Cuts to Medicaid will have to be on the menu if House Republicans want to meet their budget goals, the Congressional Budget Office said in a report this week.

The chamber’s budget blueprint includes $880 billion in spending cuts under the House Energy and Commerce Committee, which oversees the program.

Medicaid helps cover medical costs for people who have limited income and resources, as well as benefits not covered by Medicare such as nursing home care.

To curb Medicaid spending, experts say, lawmakers may choose to add work requirements. Doing so would make it so people have to meet certain thresholds, such as 80 hours of work per month, to qualify for Medicaid coverage.

Republicans have not yet suggested specific changes to Medicaid. However, a new KFF poll finds 6 in 10 Americans would support adding work requirements to the program.

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Imposing work requirements may provide a portion of lawmakers’ targeted savings. In 2023, the Congressional Budget Office found implementing work requirements could save $109 billion over 10 years.

Yet that change could also put 36 million Medicaid enrollees at risk of losing their health-care coverage, estimates the Center on Budget and Policy Priorities. That represents about 44% of the approximately 80 million individuals who participate in the program. The estimates focus on adults ages 19 to 64, who would be most likely subject to a work requirement.

The idea of work requirements is not new. Lawmakers have proposed work hurdles to qualify for other safety net programs, including the Supplemental Nutrition Assistance Program, or SNAP.  

The approach shows an ideological difference between the U.S. and European social democracies that accept a baseline responsibility to provide social safety nets, said Farah Khan, a fellow at Brookings Metro’s Center for Community Uplift.

“We view welfare as uniquely polarized based on which party comes into power,” Khan said.

When one party frames it as a moral failing to be poor because you haven’t worked hard enough, that ignores structural inequalities or systemic injustices that may have led individuals to those circumstances, she said.

When Arkansas implemented a work requirement policy in 2018, around 1 in 4 people subject to the requirement, or around 18,000 people total, lost coverage in seven months before the program was stopped, according to the Center on Budget and Policy Priorities. When New Hampshire attempted to implement a work requirement policy with more flexible reporting requirements, 2 in 3 individuals were susceptible to being disenrolled after two months.

“Generally, Medicaid work requirements have resulted in coverage losses without incentivizing or increasing employment and are a policy that is really unnecessary and burdensome,” said Laura Harker, senior policy analyst at the Center on Budget and Policy Priorities.

The “administrative barriers and red tape” from work requirements broadly lead to coverage losses among both working individuals and those who are between jobs or exempt due to disabilities, illnesses or caretaking responsibilities, according to the Center on Budget and Policy Priorities.

Notably, around 9 in 10 Medicaid enrollees are already working or qualify for an exemption, Harker said.

Separate research from the American Enterprise Institute finds that in a given month, the majority of working-age people receiving Medicaid who do not have children do not work enough to meet an 80-hour-per-month requirement.

Consequently, if work requirements are imposed on nondisabled, working-age Medicaid recipients, that would affect a large number of people who are not currently in compliance, said Kevin Corinth, deputy director at the Center on Opportunity and Social Mobility at the American Enterprise Institute.

Either those individuals would increase their work to remain eligible or they wouldn’t, and they would be dropped off the program, Corinth said.

“If you put on work requirements, you’re going to affect a lot of people, which could be good or bad, depending on what your view of work requirements are,” Corinth said.

Lawmakers may also cut Medicaid in other ways: capping the amount of federal funds provided to state Medicaid programs; limiting the amount of federal money per Medicaid recipient; reducing available health services or eliminating coverage for certain groups.

If you’re married and in a single-income household, a lesser-known retirement strategy could boost your nest egg — and there’s still time to use it for 2024.

A spousal individual retirement account is a separate Roth or traditional IRA for the non-working spouse. With this strategy, two IRAs can be maxed out annually with enough income from the working spouse. The deadline for 2024 contributions is April 15.

“Spousal IRAs are a game changer for married couples looking to build retirement savings and manage their lifetime tax burden,” said certified financial planner Jim Davis, partner at Aspen Wealth Management in Fort Worth, Texas.

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For 2024, the IRA contribution limit is $7,000, plus an extra $1,000 catch-up contribution for investors age 50 and older. The caps are the same for 2025.

That means an older married couple with sufficient earned income could save up to $8,000 per IRA for 2024 before the April 15 tax deadline. They’ll have until next year’s tax due date for 2025 IRA contributions.

“For many, it’s a simple yet powerful step toward achieving long-term goals,” Davis said.

To qualify, you must file taxes jointly and your combined IRA contributions can’t exceed “taxable compensation” reported on your tax return, according to the IRS. The strategy could also work if one spouse is unemployed without enough 2024 earnings to contribute to an IRA on their own.

Roth IRAs are funded with after-tax dollars and offer future tax-free growth, but there’s an income limit. Traditional IRAs could provide an upfront tax break, depending on your income and workplace retirement plan participation.   

Most workers can expect to see Social Security payroll taxes taken from their paychecks throughout the year.

But high earners with $1 million in gross annual wage income have already stopped paying into the program as of March 6, according to the Center for Economic and Policy Research.

In 2025, workers are subject to payroll taxes on up to $176,100 in earnings. Workers pay a 6.2% Social Security payroll tax rate, which is matched by their employers, for a total of 12.4%.

Once high earners hit that $176,100 cap, they no longer contribute to the program for the rest of the year.

“Elon Musk has already reached that cap of $176,100 within the first few minutes of 2025 just on gross annual wage income,” said Emma Curchin, research assistant at the Center for Economic and Policy Research.

That does not include the investment income he earns, which is not subject to Social Security payroll taxes, she said.

Approximately 6% of workers have earnings over the taxable maximum, according to the Social Security Administration.

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Ultimately, higher earners who contribute to the program up to the highest taxable earnings each year for most of their careers stand to receive the maximum retirement benefit.

In 2025, the maximum Social Security benefit for a worker retiring at full retirement age is $4,018 per month.

Meanwhile, the average monthly benefit for retired workers is $1,976 per month in 2025.

Last year, Social Security’s trustees projected the fund that the program relies on to pay retirement benefits may last until 2033. At that time, 79% of scheduled benefits will be payable.

To prevent those benefit shortfalls, Congress may consider a variety of tax increases or benefit cuts.

One recent survey found the most popular policy option would be to eliminate the payroll tax cap for earnings of more than $400,000, according to the National Academy of Social Insurance, AARP, the National Institute on Retirement Security and the U.S. Chamber of Commerce. The change would not provide additional benefits for higher earners who are affected.

The survey also found Americans would be open to higher taxes to ensure benefits either stay the same or increase.

“They’re willing to pay more, not to get extra benefits for themselves, but just to close the financing gap to prevent indiscriminate across the board benefit cuts,” Tyler Bond, research director for the National Institute on Retirement Security, previously told CNBC.com.

Another change survey respondents favored is reducing benefits for individuals with higher retirement incomes excluding Social Security. That would apply to individual retirees with $60,000 or more aside from Social Security per year and married couples with $120,000 or more per year.

“By scrapping the cap, the Social Security trust fund could be much more healthy and secure,” Curchin said.

But it’s not enough. To restore the program’s solvency, research has shown a combination of changes would be required.