MÁS ALLÁ DE LOS NÚMEROS
Much at Stake for People and Communities in Looming Federal Policy Debates
News reports that House Republicans are considering a set of potential cuts totaling $5 trillion over the next decade, including deep cuts in health care and food assistance, are just the latest sign of the high stakes in the coming debates in Congress. As the breadth of cuts under consideration makes clear, the decisions policymakers make this year will affect tens of millions of people — including their access to health coverage and their ability to afford food and other basic necessities — as well as the nation’s investments in people, communities, and the economy.
Those cuts would impact people from all backgrounds and all corners of the country, including children, adults, seniors, and people with disabilities. They would be used to offset the enormous price tag of Republican tax cuts, which are skewed toward wealthy households and profitable businesses.
My new paper lays out the stakes if the extreme proposals in the newly circulating House Republican list as well as previous Republican budget plans, the Heritage Foundation’s Project 2025, and past Trump Administration budgets are enacted. It then outlines an alternative, evidence-based approach that would reduce poverty and hardship and expand opportunity.
Recent Republican budget plans and the newly circulating list of potential cuts House Republicans are considering call for trillions of dollars of cuts to a wide range of domestic programs, alongside trillions of dollars in new or extended tax cuts tilted toward high-income households and profitable corporations. If even some of these proposals are enacted, more families will struggle to pay their bills and afford groceries; more children will live in poverty; more families will face eviction and homelessness; fewer people will have access to lifesaving health care and coverage, and care will cost more; and families will pay more for basic goods due to Trump-imposed tariffs — even as high-income households grow wealthier through expensive tax cuts heavily skewed toward them.
Take health care for example. Some Republican plans proposals would end the Affordable Care Act’s (ACA) Medicaid expansion, which covers some 20 million people, or make it so costly for states that many would drop the expansion. Other proposals would put health coverage at risk for millions by taking coverage away from people who can’t meet red-tape-laden work reporting requirements, artificially capping Medicaid funding to states below need, and shifting other costs onto states, making it likely that many or all states would reduce costs by taking away coverage and reducing benefits.
At the same time, Republican budget plans would let recent improvements to premium tax credits that have made private marketplace health coverage much more affordable for moderate- and middle-income families expire at year’s end. This would cause premiums to spike for nearly all of the roughly 23 million enrollees and lead some 4 million people to become uninsured.
The cuts would go far beyond health coverage. The proposals call for massive cuts in food assistance, taking all assistance away from some people and cutting the level of benefits for millions more. And they call for massive cuts in non-defense discretionary program funding — the part of the budget that funds housing, schools, roads, ports, mass transit, scientific and medical research, child care, disease monitoring and response to public health crises, housing, anti-fraud staff in Medicare, college aid, IRS customer service and tax enforcement, and environmental clean-up and enforcement.
The harm from the Republican proposals wouldn’t be limited to people who have very low incomes or are out of work. Some 100 million people have health coverage through Medicaid, the ACA marketplaces, or the Children’s Health Insurance Program; 40 million people get help buying groceries through SNAP; and 28 million children go to schools that get federal Title I education funding.
While Republicans campaigned in 2024 on the promise that they would make it easier for families to make ends meet, their proposals would do just the opposite: raise costs for basics such as health care, food, and housing; take away people’s health coverage; and weaken core public services that serve their communities.
Major policy decisions could occur starting early this year. Congressional Republicans are expected to use the fast-track budget reconciliation process, under which legislation cannot be filibustered in the Senate and so requires only a majority vote to pass, to enact key legislative changes. Also, President-elect Trump is expected to issue a series of executive orders upon taking office, as he did in his first term. He could use executive actions to try to undermine the ACA, harm immigrants and their families through a new iteration of the punitive “public charge” rule issued in his first term as well as broader immigration and deportation efforts, restrict access to food assistance through SNAP, and restrict reproductive or gender-affirming health care, among other changes.
Alternatives to these extreme policies are available, however. Policymakers could, for example, better support children and families and dramatically reduce child poverty by expanding the Child Tax Credit, especially for the roughly 17 million children who don’t receive the full credit today because their families’ incomes are too low. This group includes more than 4 in 10 of the nation’s Black children, more than 1 in 3 Latino and American Indian and Alaska Native children, roughly 1 in 6 white children, and 1 in 7 Asian American children.
Policymakers also can invest more in helping families with rent and child care — two high-cost expenses many families struggle to afford and where annual appropriations now serve only a small fraction of those eligible. And they can make health coverage more accessible and affordable, such as by permanently extending the premium tax credit improvements and closing the “Medicaid coverage gap” affecting 1.6 million adults in states that haven’t adopted the ACA Medicaid expansion.
These programs and policies have substantial track records and strong evidence of success. Research shows that investing in Medicaid and health coverage improves health outcomes and saves lives for children and adults alike. Research also shows that investing in rental assistance reduces homelessness and eviction and stabilizes children’s schooling. And studies find that helping families afford the basics through food assistance and income supports like the Child Tax Credit can have long-term benefits for children in areas ranging from health and school performance to future earnings.
Steps like these would enable us to make progress toward ensuring that everyone has the resources they need to thrive and to build the lives they want for themselves and their families.
