Republicans cannot meet their own budget target without cutting Medicare or Medicaid, budget office says

WASHINGTON — House Republicans cannot meet their own budget target that is necessary to pass President Donald Trump’s legislative agenda without making significant cuts to Medicare or Medicaid, the official budget scorekeeper confirmed on Wednesday.

House Republicans adopted a budget blueprint last week that opens the door to passing Trump’s policy priorities on immigration, energy and taxes. It instructs the House Energy and Commerce Committee to cut spending under its jurisdiction by $880 billion.

The Congressional Budget Office, a nonpartisan in-house think tank that referees the process, said that when setting aside Medicare, the total funding in the committee’s jurisdiction is $8.8 trillion over a 10-year period. Medicaid accounts for $8.2 trillion of that, or 93%.

When excluding Medicare and Medicaid, the committee oversees a total of $581 billion in spending — much less than the $880 billion target — the CBO said. The letter outlining those figures came in response to a query by Rep. Frank Pallone, D-N.J., the ranking member of the Energy and Commerce Committee, and Rep. Brendan Boyle, D-Pa. the ranking member of the Budget Committee.

That leaves Republicans in a deep predicament. The budget resolution, adopted by the slimmest of margins in the narrowly divided House, was the delicate product of negotiations between conservative hardliners who are demanding steep spending cuts and swing-district GOP lawmakers who say they don’t want to slash funding for the health programs that their constituents rely on.

Revising that target would mean upsetting one of those factions and potentially risking the support of key votes to pass the eventual budget reconciliation bill that advances Trump’s agenda.

Democrats have made the protection of Medicaid a centerpiece of their attack on the party-line GOP agenda, accusing Trump of trying to cut health care for the working class to pay for tax cuts for the wealthy. Rep. Al Green, D-Texas, was escorted out of the House chamber during Trump’s speech to Congress Tuesday night after repeatedly interrupting him and yelling, “You have no mandate to cut Medicaid!”

“This letter from CBO confirms what we’ve been saying all along: the math doesn’t work without devastating Medicaid cuts,” Pallone said Wednesday in a statement. “Republicans know their spin is a lie, and the truth is they have no problem taking health care away from millions of Americans so that the rich can get richer and pay less in taxes than they already do.” 

Trump recently said during an interview with Fox News, “Medicare, Medicaid — none of that stuff is going to be touched.”

Medicare provides health care to seniors. Medicaid extends health coverage to low-income and disabled Americans.

But House Republicans disagree with Trump and have put Medicaid on the chopping block. Speaker Mike Johnson, R-La., has said Medicaid is on the table for reining in spending.

“Medicaid is is hugely problematic because it has a lot of fraud, waste and abuse,” Johnson told reporters last week. “I think it’s $50 billion a year in fraud alone in Medicaid. Those are precious taxpayer dollars. Everybody is committed to preserving Medicare benefits for those who desperately need it and deserve it and qualify for it. What we’re talking about is rooting out the fraud, waste and abuse.”

When asked to back up that figure, Johnson’s office cited a statistic from the Centers for Medicare and Medicaid Services that the “improper payment rate” under Medicaid is $50.3 billion. But the report made clear the errors weren’t mostly a product of fraud.

“Of the 2023 Medicaid improper payments, 82% were the result of insufficient documentation,” CMS wrote in the 2023 report. “These payments typically involve situations where a state or provider missed an administrative step and do not necessarily indicate fraud or abuse.”

Trump didn’t mention Medicaid during his speech to a joint session of Congress on Tuesday.