Washington Post: GOP must cut Medicaid or Medicare to achieve budget goals, CBO finds

Republicans in Congress cannot reach their goal of cutting at least $1.5 trillion in spending over the next 10 years for President Donald Trump’s “big, beautiful bill” on taxes and immigration unless they cut Medicaid or Medicare benefits, lawmakers’ nonpartisan bookkeeper reported Wednesday.

Trump and the GOP are seeking to extend provisions of the president’s 2017 tax cut law — which would cost nearly $5 trillion — while also pushing hundreds of billions of dollars in new spending on border security, mass deportation campaigns and national defense investments. 

To do all that without sending the national debt soaring, Republicans are looking for spending cuts to pay for the new spending and lower tax rates. But Trump has said the GOP shouldn’t cut benefits for Social Security, Medicare or Medicaid. Those are the three largest social safety net programs, which together accounted for roughly $3.2 trillion of the country’s $6.75 trillion of total spending in the 2024 fiscal year.

More than 60 million Americans rely on each program for medical coverage, retirement security, unemployment due to disability and survivor benefits, and cutting benefits in any of them could be politically toxic.

But the House GOP’s budget, which passed last week in a hair-line vote, asks the committee responsible for federal health care spending to find at least $880 billion in savings over 10 years. And the Congressional Budget Office said Wednesday that reducing costs that much won’t be possible without cuts to Medicare, Medicaid or the Children’s Health Insurance Program.

Without those programs, funding within the Energy and Commerce Committee’s jurisdiction totals $381 billion, and of that amount, more than half is already paid for by collection programs or user fees. That means that even if the committee eliminates every program besides those safety net benefits, it would only be able to save a maximum of $135 billion — far less than the $880 billion the budget calls for.

“This analysis from the nonpartisan CBO confirms what we’ve been saying all along: Republicans are lying about their budget,” said Rep. Brendan Boyle (Pennsylvania), the top Democrat on the Budget Committee. His office requested the CBO report. “Their plan would force the largest Medicaid cuts in American history — all to pay for more tax giveaways to billionaires. This is a complete betrayal of the middle class, and Democrats will keep fighting to stop them.”

The budgets that the House and Senate each passed last month are the first step in a budget reconciliation package, a bill that Republicans can route through arcane procedures to get around a Democratic filibuster in the Senate and pass the legislation with a simple majority.

House Speaker Mike Johnson (R-Louisiana) has insisted that the measure would not cut safety net benefits, and that Congress can find savings simply by rooting out waste and fraud in the programs and adding new eligibility provisions, such as work requirements.

 In an interview with CNN late last month, Johnson said work requirements for Medicaid were “what everybody supports,” arguing that the program is not intended “for 29-year-old males sitting on their couches playing video games.”

“We’re going to find those guys, and we’re going to send them back to work,” he added.

Johnson also told NBC’s “Meet the Press” on Sunday that Republicans have broad support for addressing “fraud” and “inefficiencies” in the social safety net programs.

“That’s what we’re talking about. Ensuring efficiencies, ensuring that the programs are strengthened so that they can remain solvent and help the people they’re intended to help,” he said.

 But eliminating fraud and adding new work requirements will likely fall well short of the GOP’s budget goals, according to the programs’ financial reports and nonpartisan projections, provoking anxiety among some lawmakers who represent large numbers of people who rely on the low-income health insurance program that Medicaid cuts are on the horizon.

The House GOP’s Congressional Hispanic Conference wrote to Johnson last month with concerns over potential cuts to Medicaid, which would be necessary to achieve the goals outlined in the lower chamber’s budget resolution.

“As we consider reconciliation cuts, we must be strategic,” the group wrote. “We need to uphold fiscal responsibility while ensuring that essential programs — programs that have empowered Americans to succeed — are not caught in the crossfire.”