While there isn’t a framework yet for the final bill to extend the tax law enacted during Trump’s first term, we can tally a rough cost estimate. On top of the $4 trillion cost over the decade of a clean TCJA extension, the stipulations likely to make the final cut are reportedly no tax on Social Security (at least $1.5 trillion total cost over the next decade), no tax on tips ($200 billion), and at least another $300 billion on increased spending for defense and border security.

In addition, five House Republicans in name only from the wealthiest Democratic districts in the country are demanding that the House Ways and Means Committee blow up the $10,000 state and local tax deduction cap. If these SALT Republicans stick together, that’s more than enough to stop passage of the tax cut extension bill, since the GOP House majority is a slim 220-213, with Democrats set to win two vacant seats in special elections by November.

However, these SALT Republicans refuse to give House Ways and Means Committee Chairman Jason Smith (R-MO) their desired number to raise the deduction and earn their vote. While doubling the cap to $20,000 for married filers would only increase the 10-year deficit by $230 billion, raising it to $40,000 for single filers and $80,000 for couples filing jointly would cost nearly a trillion dollars over a decade. The total cost of the “one big, beautiful bill” is between $6 trillion and $7 trillion.

Looking elsewhere for budget cuts, discretionary spending only comprises about a quarter of our annual $6 trillion in federal outlays. And Trump has been steadfast in his decadelong refusal to touch Social Security or Medicare.

That leaves Medicaid, the federally backed health insurance program for low-income Americans that would be unrecognizable to even the Great Society-era Democrats who created it in 1965.

Intended as a 50-50 financial partnership between federal and state funds, Medicaid originally was only available to people already on one of two welfare programs: Aid to Families with Dependent Children, which exclusively covered very low-income children and their mothers, or Aid to the Aged, Blind, or Disabled. While Congress loosened the eligibility criteria over the decades for low-income children and pregnant women, Medicaid remained restrictive enough that by the turn of the 21st century, about 12% of the nation’s population was on the program.

Former President Barack Obama’s Affordable Care Act transformed the program. The 2010 law nominally requires any state that still participates in Medicaid to expand eligibility to all Americans, regardless of age or ability, to qualify for coverage if they earn up to 138% of the federal poverty line or below. While the Supreme Court limited Obama’s ability to withdraw funding from states that didn’t expand eligibility wholly, the cash incentive — Obamacare promised to initially cover 100% of the costs for those enrolled under the ACA expansion, with states only required to cover a measly 10% by 2020 — worked well enough. To date, only 10 states have held the line and refused, and now more than a quarter of the country’s entire population is on Medicaid.

Combined with the 20% of boomers on Medicare and nearly 20 million more on other minor federal healthcare programs, nearly half the country is on socialized healthcare. It’s going about as well as one would expect. Excluding the cost of interest, 40% of our federal spending is slated to go to Medicare and Medicaid this year, and absent reform, that figure will reach more than 50% in the next 30 years. Medicaid outlays alone are up more than 200% since 2008 and more than 50% since 2019. Medicare is estimated to cost almost $900 billion this year, and under current law, the program will tally $8.2 trillion in new debt over the next decade.

So now Congress can change the law that allows Uncle Sam to bankroll 21 million able-bodied adults, 60% of whom do not work, according to state Medicaid agency data aggregated by the Foundation for Government Accountability.

The most obvious candidate for the chopping block is Obama’s absurd diktat that forces federal taxpayers to spend twice as much money on those able-bodied adults covered by the ACA expansion than on destitute children or the disabled. The nonpartisan Congressional Budget Office projected that simply setting the Federal Medical Assistance Percentage Matching rate for the Medicaid expansion beneficiaries equal to the FMAP for Medicaid’s originally intended beneficiaries would slash $710 billion from the deficit over the next decade.

THE FOUR FACTIONS SPEAKER JOHNSON MUST PLEASE TO PASS TRUMP’S BUDGET MEGABILL

Imposing work requirements for able-bodied adults is another option that a Kaiser Family Foundation poll found has the support of 62% of Americans, including 60% of independents and 82% of Republicans. The Committee for a Responsible Federal Budget estimated this would save another $140 billion over 10 years. The CRFB also projected that banning states from fleecing the federal government with the “Medicaid provider tax” gimmick would generate $720 billion in savings from 2026 through 2035.

This and several other Medicaid-related changes would bring more than $4 trillion in savings. They would shrink the size of the federal government, force able-bodied adults off the public dole, and combat inflation to fund pro-growth tax cuts that would indeed “Make America Great Again.” Democrats had their shot to fundamentally remake the U.S. economy in 2010, and they took it. After 15 years of their failed experiment, it’s time for Republicans to take it back.