WHY I'M NOT FREAKING OUT ABOUT THE NEW BUDGET BILL (yet)

There has been a lot of talk about this and I have seen a lot of misinformation being spread, and I want to attempt to give some clarity and hopefully assuage some concerns, at least for the moment. Note I am far from an expert but I have read more about this than most, I think. (apologies for the long post)

First - let’s talk about what it is that actually passed. 

What just passed was a budget resolution for the next 10 years, 2025-2034. It only passed in the house, and it still has to pass in the Senate to actually "pass" pass, but let's just assume that it WILL pass.

OK - so what even IS a budget resolution? From this link, the budget resolution is:

• A blueprint, in the broadest terms, on what the federal government should both spend and take in in revenue the next fiscal year, tracked out over 5 or 10 years
• A document that limits discretionary spending with a top-line cap, known as the 302(a) allocation (although allocations have already been set forth in statute by the 2011 Budget Control Act)
• A statement of the party’s budget priorities
• A way to instruct committees of jurisdiction to work on changes in tax law or mandatory spending programs

OK - so it's primarily a "blueprint" on government spending - we will get more into that later.

For now let's focus on the second bullet point. While it does limit DISCRETIONARY spending, most of the big items like social security, medicare and medicaid are NOT discretionary. They are known as “mandatory” spending items (or, as Republicans often call them "entitlements"). 

This distinction is important because it means there is no hard cap on the amount they will cost every year. Their "budget" is not some predetermined number that could be "cut" by some amount, like 10%, in fact we don't even know what the final budget will be until the end of the year when everything is tallied up. What these programs cost is not set in stone, it is determined by things like eligibility; however many people are in the program, and then all the medical things they require throughout the year (check-ups, procedures, prescriptions, etc) - so at the end of the year they add everything up and whatever the final costs of the program are, that’s what it costs. This is why IMHO, calling it a "budget" is not accurate, and I would urge people NOT to think of it as a budget, because the government is on the hook for whatever it costs. They don't set a budget for it, they just pay the costs of it, whatever they end up being.

This is also why if you try searching for the Medicaid budget, you will only see actual numbers for previous years where we have already added it up and we know what the total was. For future years, there are PROJECTIONS about what the cost will be, but that's all they are - guesses based on things like expected eligibility and other factors. For the most part these guesses are usually pretty close, but obviously they can't know what all the final costs will be for a program like this beforehand, they can only know once the fiscal year is over and they add everything up. 

Understanding how these budgets work is important because people do not usually think about budgets like this, they think you pick some number and you put that money into an account and that's it, that's all you can spend, you can't go over that amount because there's literally no more money left once you exceed it. If you actually think about it for a second, medicaid can't work like that, because if it did you would have people going to the doctor and then being turned away because the budget was exceeded and there is no money left for people to get coverage. That would also lead to weird behaviors like people rushing to get all their procedures done at the beginning of each fiscal year so they could be sure there was "money in the budget" available for whatever they needed, but these sorts of things don't happen, because it doesn't work like that. The budget is not some pre-set amount that can't be exceeded, and again, it's really not a budget at all, so let's try not to think about it in those terms.

Anyways - now that we know what the budget resolution IS, let’s look at what the budget resolution is NOT: 

• It is NOT a law - the budget resolution itself is not legally binding (it doesn’t go to the president for his signature) - it is meant only as a blueprint for congressional action on budgetary matters
• It is NOT a detailed document - the resolution is a relatively short document and contains few details on what should be done with government programs, and to the extent there are specifics they are not binding anyway

(bold emphasis is mine)

This is why in some comments I have said this isn’t really a bill. Some articles online call it a bill, but it’s not a bill in the way that we usually think of bills in congress, because it doesn’t require the presidents' signature, and it doesn't become law. All it represents is their spending / reduction goals and priorities. If they fall short of their goals, oh well. They are not legally forced to implement the reductions set forth in the resolution. They are basically guidelines, that's it.

The second bullet point is also important - it’s not a detailed document. It does not specify anything about how these "cuts" will happen, it just sets the target goals and then it leaves the individual committees that oversee those items to come up with the details, which will then have to get passed into law later. So while it may say we aim to reduce spending by X amount over 10 years, it does not get into any specifics of HOW that will happen, and for the mandatory spending programs that don’t have pre-set budgets, this is important because they can’t just say “cut the budget by 10%” - that literally wouldn’t make sense because the budget is not predetermined. You can't cut a budget when the budget is theoretically unlimited. As I said before, it is really not a budget and we shouldn't think of it as such. It costs whatever it costs.

The only way to "cut" a program like this is to change the program in a way that you think will reduce costs. There are many ways they could do this - one is by changing the eligibility of the program so less people qualify for it. Another way is they could change how the government reimburses the states for each person. Another idea they have floated is "per capita" caps, which you can read more about here. The topic of Medicaid cuts has come up before, and there have been a lot of things written about what they might do to achieve these reductions - if you want to read about some of them, here is a good link - just remember these are all speculative, and we do not have any actual proposals on the table yet. At this point it's all conjecture, but you should take SOME comfort knowing that there are no current threats to IHSS, and it's entirely possible that they come up with stuff that does not impact IHSS at all. Remember, IHSS is run by the state - California controls how it works. Yes, it is partially funded by Medicaid, but the federal government doesn't dictate the rules around how IHSS runs or its existence. All that is decided by California. If they have less money to work with, then that COULD impact IHSS, but that is up to the state to decide, not the federal government.

The thing is, whatever plans or ideas they come up with for reducing costs, they can't just put it into effect without getting them passed into law, and that is going to be a tall order. They can't just say "well it was already approved in the budget resolution" - they have to put all these plans into their own bills and then get them passed into laws before anything actually happens. That's why all the attention on THIS budget resolution is IMHO, premature. It is one thing to pass a vague, non-binding budget goal that says "we will aim to reduce spending by $880B over 10 years" - since it's not legally binding, passing something like that is easy, cause there is no real commitment. It gets a lot more difficult when they actually start deciding on the tough decisions that represent voters losing coverage - that's when the politicians start pushing back and saying "I am on board with reductions, but NOT LIKE THIS". I know most people do not have a lot of faith in the current party that controls congress, but trust me, these people want to stay in power, and they do listen to their voters sometimes, and Republicans have a lot of voters on Medicaid. Getting this stuff passed will NOT be easy for them. That doesn't mean it won't happen, I'm just saying it's not a foregone conclusion, it will be a fight.

Here are some of the questions that people have been asking me about this:

Did this bill pass cuts to Medicaid???

No, it didn’t. In fact the bill doesn’t even mention Medicaid. I would actually recommend everyone read the bill - it's not very long and it's not that complicated, and you will only be a more informed citizen by actually reading it and trying to understand it. Here is a link to it: https://docs.house.gov/meetings/BU/BU00/20250213/117894/BILLS-119NAih.pdf

So why is everyone saying it is going to cut Medicaid?

Because of this part:

(4) COMMITTEE ON ENERGY AND COMMERCE

The Committee on Energy and Commerce shall submit changes in laws within its jurisdiction to reduce the deficit by not less than $880,000,000,000 for the period of fiscal years 2025 through 2034.

Note the way that is phrased - the committee on energy and commerce "shall submit changes in laws TO REDUCE THE DEFICIT BY NOT LESS THAN $880B FROM 2025-2034"

Like I have said before - this language is not itself a cut. What it says is they have a goal to REDUCE spending ("the deficit") by at least $880B over the course of 10 years. As for why the focus is on Medicaid when it wasn't explicitly mentioned, that's because of what the committee on energy and commerce has jurisdiction over. Basically, if you look at all the things they oversee, there's nothing else within their jurisdiction where that amount of reductions could even come from. Trump and Republicans have committed to not touch social security or Medicare, so that basically leaves Medicaid as the only thing left, but remember all the stuff I said previously - this isn't legally binding, they are not FORCED to come up with these reductions, it's a goal, but before anything REAL happens, they have to actually pass the laws that will change how Medicaid works in order to achieve these reductions, and that has not happened yet. That's the part that is going to be significantly harder to accomplish. Some republicans are already signaling their resistance to it.

How will this impact IHSS?

We don't know at this point, but it may not impact it at all. Now, I don't think people should be complacent here - I think everyone should still call their rep's and make sure you talk to them about opposing ANY cuts or changes to Medicaid, but the more informed and the more intelligent you are about this stuff and how the process works, the more effective you will be when talking to them (and they will probably be more likely to listen to you, I imagine). Just know that at the moment, there are no specific threats to IHSS. Even if they do make changes to medicaid, there is no guarantee that it will impact IHSS, which is why I am personally not freaking out at the moment. If changes happen to IHSS, it will happen at the state level, not the federal level.

What do you think will happen?

I really don't know. I think passing any cuts or changes to Medicaid is going to be pretty hard. There are already Republicans that are speaking out about it, and they don't have huge margins to work with. I do think they will pass tax cuts, but whether they can actually pay for them through other reductions like Medicaid cuts is another story. They could just end up adding them to the debt and say "screw fiscal responsibility" the way they have in the past. Or, as I have said, they may make some changes to Medicaid, but those changes may not impact IHSS. It's just too soon to know, but I know I feel a lot better about things living in California - that's for sure. 

Great! So I can stop worrying about all this entirely?

Uh, not exactly. Honestly, I have been on the fence about making this thread because while on the one hand I don't want people to freak out needlessly, I also don't think they should be complacent. You should be informed, educated, and diligent about this stuff. You need to stay engaged and keep following the news, because if they do start making proposals on cuts, that's when it will start getting more real for people, once we know specifically what they have in mind. For now, I would keep calling your rep's and telling them NOT to support any Medicaid cuts, and even if they do end up happening, how much you rely on IHSS and how important it is that it remains protected.

Actually, this is my biggest suggestion for anyone that has made it this far - if you are calling your state rep's, don't just tell them to oppose Medicaid cuts, tell them HOW IMPORTANT IHSS IS TO YOU AND YOUR FAMILY. Tell them to make sure they protect that, REGARDLESS of what happens with Medicaid.

I've said this before in this post, but even if Medicaid does get cut, it doesn't mean IHSS has to be affected - that will come down to the state and what they decide, so if you are calling your state rep's about Medicaid then you might as well also tell them how important IHSS is for you and your family, and how you want them to protect it at all costs, even if they can't save Medicaid because Republicans are in full control.