at the Democratic National Convention.

A spokesperson cited news reports on Trump proposals as president to reduce Medicare spending.

This fact brief is responsive to conversations such as this one.

Sources

New York Times: Assessing Trump’s and Harris’s Attacks on Each Other

PolitiFact: Kamala Harris says Donald Trump ‘intends to cut’ Medicare. This ignores Trump’s repeated pledges.

Reuters: Trump warns U.S. House Republicans not to touch Social Security, Medicare

Breitbart: Donald Trump: ‘I Will Never Do Anything that Will Jeopardize or Hurt Social Security or Medicare’

Forbes: Trump Backtracks On ‘Cutting’ Social Security And Medicare—Vows He’ll Never ‘Hurt’ Programs

CNN: Trump suggests he’s open to cuts to Medicare and Social Security after attacking primary rivals over the issue

St. Cloud Times: Trump bashes Biden, Harris and promises to keep Social Security, Medicare at MN rally

Republican National Committee: ICYMI: RNC Platform Committee Adopts 2024 Republican Party Platform

PBS NewsHour: WATCH: Wisconsin Lt. Gov. Rodriguez speaks at 2024 Democratic National Convention | 2024 DNC Night 1

FactCheck.org: Competing Claims on Trump’s Budget and Seniors

Washington Post: GOP hopefuls’ past positions on Social Security loom over 2024 primary

Washington Post: The Daily 202: Trump budget highlights disconnect between populist rhetoric and plutocrat reality

Washington Post: No, every Trump budget did not seek to cut Social Security and Medicare

Is Donald Trump ‘threatening to slash Medicare’? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.