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.

Speaker Mike Johnson (R-Louisiana) just cast the deciding vote for President Donald Trump’s budget bill on behalf on Rep. David Schweikert (R-Arizona). Schweikert handed Johnson his voting card. Johnson cast the vote, and handed it back. That was the vote that put Republicans over the top.