WASHINGTON (AP) — As a presidential candidate, Donald Trump promised not to cut Social Security, Medicare, or Medicaid. Trump later went back on his Medicaid promise, and now he’s being criticized for steep Medicare payment cuts proposed in his new budget.

The budget calls for $845 billion in spending reductions to Medicare over 10 years, mainly by cutting future payments to hospitals and other service providers. Medicare now costs about $650 billion a year, and spending is expected to rise sharply as the baby boom generation goes into retirement.

House Speaker Nancy Pelosi told The Associated Press on Tuesday that the budget embodies long-standing Republican ambitions “to make Medicare wither on the vine.”

“After exploding the deficit with his GOP tax scam for the rich, President Trump is once again trying to ransack Medicare, Medicaid and the health care of seniors and families across America,” Pelosi said in a statement.

The White House says the budget doesn’t reflect benefit cuts to seniors but makes better use of taxpayers’ dollars and reduces spending by cutting prescription drug costs.

“He’s not cutting Medicare in this budget,” acting White House budget director Russell Vought told reporters on Monday. “What we are doing is putting forward reforms that lower drug prices, (and) that because Medicare pays a very large share of drug prices in this country, it has the impact of finding savings.

“We’re also finding waste, fraud, and abuse,” Vought added. “Medicare spending will go up every single year by healthy margins, and there are no structural changes for Medicare beneficiaries.”

However, the head of a major hospital association is pushing back, saying in a blog that “arbitrary and blunt” Medicare cuts would have a “devastating” impact on care for seniors.

“Hospitals are less and less able to cover the cost of care for Medicare patients; it is no time to gut Medicare,” says Chip Kahn of the Federation of American Hospitals.

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