Dive Brief:

• Republicans won’t be able to meet their budget target without slashing Medicaid, according to a letter sent to lawmakers last week from the Congressional Budget Office. 
• The House passed a budget blueprint late last month that directs the Energy and Commerce Committee, which oversees healthcare programs like Medicare and Medicaid, to find $880 billion in cuts over the next decade.
• But spending under the committee’s purview only totals $381 billion excluding Medicaid, Medicare and the Children’s Health Insurance Program, according to the CBO. And about half of that total is paid for through collections and fees, leaving just $135 billion available for cuts.

Dive Insight: 

The budget resolution passed by House Republicans last month aims to cut government spending by at least $1.5 trillion over 10 years, offsetting President Donald Trump’s promised tax cuts as well as increases in defense funding and border security. 

The blueprint doesn’t specifically mention Medicaid, but Trump has previously vowed not to cut Medicare — leaving the safety-net insurance program, which alongside CHIP provides coverage for 80 million Americans, as a large target for cuts.

Lawmakers must cut Medicaid in order to meet Republicans’ budget goals, said Reps. Frank Pallone, D-N.J., and Brendan Boyle, D-Pa., who requested the analysis. 

“This letter from CBO confirms what we’ve been saying all along: the math doesn’t work without devastating Medicaid cuts,” Pallone said in a statement. “The reality is the only way Republicans can cut at least $880 billion within the Energy and Commerce Committee’s jurisdiction is by making deep, harmful cuts to Americans’ health care.”

Shrinking Medicaid could be a politically tricky decision for Republicans, given the popularity of the program among constituents as well as financial worries from states and hospitals. 

Some Republicans have raised concerns about cutting Medicaid spending. Last month, a group of House Republicans in districts with large Hispanic populations sent a letter to House Speaker Mike Johnson, R-La., arguing Medicaid cuts would hurt their constituents. Trump himself has given conflicting statements on whether the budget will target Medicaid cuts. 

Johnson said on CNN last month that lawmakers plan to find savings by rooting out “fraud, waste and abuse” and adding work requirements, which could limit eligibility in the safety-net insurance program. 

But Republicans are also considering reducing the amount paid for enrollees who receive coverage under the Affordable Care Act’s Medicaid expansion, Axios reported this week. That could serve as a significant financial hit to states, according to a report by the Urban Institute and Robert Wood Johnson Foundation.