Deep Medicaid cuts will rattle America’s health care system along with state and local budgets. Forbes contributor Dr. Arthur Kellerman says “if Trump’s Medicaid cuts happen, healthcare costs will rise and access to care will decline for everyone—including you.”

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.

Although the budget resolution does not mention Medicaid specifically, lawmakers would be hard pressed to find enough cuts to meet an $880 billion target without touching federal healthcare programs.