In theory, the budget, which kicks off the process of passing an extension of tax cuts enacted in 2017 and up to $2 trillion in spending cuts meant to partly offset them, could become law without significant cuts to Medicaid. But it won’t be easy.

The House budget bill that passed does not include specific policies, and targeted spending cuts are too big to achieve without cutting Medicaid.

Republicans must fight for every seat during the midterms to keep control of the chamber. And they can lose only one vote in the House and still pass their budget bill. House Republican leaders plan to use Medicaid cuts to pay for tax relief,