The House of Representatives has passed a budget resolution that encapsulates the stark priorities of the current Republican majority: deep cuts to Medicaid and other social safety net programs, paired with $4.5 trillion in tax cuts that overwhelmingly benefit the wealthiest Americans.
This budget, which narrowly passed 217-215, is a blueprint for a profound reshaping of the federal government’s role in supporting low-income Americans, while simultaneously exacerbating the national debt.
Medicaid: A Lifeline Under Threat
Medicaid, the nation’s largest health insurance program, provides coverage to over 70 million Americans, including low-income families, seniors, and people with disabilities. It also funds nearly half of all births in the United States and supports long-term care for millions. Yet, the House budget directs the Energy and Commerce Committee to find $880 billion in savings over the next decade, a target that experts agree is impossible to meet without slashing Medicaid.
The proposed cuts would likely reduce federal funding for Medicaid expansion under the Affordable Care Act (ACA), which has extended coverage to over 21 million adults. States that expanded Medicaid under the ACA currently receive a 90% federal match for these enrollees. Reducing this share would force states to either shoulder the additional costs or roll back coverage, leaving millions uninsured. For states with “trigger laws” tied to federal funding levels, such as Montana and Illinois, Medicaid expansion could be reversed entirely.
The consequences of these cuts would be devastating. Hospitals, particularly in rural areas, rely heavily on Medicaid funding to stay afloat. Without it, many could face closure, further limiting access to care in underserved communities. For individuals like Jeannie Brown, a part-time bus driver in Montana who relies on Medicaid for essential surgeries and medications, these cuts could mean the difference between health and disability—or even life and death.
Tax Cuts for the Wealthy: Déjà Vu from 2017
At the heart of the House budget is a $4.5 trillion tax cut package, which extends and expands the 2017 Trump tax cuts. These cuts disproportionately benefit the wealthiest Americans and corporations. For example, the top 1% of earners would see the largest gains, while middle- and lower-income families would receive minimal relief. The budget also proposes eliminating taxes on tips and overtime pay, reducing corporate taxes for domestic manufacturers, and lowering taxes on Social Security benefits.
The cost of these tax cuts is staggering. Extending the 2017 tax cuts alone would add $4 trillion to the deficit over the next decade. Combined with the proposed spending cuts, the budget would still leave a significant shortfall, further ballooning the national debt. This contradiction—slashing programs for the poor while adding trillions to the deficit—highlights the ideological underpinnings of the budget: a commitment to shrinking the social safety net, regardless of fiscal consequences.
The Political Calculus
The budget’s passage was far from smooth. Moderate Republicans from swing districts, where Medicaid is a lifeline for many constituents, expressed deep reservations. Representatives like Don Bacon of Nebraska and Nicole Malliotakis of New York warned that slashing Medicaid could have dire consequences for their communities. Ultimately, however, most fell in line, swayed by party leadership and pressure from President Trump, who has made extending his tax cuts a cornerstone of his agenda.
Democrats, meanwhile, have seized on the budget as a potent political weapon. Representative Brendan Boyle, the top Democrat on the Budget Committee, called the cuts “an attack on middle-class families,” while Representative Pramila Jayapal accused Republicans of “gutting Medicaid to fund tax breaks for billionaires.” The parallels to the 2018 midterms, when Democrats successfully campaigned against Republican efforts to repeal the ACA, are striking.
A Budget That Reflects Values
Budgets are moral documents. They reveal the priorities and values of those who craft them. This budget makes clear that the current House majority prioritizes tax cuts for the wealthy over health care for the poor. It envisions a government that does less for those who need it most, while doing more for those who need it least.
The question now is whether this vision aligns with the values of the American people. Polls consistently show strong support for Medicaid and other safety net programs, as well as growing concern about income inequality. As the budget moves to the Senate, where Republicans are pursuing a narrower approach focused on border security and defense, the debate over these priorities will only intensify.
In the end, this budget is not just about numbers. It’s about who we are as a nation and who we choose to protect. For millions of Americans who depend on Medicaid, the stakes could not be higher.