Earmarks:

The House Appropriations Committee is considering restoring the use of earmarks for appropriations bills. These earmarks would allow the use of federal funds to support a limited number of local projects that are of interest to lawmakers. House members argue that the earmarks process would allow Congress to continue to have power of the purse, rather than administrative agencies, and would also encourage a faster passage of appropriations bills by giving minority lawmakers a stronger reason to support spending legislation.

Any plan to move earmarks forward will mostly likely only happen in the House, making it a challenge for the House and Senate to reconcile any future spending bills.

Medicaid:

On Thursday, January 30, the Trump Administration, through the Centers for Medicare and Medicaid Services rolled out new guidance to the Medicaid program. The new guidance encourages states to apply for waivers to block grant Medicaid funding at the state level. This block grant guidance means that states would receive a finite amount of money that is capped, thus putting pressure on states to cover additional costs or cut back services provided. The capped block grant program would also allow states to limit Medicaid requirements and patient protections. See NCSD’s statement on this guidance here.

As it currently stands, Medicaid is structured as an entitlement program, meaning that the federal government will pay whatever a state spends, allowing for unexpected health care costs associated with natural disasters, disease outbreaks, or increased enrollment due to economic downturn.