U.S. Senate Republicans voted last week, on a 51-48 party line vote, to pass a budget resolution to advance President Trump’s legislative agenda which includes increased spending for border security and defense spending, and extending the 2017 tax cuts that are set to expire this year. The Senate budget resolution, like the U.S. House budget reconciliation adopted last month, directs the Energy and Commerce Committee to reduce spending by at least $880 billion over the next ten years. The Energy and Commerce Committee has jurisdiction over the Medicaid program, putting Medicaid at serious risk of significant budget cuts as the budget process moves forward. While neither the Senate nor the House budget resolution bills specifically identify Medicaid changes, the House Budget Committee earlier this year released an options document that includes seven Medicaid proposals that cumulatively would cut federal spending by $2.3 trillion over ten years, including capping Medicaid funding on a per capita basis, reducing the federal matching rate which provides revenue to states, and restricting state use of provider taxes to finance state Medicaid costs.
The budget resolution phase serves as a blueprint to a final budget measure. It is mostly a procedural step toward final legislation and offers little detail about specific policy questions such as what the tax cuts will be or which programs, including potentially Medicaid, would be cut to finance new spending. The next stage in the budget process is for the Senate and House to reconcile differences between their two versions of the budget resolutions. Reaching agreement on the same budget resolution blueprint will allow Congress to move to the budget reconciliation stage, where final budget details will be defined and adopted, absent the threat of a Senate filibuster when a final vote is called.