House Republican leaders keep saying the budget plan they passed last week doesn’t envision big cuts to Medicaid.
The Congressional Budget Office doesn’t agree.
On Wednesday, the official scorekeeper for legislation issued an analysis showing that Republicans can’t possibly hit their budget targets without taking hundreds of billions of dollars out of government health programs.
And if Republicans are true to their word about not touching Medicare, the program for seniors and some people with disabilities, that means some of the reductions would have to come from Medicaid, the joint federal-state program that primarily serves low-income Americans, and CHIP, the program that targets lower- and middle-income children.
“This is an instruction to take health coverage away from people,” Bobby Kogan, a veteran Democratic budget analyst who is now at the Center for American Progress, told HuffPost.
The focus of the new CBO analysis is the part of the House budget that instructs one particular committee, Energy and Commerce, to find $880 billion in spending reductions over the next 10 years. The budget document says nothing about where the Committee should find those cuts, as Republican leaders have pointed out.
“Go do a word search of the budget resolution,” House Speaker Mike Johnson (R-La.) said Sunday. “There is not one mention of Medicare, Medicaid or Social Security. It’s not in the bill because we haven’t set the policy.”
Even President Donald Trump himself has said Republicans aren’t going to touch Medicaid.
But, like any congressional committee, Energy and Commerce has a clearly defined jurisdiction covering a limited set of government functions. That makes it possible to figure out where the cuts would have to be.
And that is precisely what CBO did.
At the request of Rep. Brendan Boyle (D-Pa.), the top Democrat on the House Budget Committee, and Rep. Frank Pallone (D-N.J.), the top Democrat on Energy and Commerce, CBO looked at all the programs that fall under the purview of Energy and Commerce, and determined that the only way to hit the $880 billion target is with hundreds of billions of dollars in cuts to federal health programs — mainly Medicare, Medicaid and CHIP, though Republicans have said Medicare is off the table.
“This analysis from the nonpartisan CBO confirms what we’ve been saying all along: Republicans are lying about their budget,” Boyle said in a statement. “Their plan would force the largest Medicaid cuts in American history — all to pay for more tax giveaways to billionaires.”
Democrats and their allies have been warning about this possibility since the 2024 campaign, arguing that Republican plans to cut taxes by trillions of dollars would require massive spending cuts, with many of those cuts likely to come from Medicaid.
It’s a politically potent argument, because Medicaid today covers medical bills for more than 70 million Americans. It pays for more than 40% of all births, and is the single-largest financier of nursing home care as well.
And past efforts to cut Medicaid, including ones that were part of Republican proposals to repeal the Affordable Care Act, proved highly unpopular.
“The CBO letter just confirms what we and others have been saying all along,” Edwin Park, a Georgetown University research professor who has been warning about GOP interest in Medicaid cuts, told HuffPost.
Republicans have sometimes clashed with their in-house budget experts. Rep. Morgan Griffith (R-Va.), a senior member of the Energy and Commerce Committee, has previously proposed eliminating a portion of the CBO’s staff. He said that when the CBO scored the proposal, they determined it would have no effect on the federal budget.
“If they think they have no value, why should I?” Griffith told HuffPost on Thursday.
As for Medicaid, Griffith allowed that the committee would seek reforms to the program, but that they could still find savings elsewhere, and that the conversation was premature anyway, since the Senate hasn’t yet adopted the House-approved budget.
“I think we’re going to do work requirements, but you know, there’s lots of things we can do that don’t impact the patient,” Griffith said. “There are thousands of things that we can take a look at and revamp If need be.”
Exactly what form cuts to Medicaid might take ― and what those cuts would mean for real people ― is an open question.
Insofar as Republican leaders have acknowledged an interest in cutting Medicaid, they have said they are interested merely in reducing waste, fraud and abuse — both in order to reduce federal spending generally, and to rein in a program that has grown substantially in the last few years.
But “waste, fraud and abuse” is a broad category that could include anything from going after “improper payments” and state financing gimmicks, to adding “work requirements” that would require beneficiaries to demonstrate that they are either employed or have good reason why they are not.
Curbing those improper payments and state financing schemes has been a bipartisan cause in the past, though getting rid of the wasteful spending without getting rid of the legitimate spending is difficult in the famously convoluted U.S. health care system. Many “improper” payments are simply instances of documentation error.
As for work requirements, most people on Medicaid are already working. Putting them through the bureaucratic process of verifying their status has, in past experiments, led to large numbers of eligible people losing their benefits ― with negative consequences for their medical and financial well-being. But Republicans might characterize such cutbacks as mere reductions in waste, fraud or abuse.
No cuts to Medicaid, or any other federal health plans, have taken place yet. The House and Senate still have to agree on a budget plan. Once they do, each chamber has to write tax and spending bills that fit within the budget outline, and come to agreement on those.
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Already some Republicans in the Senate have said cutting Medicaid would be a bad idea. Whether that’s enough to stop the cuts from becoming law — especially given the determination of some Republicans to offset their big tax cuts — remains to be seen.