called "impossible." Medicaid, Medicare, and Social Security, along with funding for the Affordable Care Act and Children's Health Insurance Program, account for nearly half of the federal budget on their own.

The Washington Post recently reported that a former Trump administration official had briefed lawmakers on a balanced-budget proposal that includes $2 trillion in cuts to Medicaid. A separate proposal from House Republicans last year would cut total federal Medicaid, CHIP, and ACA marketplace subsidy spending by nearly half over the next decade.

Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy's Center for Children and Families, wrote that the House proposal "would likely drive tens of millions into the ranks of the uninsured and severely reduce access to health care and long-term services and supports needed by low-income children, families, seniors, people with disabilities, and other adults."

"More than 1 in 4 Americans are currently covered through Medicaid or the CHIP, including children, pregnant people, people with disabilities, and people living on a lower income."

Because Medicaid is the largest source of federal funding for the states, dollars could also dry up for priorities like education, Park added. A longtime push by conservatives has been to trim Medicaid by adding eligibility restrictions like work requirements or more stringent verifications. Republicans tried to do that in the failed repeal of the ACA in 2017. The same plan included a bid to convert state Medicaid funding to a per capita allotment instead of the federal government matching a percentage of whatever a state spends.

Republicans could also push to rein in the Federal Medical Assistance Percentage that states get for Medicaid. Currently, that percentage match has been boosted under the public health emergency. And at least one top Republican has expressed interest in making changes to the way disabled people get home- and community-based care services that allow them to remain in their homes, said Yvette Fontenot, senior policy and legislative affairs adviser at the liberal-leaning Protect Our Care.

FonBrian Blase, a former Trump administration economic adviser who is now president of the Paragon Health Institute, told KHN he doubted Republicans would have much success going after Medicaid – especially ahead of next year's presidential election, when Democrats would be less likely to cave on any entitlements.

But he noted potentially promising discussions on Capitol Hill for some GOP goals – specifically, cutting Medicaid provider taxes or pushing new work requirements, an idea that some conservative Democrats like Sen. Joe Manchin of West Virginia have signaled they are open to.

Conservatives see the taxes, which states levy on Medicaid providers, as a backdoor way to boost what the federal government sends to states, since states use those taxes to fund their share of Medicaid funding under FMAP.

Blase pointed to reporting from the major budget showdowns in 2011 and 2013 as evidence that Biden, who was then vice president, might be open to cuts there.

"The fact that Biden is on record as calling them 'a scam' that should be eliminated, I think, makes it a little bit easier for congressional Republicans to argue that they should be on the table," he said.

The fight over government spending is nearing an inflection point. The nonpartisan Congressional Budget Office recently estimated the United States would hit the debt ceiling between July and September, meaning the Treasury Department’s ability to pay the nation’s bills and prevent defaulting on its debt could be exhausted as early as this summer without congressional action.

A recent NPR-PBS NewsHour-Marist poll showed that while a majority of voters support raising the debt ceiling, they are split on how lawmakers should address the nation’s debt. Nearly threequarters of Republicans and a majority of independent voters said Congress should cut programs and services rather than raise taxes and other revenue.

Though Republicans have yet to propose specific cuts, Democrats are betting that Medicaid and other entitlements will prove as difficult to target as Social Security and Medicare if voters understand the impact on many Americans’ lives.

“I think it’s going to be tough for Republicans right now,” Rep. Alexandria Ocasio-Cortez (D-N.Y.) told KHN. If the GOP wants to cut benefits for low-income families “in a time when eggs are expensive and a time when groceries and food have gotten quite expensive for everyday people, then they need to go in front of the public, in front of the American people, and make the case as to why they want to cut people’s ability to feed themselves and their children.”•

ABOUT THE AUTHOR:

Michael McAuliff covers Congress, the White House and national politics, currently as an independent reporter for the New York Daily News and other outlets including Kaiser Health News, The Daily Beast, Tarbell, and Now This.

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