Mike Johnson’s prize for victory on Trump’s budget? A fight over Medicaid

House Republicans go to war with math as they try to save hundreds of billions of dollars without scaling back critical health care coverage, writes John Bowden. House Speaker Mike Johnson pulled his caucus through a tight vote Tuesday as he fights to deliver on several of Donald Trump’s legislative priorities in one large bill.

As a reward, his party will now undergo a public battle over where to come up with hundreds of billions of dollars in spending cuts — much of which the GOP has claimed will come from Medicaid. With an ultra-slim majority in the House and only slightly better margins in the Senate, the Republican Party is entering politically fraught territory. Any cuts to a service that impacts roughly one in five Americans will be divisive, even just within the Republican caucuses.

During his Cabinet meeting on Wednesday, the president recognized this reality. He admonished reporters for even repeating such threats, which were first outlined in the Project 2025 plan authored by Russ Vought, his hire to head the Office of Management and Budget. Vought’s wide-ranging policy platform called on a second Trump administration to institute lifetime Medicaid benefit caps for individuals, as well as allowing states to put work requirements in place to access coverage.

Experts believe that the implementation of work requirements would kick millions of people with low-income jobs off of the program. It’s unclear whether it remains on the table after Trump and Johnson’s new guarantees that the program will not be “touched” by appropriators in Congress.

“I have said it so many times. You shouldn't be asking me that question ... We're not going to touch it,” Trump said of Medicaid cuts on Wednesday. Johnson was even clearer on CNN: “The White House has made a commitment. The president said over and over and over, ‘We’re not going to touch Social Security, Medicare or Medicaid.’” (But that apparently does not include work requirements, which Johnson intimated this week that he would like to see established).

He has little choice. Republicans in both chambers released a flurry of statements after the bill’s passage on Tuesday indicating opposition to Medicaid cuts — though Missouri Republican Senator Josh Hawley has claimed that work requirements would likely get unified GOP support.

In the wake of the budget framework’s passage, some Republicans shifted to the assertion that Elon Musk’s DOGE hunt for “waste, fraud and abuse” in programs including Medicaid, Medicare, and Social Security will be able to make up the bulk of the GOP’s $2.3 trillion funding hole.

“Republicans are lying,” House Minority Leader Hakeem Jeffries said at his weekly press conference Thursday. “Prove me wrong,” he added. “There’s nothing that we as House Democrats would like better than for the Republicans to prove us wrong — [and] that they are not planning to cut Medicaid.”.

Democrats are arguing that hypothetically eliminating the entirety of the committee’s remaining charges, excluding Medicaid, would not add up to the total savings called for in the budget framework. In the Senate, New York Democrat Kirsten Gillibrand added to The Independent on Thursday: “Literally, not possible. The budget that they just sent out to their committees, there's no other way to get the money to cut.”.

There's “nowhere else to get the money; that's their whole budget,” said the senator. “Yeah, so they're lying to the American people when they say they're not.”. Steve Scalise, the House Majority Leader, has argued in return that the “proof” that Democrats are lying stems from the lack of any language explicitly mentioning Medicaid cuts in the passed budget framework — which, as it’s described, is not the final bill.

The budget framework passed by the House does direct the Energy and Commerce Committee, which oversees Medicaid (and other programs), to identify that massive savings sum for the final bill. But the committee’s chair asserted to Politico: “Massive cuts in the [Medicaid] program just aren’t going to happen.”.

And so it’s still not apparent just where $880 billion in savings is going to come from. While the chair of the committee has looked to potentially eliminate state-level provider taxes as one way to reduce federal Medicaid spending, some say that will just force cuts to Medicaid benefits by individual states unable to make up the funding gap.

Mike Johnson and Donald Trump may have led the House over the first legislative hurdle of Congress’s budget battle. But it’s clear that the track is only going to get tougher ahead as DOGE’s cost-cutting dreams meet reality. Eric Garcia contributed reporting.