Back at the beginning of April, the U.S. Senate and House each passed a “blueprint” laying out the broad strokes of what they’d like the federal government to look like. The votes were narrow — 51-48 in the Senate and 216-214 in the House — but the result is that both chambers now have to get down to brass tacks. There hasn’t been much coverage (yet) of this next stage and there’s a great deal of uncertainty, but one thing you can count on: What they do will affect your life. So, let’s take a look.

For starters, the GOP majorities in both chambers seem willing to add massively to the federal deficit — the Senate blueprint would increase it by $5.7 trillion to $6.9 trillion, according to independent analyses, while the House would add an estimated $3.4 trillion to $4 trillion over 10 years. This is largely because both chambers want to extend tax cuts from the first Trump administration that tilt heavily toward the wealthy and were due to expire; lop billions (or, in the case of the House, $1.5 trillion) out of the budget; yet also fund big increases for spending on border security and defense.

What happens next is where things get interesting. The blueprints were marching orders for committees on each side of Capitol Hill. But the Senate’s marching orders are different from those in the House, and at some point down the road, they’re going to need to come into agreement. Among other things, the two chambers disagree on how to account for extending the tax cuts (the Senate’s approach basically assumes that extending them would have no deficit impact during the 10-year budget window); they differ on how much to raise the federal debt ceiling; and they differ on how much they want to spend on defense and border security.

But what is undoubtedly going to produce the most headaches for the GOP majorities in both chambers is basic math. In order to extend the tax cuts — and boost border and defense spending — they’ll have to take a cleaver to other parts of the federal budget. And since roughly half of all federal spending goes to three popular programs — Social Security, Medicare, and Medicaid — many analysts (and members of Congress) believe that at the very least, serious cuts to Medicaid funding are on the way.

This might seem like a remote problem, but it would affect health care and the economy in pretty much every nook and cranny of the country. Medicaid doesn’t just help one in five low-income Americans get primary and acute care, but it undergirds health care for about half of U.S. children. It underwrites six in 10 nursing-home residents. Moreover, Medicaid buttresses primary care practices, clinics, hospitals (especially rural hospitals), nursing homes, and health-care workers. Cutting it dramatically will reshape health care in communities everywhere.

On the other hand, there’s another kind of math in effect: The narrow House majority allows very little wiggle room for the GOP leadership, and in mid-April a dozen Republican members — more than enough to sink any agreement — sent a letter to the leadership saying they would not support “a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.” What this actually means we’ll just have to wait to see.

Expect much drama as Congress tries to cut federal agencies and programs to pay for the tax cuts it would like to enshrine. But one thing is certain: Even though committees in both chambers will work on the package, what it looks like will be steered by the leadership and by the White House. The opportunities that once existed for experts and rank-and-file members to weigh in and shape budgets and other legislation have narrowed over the years, as congressional leaders have concentrated more power in their own hands.

As a result, many members of Congress — as they have on so many fronts — have essentially sidestepped their accountability for what happens on Capitol Hill, and have made it tougher for the public to weigh in on the details. With something so momentous as the forthcoming tax and budget cuts, that’s too bad.      

Lee Hamilton, 94, is a senior advisor for the Indiana University (IU) Center on Representative Government, distinguished scholar at the IU Hamilton Lugar School of Global and International Studies, and professor of practice at the IU O’Neill School of Public and Environmental Affairs. Hamilton, a Democrat, was a member of the U.S. House of Representatives for 34 years (1965-1999), representing a district in south-central Indiana.