Sara Rosenbaum, Maddie Krips, Kay Johnson
March 2025
The House of Representatives and the Senate have passed very different FY 2025 budget resolutions. Each bill paves the way for Medicaid changes, but the measures differ significantly. The Senate calls for at least (i.e., “not less than”) $1 billion in Medicaid spending reductions over the 10-year budget window. By contrast, the House calls for at least (i.e., “not less than”) $880 billion over the same window. The Senate bill also authorizes the Budget Committee to adjust the targets for the purpose of “protecting the Medicaid program,” which may include “strengthening and improving” Medicaid (undefined) in a deficit-neutral fashion. The Senate measure thus effectively prioritizes protections for Medicaid over other potential policy aims to be achieved through the reconciliation process. The House bill, by contrast, calls for scaling back tax relief if the spending reduction targets are not met, thereby placing additional pressure on the $880 billion floor.
The House and Senate now must reconcile two extremely different measures before the reconciliation process actually proceeds, although it is unclear whether the House will proceed with a legislation to achieve reconciliation in advance of a final agreement (the House bill instructs the authorizing committees, in the case of Medicaid, Energy and Commerce) to report legislation by March 27th.
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