Vice President Mike Pence was confronted by an emergency room doctor and health care advocate about the state of Medicare and Medicaid while at a campaign stop in Iowa on Thursday.
"I'm worried about plans they talked about last week of maybe cutting the Medicare and then the rollout today of cutting Medicaid. I work ... with one of the poorest counties in Michigan and my patients depend on expanded Medicaid. So how is that going to affect my patients?" Dr. Rob Davidson, the executive director of the advocacy group Committee to Protect Medicare, asked Pence.
Pence replied: "I haven't heard about cuts to Medicare."
"Cutting Medicaid, yeah, the head of (Centers for Medicare and Medicaid Services) announced the plan to let states file for waivers so they could get block grants. So that would essentially cut the amount of money going to the states. So it would cut federal Medicaid funding. Is that a good idea?" Davidson pressed.
Pence, in the diner, responded to Davidson by offering up his record as governor of Indiana, which expanded Medicaid to low-income adults under his watch through a waiver.
Davidson was referencing the Trump administration's new guidance to allow states to ask for a capped amount of federal financing for part of their programs in exchange for more local control.
The guidance permits states to apply for so-called block grants to cover certain low-income adults, particularly those who gained benefits under the Affordable Care Act's Medicaid expansion provision. Federal funding, which is now open-ended, would be capped, with states receiving either a lump sum or a specific amount per enrollee.
A coalition of 27 patient and consumer groups, including the American Heart Association, the Arthritis Foundation and the American Cancer Society Cancer Action Network, said the effort will hurt people with preexisting conditions.
Pence, who incorrectly described the waivers as intended for states that didn't expand Medicaid, was also asked whether the waiver plan was a good idea or a bad idea, and he told Davidson that he thought the doctor was "oversimplifying" the issue.
But Davidson contended that once people get Medicaid, they can get primary care doctors and stay out of the emergency room.
"They actually work more. They actually contributed to our community more," said Davidson.
Pence later added Medicaid has "a lot of problems" and that the issue isn't about "expansion" but rather "improvement" of the program.
"Reform and innovation in the setting of cuts equals less people with health care," said Davidson, who called Medicaid a "godsend" and a "lifeline" for his patients.
"I respectfully disagree," the vice president responded.
The exchange on video, which was posted online by Davidson and has been seen more than 2 million times on Twitter, took place in a booth at Drake Diner, a popular presidential campaign stop that's steps from the Drake University campus in Des Moines, Iowa, where Trump held a rally Thursday evening.
The confrontation was a rare sight for an official rarely exposed to criticism while in public thanks to the insulation of a heavy Secret Service detail and carefully curated events by White House staff.
During his Thursday rally in Iowa, Trump warned of the threat of Democrats making changes to entitlements.
"Today's Democrat Party is run by left-wing extremists who want to massively raise your taxes, increase regulations, cancel your health plans, raid Medicare, shut down American energy, destroy your Social Security -- they will destroy your Social Security -- eliminate religious liberty, punish free speech, confiscate your guns, abolish your borders and indoctrinate America's children with hateful left-wing ideology," Trump said.
But earlier this month he signaled that he's open to cutting federal entitlements, including Medicare, to reduce the federal deficit.
Asked by CNBC at the World Economic Forum in Davos, Switzerland, whether entitlements would ever be on his plate, Trump responded, "At some point they will be."
"We have tremendous growth. We're going to have tremendous growth. This next year I -- it'll be toward the end of the year. The growth is going to be incredible. And at the right time, we will take a look at that," he added.
Asked whether he was willing "to do some of the things that you said you wouldn't do in the past, though, in terms of Medicare," Trump said: "We're going to look."