Aside from xenophobic outlines for immigration and trade policy, the Trump-Vance campaign has been vague about the policy agenda they would pursue if elected. But we know that Trump embraced two longstanding conservative policy priorities—rolling back the Affordable Care Act (ACA) and cutting taxes for corporations—after taking office in 2017.
Trump just missed achieving the first goal—the ACA was saved by a single vote—but accomplished the second in what became a 42% effective tax cut for the largest and most profitable corporations. This history suggests that whatever candidate Trump says while campaigning, we should take seriously what his more policy-focused allies want, especially Project 2025 and members of the U.S. House Republican Study Committee (RSC).
The RSC represents 80% of House Republicans, including the entire leadership, and for years has detailed a consistent policy agenda in the form of an annual budget plan. A previous EPI Action brief detailed how the RSC budget plan would extend tax cuts for billionaires and corporations. This brief outlines the RSC budget plan’s deep and damaging cuts to popular social insurance programs. As discussed in greater detail below, the RSC budget plan:
- Cuts $1.5 trillion from Social Security retirement and disability benefits over a decade, including by increasing the normal retirement age.
- Cuts $4.5 trillion from Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act over a decade—essentially cutting these programs in half. This is roughly equal to the cost of renewing expiring provisions of the Trump tax cuts that overwhelmingly benefit the wealthy and corporations.
- Cuts $1.2 trillion from Medicare over a decade and eliminates Medicare’s guarantee of coverage, substituting instead “premium support” vouchers that seniors can use to shop on their own for health insurance.
- Cuts key public health programs in the National Institutes of Health and the Centers for Disease Control, doubling down on the disastrous Trump administration response to the COVID-19 pandemic and leaving the country more vulnerable to future pandemics.
Republicans want to cut $1.5 trillion from Social Security
The RSC budget plan would cut $1.5 trillion from Social Security retirement and disability benefits over 10 years by raising the normal retirement age to 69 or 70, among other cuts. Raising the normal retirement age is equivalent to a 14-19% benefit cut across the board.
Republicans claim that raising the normal retirement age is necessary because people are living longer. However, the normal retirement age has already increased from 65 to 67, and low earners who would be most affected by a further increase in the retirement age have seen little or no improvement in life expectancy.
Contrary to conventional wisdom, an increase in life expectancy isn’t the main driver of Social Security’s projected shortfall. The biggest challenge is a decline in birth rates, because slower population growth decreases the number of workers contributing to the system. Republican policies would exacerbate the problem of slow population growth by drastically curtailing immigration and opposing policies such as expanding the Child Tax Credit that make it easier for families to afford raising children.
The plan also includes reductions to retirement benefits that at first fall only on higher earners, but would gradually reduce benefits for most people.
The RSC models this plan on that of former Representative Sam Johnson (R-Texas), who helped revive the RSC and came up with a proposal that cut retirement benefits even more than would be needed to close Social Security’s projected shortfall. In the same vein, though the RSC claims to spare seniors from automatic benefit cuts that would happen if nothing were done to shore up the program’s finances, the plan ensures that the shortfall is addressed entirely through benefit cuts rather than revenue increases.
The RSC budget plan further suggests that Social Security’s cost-of-living adjustments are too high and eliminates spousal and dependent benefits for higher earners.
It might seem surprising that House Republicans want to cut Social Security benefits for higher earners, who tend to do well by Republican policies. But this is because cutting Social Security benefits—which currently max out around $46,000 per year for someone retiring at the normal age—would cost billionaires a lot less than popular alternative proposals to increase Social Security revenue by taxing some earnings above the taxable earnings cap, currently set at $168,600. (Most Democrats in the House and Senate as well as President Biden and Vice President Harris support taxing pay above $400,000.) In other words, by opposing revenue increases for Social Security, the RSC is throwing the upper middle class under the bus in favor of wealthy donors.
Gradually shrinking Social Security to a flattened benefit is part of Republicans’ anti-government agenda that aims to turn popular universal programs into bare-bones anti-poverty programs. Republicans sometimes describe such plans as “progressive” because they typically include modest benefit improvements for low-income households alongside far greater benefit reductions for everyone else. However, Republican lawmakers have long neglected anti-poverty programs—such as Supplemental Security Income (SSI)—so promises to prioritize poor households should be treated with skepticism. Not surprisingly, the RSC budget plan would convert SSI to a block grant and end guaranteed benefits for millions of low-income seniors and people with disabilities.
Unlike House Republicans, Trump claims he won’t cut Social Security benefits. However, he has no plan to raise revenue to close the program’s projected shortfall. Instead, Trump has called for exempting Social Security benefits from taxes for higher-income recipients, which would increase Social Security’s projected shortfall by 25%. And while both Trump and Harris have called for tipped income to be exempt from income taxes, only the Harris campaign has specified that this income would still be subject to payroll taxes that fund tipped workers’ Social Security benefits.
Republicans want to cut $5.7 trillion from Medicare, Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program
The tax cuts in the RSC budget plan would starve the government of funds and serve as an excuse to slash government programs that families rely on, especially those providing health benefits. The plan would eliminate Medicare’s coverage guarantee in favor of a “premium support” or voucher program, cutting Medicare funding by $1.2 trillion over a decade. It would slash funding for Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) marketplace subsidies by more than half—$4.5 trillion—over the next decade, which, perhaps not coincidentally, is roughly the cost of extending Trump’s tax cuts.
The RSC budget plan would convert federal support for Medicaid and CHIP into block grants that don’t increase with health cost inflation, an aging population, a public health emergency, or other factors. These draconian budget cuts would force these programs to restrict eligibility and increase participants’ out-of-pocket costs, causing millions of people to face higher costs, skip necessary treatment, or lose coverage entirely while severely straining state government budgets, since the RSC budget plan would also prevent states from taxing providers to help pay for their share of costs.
The RSC budget plan would scrap provisions in the Inflation Reduction Act that lower costs for Medicare beneficiaries, including a $35 monthly cap on insulin costs and a limit on how much beneficiaries spend on prescription drugs. Medicare’s ability to negotiate lower prescription drug prices, which is gradually being introduced, would also be revoked.
Because the RSC has become more guarded in an election year, it’s sometimes necessary to refer to earlier versions to unpack vague descriptions in this year’s plan. The version of the RSC budget plan released last year would require disability beneficiaries to wait five years before becoming eligible for Medicare benefits. An earlier version, released under the leadership of current House Speaker Mike Johnson, also called for aligning the Medicare eligibility age with the normal retirement age for Social Security, which it would also raise to age 69 or 70.
In addition to gutting health insurance programs, the RSC budget plan would harm medical research and emergency preparedness by eliminating funding for the World Health Organization and reducing funding for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC).
Republican health policies shift costs to patients and increase corporate profits
Poorer states would be hardest hit by the cuts outlined in the RSC budget plan since they are more reliant on federal funds to fund health care programs. However, Americans all over the country— especially those with preexisting conditions that are expensive to treat—would be hurt by proposed cuts to health care programs. The RSC budget plan would give states the authority to determine the extent to which insurance companies could “incorporate the health risks of individuals into premiums,” which would raise costs for people with preexisting conditions.
The RSC budget plan falsely claims that cuts to health care programs are necessary because the Affordable Care Act “dramatically escalated the unsustainable rise in American health care spending.” In fact, the opposite is true. Health care spending as a share of the economy leveled off after the ACA was enacted in 2010, even as the program almost halved the share of people lacking health insurance. Gutting government health programs would increase health cost inflation because these programs are better at restraining costs than private insurers with less negotiating power.
The policies in the RSC budget plan aren’t aimed at increasing the efficiency or effectiveness of our health care system, but rather at increasing the profits of insurance companies, pharmaceutical firms, and for-profit health care providers at the expense of patients. Government spending would decrease only because Americans would pay more out of their own pockets or skip needed treatments.
Among other policies designed to enrich for-profit providers, the RSC budget plan would make privatized Medicare plans the default providers, even though these plans cost taxpayers 22% more to cover people with similar health care needs despite requiring pre-approval for many treatments and offering limited provider networks.
The RSC and Project 2025 plans should be taken seriously
The RSC budget plan to gut health programs is closely aligned with Project 2025. These shouldn’t be dismissed as idle threats. The Republican Congress under President Trump came close to repealing the Affordable Care Act in 2017, which would have caused 32 million Americans to lose health insurance and would have doubled nongroup premiums by 2026. Likewise, the nonpartisan Center for Budget and Policy Priorities estimates that annual premiums would rise by $25,000 or more for some groups if the RSC succeeds in cutting financial assistance for people enrolled in ACA marketplace plans.