End Notes
[1] This report’s authors: Sharon Parrott, Allison Orris, Claire Heyison, Sarah Lueck, Katie Bergh, Dorothy Rosenbaum, Joseph Llobrera, Catlin Nchako, Sonya Acosta, Will Fischer, David Reich, Richard Kogan, Samantha Jacoby, Chuck Marr, and Shelby Gonzales.
[2] See pp. 96 and 176 of Republican Study Committee, “Fiscal Sanity to Save America: Republican Study Committee FY 2025 Budget Proposal” (hereinafter RSC budget proposal), March 20, 2024, https://hern.house.gov/uploadedfiles/final_budget_including_letter_word_doc-final_as_of_march_25.pdf. For a detailed analysis of the agendas’ health proposals, see Allison Orris and Claire Heyison, “Republican Health Coverage Proposals Would Increase Number of Uninsured, Raise People’s Costs,” CBPP, September 3, 2024, https://www.cbpp.org/research/health/republican-health-coverage-proposals-would-increase-number-of-uninsured-raise.
[3] See pp. 11 and 44-45 of House of Representatives Committee on the Budget, “Concurrent Resolution on the Budget — Fiscal Year 2025, Report to Accompany H. Con. Res. 117” (hereinafter HBC report), report 118-568, June 27, 2024, https://www.congress.gov/congressional-report/118th-congress/house-report/568/1?outputFormat=pdf&s=1&r=4&q=%7B%22search%22%3A%22HCR+117%22%7D. CBPP calculations relative to Congressional Budget Office’s (CBO) February 2024 baseline, available at CBO, “The Budget and Economic Outlook: 2024-2034,” February 7, 2024, https://www.cbo.gov/publication/59710.
[4] See p. 42 of the RSC budget proposal.
[5] Heritage Foundation, “Mandate for Leadership” (hereinafter Project 2025), 2023, https://static.project2025.org/2025_MandateForLeadership_FULL.pdf, pp. 300-301; 118th Congress, Second Session, “H. Con. Res. 117 [Report No. 118–568]” (hereinafter HBC budget proposal), Section 412, June 27, 2024, https://www.congress.gov/118/bills/hconres117/BILLS-118hconres117rh.pdf.
[6] As with SNAP, the grocery benefits are distributed through a debit-style, electronic benefit transfer (EBT) card. For the proposal see pp. 303 of Project 2025.
[7] See pp. 11 and 52-53 of the HBC report. CBPP calculations are relative to CBO’s February 2024 baseline, and take into account that some of the total savings in the income security category reflect cuts to civil service retirement, which is another program the HBC report targets.
[8] The climate provisions in the Inflation Reduction Act are primarily in the form of tax credits.
[9] See p. 29 of the RSC budget proposal and pp. 71-72 of the HBC report.
[10] CBPP estimates based on CBO estimates. See Congressional Budget Office, “Budgetary Outcomes Under Alternative Assumptions About Spending and Revenues,” May 8, 2024, https://www.cbo.gov/publication/60114. We use the ten-year period 2026-2035 because extending the Trump tax cuts would reduce tax liability starting in 2026. And in 2025, when Congress will debate how to handle the scheduled expirations, it will be looking at the 2026-2035 ten-year budget window.
[11] Committee for a Responsible Federal Budget, “TCJA Extension Could Add $4 to $5 Trillion to Deficits,” June 13, 2024, https://www.crfb.org/blogs/tcja-extension-could-add-4-5-trillion-deficits#appendix.
[12] See Section 302 of the HBC budget proposal.
[13] See pp. 145 and 680 of Project 2025, pp. 84-85 of the RSC budget proposal, and pp. 52-53 of the HBC report.
[14] See pp. 11 and 44-45 of the HBC report. CBPP calculations relative to CBO’s February 2024 baseline. While the cuts could also affect CHIP and ACA marketplace coverage, the accompanying report discusses cuts only to Medicaid.
[15] See pp. 96 and 176 of the RSC budget proposal.
[16] CBPP analysis of 2013 and 2022 American Community Survey data. The American Indian and Alaska Native (AIAN) category includes people who may be AIAN alone or in combination with other races and ethnicities. The Latino category includes people of any race. The Black and white categories include only people who identify as a single race and not Latino. (The use of “Latino” does not necessarily reflect how everyone who is part of this community would describe themselves. Elsewhere in this report we also use “Hispanic,” and “Latine” for gender inclusivity.)
[17] See p. 45 of the HBC report, pp. 95-96 of the RSC budget proposal, and p. 466 of Project 2025. For analysis of prior attempts to cap and block-grant Medicaid, see Aviva Aron-Dine, “Medicaid ‘Block Grant’ Guidance Will Likely Encourage States to Undermine Coverage,” CBPP, January 29, 2020, https://www.cbpp.org/blog/medicaid-block-grant-guidance-will-likely-encourage-states-to-undermine-coverage; and Gideon Lukens and Allison Orris, “Changing Medicaid’s Funding Structure to a Per Capita Cap Would Shift Costs to States, Force Deep Cuts, and Leave Millions Uninsured,” CBPP, March 27, 2023, https://www.cbpp.org/research/health/changing-medicaids-funding-structure-to-a-per-capita-cap-would-shift-costs-to.
[18] See p. 45 of the HBC report, p. 96 of the RSC budget proposal, and pp. 467-469 of Project 2025.
[19] See p. 96 of the RSC budget proposal and p. 467 of Project 2025.
[20] See p. 45 of the HBC report, pp. 466-467 of Project 2025, and pp. 95-96 of the RSC budget proposal.
[21] Laura Harker, “Pain But No Gain: Arkansas’ Failed Medicaid Work-Reporting Requirements Should Not Be a Model,” CBPP, August 8, 2023, https://www.cbpp.org/research/health/pain-but-no-gain-arkansas-failed-medicaid-work-reporting-requirements-should-not-be; Laura Harker, “6 Months Into Georgia Pathways Program, Over 400,000 People Still Lack Health Coverage; Expanding Medicaid Would Improve Access for Low-Income Georgians,” CBPP, January 25, 2024, https://www.cbpp.org/blog/6-months-into-georgia-pathways-program-over-400000-people-still-lack-health-coverage-expanding.
[22] See p. 45 of the HBC report, pp. 38 and 96 of the RSC budget proposal, and pp. 468-469 of Project 2025.
[23] See p. 468 of Project 2025.
[24] See pp. 95-96 of the RSC budget proposal and pp. 468-469 of Project 2025.
[25] See p. 4 of the HBC report and pp. 87-88 of the RSC budget proposal.
[26] Jared Ortaleza et al., “Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?” KFF, July 26, 2024, https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/.
[27] See pp. 87-88 of the RSC budget proposal.
[28] See pp. 469-470 of Project 2025.
[29] The Heritage Foundation paper, and the Health Policy Consensus Group proposal it cites, propose converting the PTC into state block grants. These grants would be based on current subsidy levels. While the proposal does not specify how block grants would be adjusted over time, prior repeal plans set adjustments to increase funding cuts year over year. States would not be obligated to accept block grant funding and could instead choose to provide no or limited premium assistance for individual market coverage. See Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation, November 2, 2021, https://www.heritage.org/sites/default/files/2021-11/BG3668.pdf.
[30] U.S. Department of Health and Human Services, “Health Insurance Marketplaces: 10 Years of Affordable Private Plan Options,” March 22, 2024, https://aspe.hhs.gov/sites/default/files/documents/00d1eccb776ac4abde9979aa793e2c7a/aspe-10-years-of-marketplace.pdf; Ortaleza et al.
[31] See p. 4 of the HBC report and pp. 87-88 of the RSC budget proposal.
[32] Estimate is based on age-adjusted 2024 average benchmark premiums and 2023 poverty guidelines, which are used to determine premium tax credits for 2024 marketplace coverage. Gideon Lukens, “Health Insurance Costs Will Rise Steeply if Premium Tax Credit Improvements Expire,” CBPP, June 4, 2024, https://www.cbpp.org/research/health/health-insurance-costs-will-rise-steeply-if-premium-tax-credit-improvements-expire.
[33] Jessica Banthin, Michael Simpson, and Mohammed Akel, “The Impact of Enhanced Premium Tax Credits on Coverage by Race and Ethnicity,” Urban Institute, August 12, 2024, https://www.urban.org/research/publication/impact-enhanced-premium-tax-credits-coverage-race-and-ethnicity.
[34] The RSC proposal “adopts regulatory reforms developed by the RSC’s Health Care Task Force . . . and set forth in its report: A Framework for Personalized, Affordable Care. Republican Study Committee.” This report proposes eliminating the PTC and rolling back the ACA’s Medicaid expansion, and repurposing those funds for state “guaranteed coverage pools.” See p. 89 of the RSC budget proposal.
[35] KFF, “Health Insurance Marketplace Calculator,” updated October 27, 2023, https://www.kff.org/interactive/subsidy-calculator/.
[36] See pp. 89-90 of the RSC budget proposal.
[37] See p. 90 of the RSC budget proposal.
[38] Edwin Park, “Trump, House GOP High-Risk Pool Proposals a Failed Approach,” CBPP, November 17, 2016, https://www.cbpp.org/blog/trump-house-gop-high-risk-pool-proposals-a-failed-approach.
[39] See pp. 469-470 of Project 2025.
[40] Nambi Ndugga, Latoya Hill, and Samantha Artiga, “Key Data on Health and Health Care by Race and Ethnicity,” KFF, June 11, 2023, https://www.kff.org/key-data-on-health-and-health-care-by-race-and-ethnicity.
[41] See pp. 91-92 of the RSC budget proposal and pp. 468 and 470 of Project 2025.
[42] Sarah Lueck, “Commentary: Growing Evidence Shows Need for Stronger Rules for Short-Term Health Plans,” CBPP, October 23, 2020, https://www.cbpp.org/research/health/commentary-growing-evidence-shows-need-for-stronger-rules-for-short-term-health.
[43] See pp. 475 and 495-496 of Project 2025.
[44] See p. 12 of the HBC report.
[45] See pp. 11 and 52-53 of the HBC report. CBPP calculations are relative to CBO’s February 2024 baseline, and take into account that some of the total savings in the income security category reflect cuts to civil service retirement, which is another program the HBC report targets.
[46] Lauren Hall, “Food Insecurity Increased in 2022, With Severe Impact on Households With Children and Ongoing Racial Disparities,” CBPP, October 26, 2023, https://www.cbpp.org/blog/food-insecurity-increased-in-2022-with-severe-impact-on-households-with-children-and-ongoing.
[47] Laura Samuel et al., “Supplemental Nutrition Assistance Program Access and Racial Disparities in Food Insecurity,” JAMA Network Open, Vol. 6, No. 6, June 2023, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.20196; Benjamin Glasner et al., “The Effectiveness of the Food Stamp Program at Reducing Differences in the Intergenerational Persistence of Poverty,” Washington Center for Equitable Growth, May 2023, https://equitablegrowth.org/wp-content/uploads/2023/05/053023-WP-The-Effectiveness-of-the-Food-Stamp-Program-at-Reducing-Racial-Differences-in-the-Intergenerational-Persistence-of-Poverty.pdf; Alfonso Flores-Lagunes et al., “Moving Policies toward Racial and Ethnic Equality: The Case of the Supplemental Nutrition Assistance Program,” American Journal of Agricultural Economics, Vol. 106, No. 2, May 2023, https://doi.org/10.1111/ajae.12402.
[48] See p. 42 of the RSC budget proposal.
[49] Joseph Llobrera, “Recent Increase in SNAP Purchasing Power Invests in Children’s Health and Well-Being,” CBPP, August 29, 2022, https://www.cbpp.org/research/food-assistance/recent-increase-in-snap-purchasing-power-invests-in-childrens-health-and; Laura Wheaton and Danielle Kwon, “Effect of the Reevaluated Thrifty Food Plan and Emergency Allotments on Supplemental Nutrition Assistance Program Benefits and Poverty,” Urban Institute, August 1, 2022, https://www.urban.org/research/publication/effect-reevaluated-thrifty-food-plan-and-emergency-allotments-supplemental.
[50] See pp. 300-301 of Project 2025 and Section 412 of the HBC budget proposal.
[51] Under the Fiscal Responsibility Act, 53- and 54-year-olds will become newly subject to this work requirement beginning October 1, 2024. See pp. 41-42 of the RSC budget proposal and pp. 299-300 of Project 2025.
[52] Joseph Llobrera, “Most Working-Age SNAP Participants Work But Job Instability Overstates Joblessness in Some Analyses,” CBPP, May 19, 2023, https://www.cbpp.org/blog/most-working-age-snap-participants-work-but-job-instability-overstates-joblessness-in-some.
[53] Tori Coan and Shawn Fremstad, “The Dismal Economics of SNAP’s Work-Hours Test and Time Limit,” Center for Economic and Policy Research, April 18, 2023, https://cepr.net/report/the-dismal-economics-of-snaps-work-hours-test-and-time-limit/.
[54] See p. 52 of the HBC report.
[55] See pp. 42-43 of the RSC budget proposal and p. 300 of Project 2025.
[56] Project 2025 proposes providing summer meals to children in low-income families only if they are taking summer-school classes, which would substantially cut the Summer Food Service Program (which provides meals) and could mean eliminating the Summer EBT program (which provides grocery benefits to enable low-income households with children to purchase food). See p. 303 of Project 2025.
[57] Mark Nord and Kathleen Romig, “Hunger in the Summer: Seasonal food insecurity and the National School Lunch and Summer Food Service programs,” Journal of Children and Poverty, Vol. 12, No. 2, 2006, pp. 141-158, https://doi.org/10.1080/10796120600879582; Jin Huang, Ellen Barnidge, and Youngmi Kim, “Children Receiving Free or Reduced-Price School Lunch Have Higher Food Insufficiency Rates in Summer,” Journal of Nutrition, Vol. 145, No. 9, September 2015, pp. 2161-68, https://doi.org/10.3945/jn.115.214486.
[58] Allyson Pérez and Crystal FitzSimons, “Community Eligibility: The Key to Hunger-Free Schools, School Year 2022-2023,” Food Research and Action Center, May 2023, https://frac.org/wp-content/uploads/cep-report-2023.pdf.
[59] See p. 303 of Project 2025 and p. 46 of the RSC budget proposal.
[60] U.S. Department of Health and Human Services, “Head Start Program Facts: Fiscal Year 2022,” https://eclkc.ohs.acf.hhs.gov/data-ongoing-monitoring/article/head-start-program-facts-fiscal-year-2022.
[61] Ibid.
[62] Social Security Administration, “SSI Recipients by State and County, 2022,” https://www.ssa.gov/policy/docs/statcomps/ssi_sc/2022/table01.html.
[63] RSC budget, p. 45.
[64] Project 2025, p. 509.
[65] Project 2025, p. 509, and RSC, p. 171.
[66] Another proposal, from the conservative Paragon Institute, would not only reduce the enhanced matching rate for the Medicaid expansion but also shift costs to some states by dropping the current Medicaid matching rate floor from 50 percent to 40 percent. The institute justifies its proposal by arguing that its policies would reorient spending in support of traditional populations, such as children and people with disabilities, but the proposal fails to acknowledge deep cuts states could make across their programs given the extreme cost shift to states they propose. Brian Blase and Drew Gonshorowski, “Medicaid Financing Reform: Stopping Discrimination Against the Most Vulnerable and Reducing Bias Favoring Wealthy States,” Paragon Health Institute, July 2024, https://paragoninstitute.org/medicaid/medicaid-financing-reform-stopping-discrimination-against-the-most-vulnerable-and-reducing-bias-favoring-wealthy-states/.
[67] See pp. 41-42 and 46 of the RSC budget proposal.
[68] The RSC proposal would shrink the federal government’s commitment to sharing in Medicaid costs in the 40 states and the District of Columbia that would otherwise have a standard Medicaid matching rate over 50 percent in fiscal year 2025. U.S. territories presumably would face a cut as well, since their matching rates now exceed 50 percent. KFF, “Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier,” FY 2025, https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
[69] Also see Jabari Cook et al., “House Appropriations Bills Take Steps to Use the Federal Budget as a Tool for Antiracism,” CBPP, February 23, 2022, https://www.cbpp.org/research/house-appropriations-bills-take-steps-to-use-the-federal-budget-as-a-tool-for-antiracism.
[70] While Project 2025 includes a number of proposals for non-defense discretionary programs, it did not provide overall estimates for this budget category (unlike the HBC and RSC plans, which included full budget estimates).
[71] Cuts are measured from CBO’s February 2024 baseline but with the discretionary levels adjusted to reflect final appropriations for 2024 and the level of agreed-on adjustments to the 2025 non-defense discretionary cap that accompanied the enactment of that cap, which adds $652 billion in outlays over the decade. See the appendix of Richard Kogan et al., “More Revenue Is Required to Meet the Nation’s Commitments, Needs, and Challenges,” CBPP, June 17, 2024, https://www.cbpp.org/research/federal-budget/more-revenue-is-required-to-meet-the-nations-commitments-needs-and.
[72] Project 2025, Chapter 11, “Department of Education,” pp. 319-362.
[73] RSC budget, pp. 164-5.
[74] RSC budget, p. 163.
[75] RSC budget, p. 146; HBC report, p. 60.
[76] RSC budget, p. 155.
[77] Project 2025, Chapter 13, “Environmental Protection Agency,” pp. 417-448, and HBC report, p. 30.
[78] RSC budget, pp. 149-151.
[79] RSC budget, pp. 169-170.
[80] Project 2025, p. 365.
[81] HBC report, p. 35.
[82] RSC budget, p. 17; HBC report, p. 67; and Project 2025, p. 365. Note that the climate provisions in the Inflation Reduction Act are not funded by appropriations, but rather are in the form of tax incentives and mandatory spending.
[83] RSC budget, pp. 170-71.
[84] RSC budget, p. 151.
[85] RSC budget, pp. 171-172.
[86] For example, Latino and Black households represented 24 percent of all households in 2019, but they represented 32 percent of the least wealthy 60 percent of households and less than 1 percent of the wealthiest 1 percent. University of California at Berkeley, “Study: Survey of Consumer Finances (SCF) Combined Extract Data 1989-2019,” https://sda.berkeley.edu/sdaweb/analysis/?dataset=scfcomb2019.
[87] White households in the highest-earning 1 percent receive 23.7 percent of the law’s total tax cuts, far more than the 13.8 percentage share that the bottom 60 percent of households of all races receive. Chye-Ching Huang and Roderick Taylor, “How the Federal Tax Code Can Better Advance Racial Equity,” CBPP, July 25, 2019, https://www.cbpp.org/research/federal-tax/how-the-federal-tax-code-can-better-advance-racial-equity.
[88] See pp. 71-72 of the HBC report.
[89] See Section 302 of HBC budget proposal.
[90] See pp. 29-33 of the RSC budget proposal.
[91] See Chye-Ching Huang and Kathleen Bryant, “Indexing Capital Gains for Inflation Would Worsen Fiscal Challenges, Give Another Tax Cut to the Top,” CBPP, September 6, 2018, https://www.cbpp.org/research/federal-tax/indexing-capital-gains-for-inflation-would-worsen-fiscal-challenges-give.
[92] Chuck Marr, Samantha Jacoby, and George Fenton, “The Pass-Through Deduction Is Skewed to the Rich, Costly, and Failed to Deliver on Its Promises,” CBPP, June 6, 2024, https://www.cbpp.org/research/federal-tax/the-pass-through-deduction-is-skewed-to-the-rich-costly-and-failed-to-deliver.
[93] See p. 696 of Project 2025.
[94] Brendan Duke, “Project 2025’s Tax Plan Would Raise Taxes on the Middle Class and Cut Taxes for the Wealthy,” Center for American Progress, August 27, 2024, https://www.americanprogress.org/article/project-2025s-tax-plan-would-raise-taxes-on-the-middle-class-and-cut-taxes-for-the-wealthy/.
[95] CBPP calculations based on CBO, “Increase the Corporate Income Tax Rate by 1 Percentage Point,” December 7, 2022, https://www.cbo.gov/budget-options/58701.
[96] See p. 698 of Project 2025.
[97] See p. 699 of Project 2025, p. 27 of the RSC budget proposal, and pp. 61 and 62 of the HBC report.
[98] Kayla Williams, “Tax Day Highlights IRS Progress and Need to Protect and Replenish Funding,” CBPP, April 10, 2024, https://www.cbpp.org/blog/tax-day-highlights-irs-progress-and-need-to-protect-and-replenish-funding.
[99] See pp. 87-88 of the RSC budget proposal, pp. 469-470 of Project 2025, and p. 4 of the HBC report.
[100] Congressional Budget Office, “An Update to the Budget and Economic Outlook: 2024 to 2034,” June 18, 2024, https://www.cbo.gov/publication/60039.
[101] Congressional Budget Office, “Effects of the Immigration Surge on the Federal Budget and the Economy,” July 2024, https://www.cbo.gov/system/files/2024-07/60165-Immigration.pdf.
[102] See p. 145 of Project 2025, pp. 84-85 of the RSC budget proposal, and p. 52 of the HBC report.
[103] Danilo Trisi, “Trump Administration’s Overbroad Public Charge Definition Could Deny Those Without Substantial Means a Chance to Come to or Stay in the U.S.,” CBPP, May 30, 2019, https://www.cbpp.org/research/poverty-and-inequality/trump-administrations-overbroad-public-charge-definition-could-deny.
[104] Hamutal Bernstein et al., “Amid Confusion over the Public Charge Rule, Immigrant Families Continued Avoiding Public Benefits in 2019,” Urban Institute, May 2020, https://www.urban.org/sites/default/files/publication/102221/amid-confusion-over-the-public-charge-rule-immigrant-families-continued-avoiding-public-benefits-in-2019_3.pdf.
[105] See p. 49 of the RSC budget proposal.
[106] Project 2025 also includes a range of harsh immigration policy measures, such as ending lawful immigration statuses for certain victims of trafficking and domestic violence, but those policies are beyond the scope of this analysis.