The fiscal year 2019 budget proposal from President Donald Trump’s administration would cut nearly $18 billion in funding to HHS, while relying on repealing the Affordable Care Act (ACA) and turning Medicaid into a state-administered block grant program to reduce healthcare spending by the federal government by $675 billion by 2028.

While the budget proposal contains many provisions Congress would have to enact—but likely won’t—the $1.4 trillion in proposed cuts to Medicaid (offset by the block grant spending) show where the administration’s priorities lie. As Vox explains, this budget would fundamentally change the nature of the program, capping spending based on a rate which is already below medical price growth.

It would also cut $266 billion in “wasteful spending” within Medicaid by cutting payments to providers. Smaller cuts would come from policy changes like increasing copayments for beneficiaries judged to have improperly visited an emergency room or denying benefits to people who can’t prove their immigration status.

Read more about the budget, including additional funding to tackle opioid abuse and changes to the Medicare prescription drug benefit, at the link below: