Speaker of the House Mike Johnson was asked on Sunday by CNN’s Jake Tapper about how the $625 billion of Medicaid cuts in the One Big Beautiful Bill Act would, according to a Congressional Budget Office [CBO] estimate, take away health insurance from 7.7 million people.
Johnson replied with bald-faced lies, beginning with, “We are not cutting Medicaid in this package.”
How could Johnson possibly turn $625 billion into $0? By deeming it “waste, fraud, and abuse”:
The numbers of Americans who are affected are those that are entwined in our work to eliminate fraud, waste, and abuse. So, what do I mean by that? You got more than 1.4 million illegal aliens on Medicaid. Medicaid is not intended for non-U.S. citizens…
Let’s break in to note that the number of “illegal aliens” or undocumented immigrants on Medicaid is zero because they are not eligible for Medicaid.
Fourteen states, however, have health insurance programs—not funded by federal Medicaid dollars—that include undocumented immigrants (covering an estimated 1.9 million people, including 300,000 children).
The One Big Beautiful Bill punishes states with such programs by reducing their Medicaid funds. The CBO estimates it will strip 1.4 million immigrants of coverage; that’s where Johnson gets the 1.4 million number. But it’s not people “on Medicaid,” so it’s not evidence of Medicaid fraud.
Ok, let’s return to Johnson’s answer to Tapper on State of the Union:
It’s intended for the most vulnerable populations of Americans, which is pregnant women and young single mothers, the disabled, the elderly. They are protected in what we’re doing because we’re preserving the resources for those who need it most. You’re talking about 4.8 million able-bodied workers, young men, for example, who are on Medicaid and not working. They are choosing not to work when they can. That is called fraud. They are cheating the system.
First, Republicans have been using this “4.8 million able-bodied men… on Medicaid and not working” number but have failed to produce evidence. Earlier this month, after several House and Senate members claimed the number came from a CBO estimate, The Washington Post and Snopes asked CBO for the document. CBO did not comply or give any explanation.
Second, Johnson said Medicaid is “intended for the most vulnerable populations of Americans, which is pregnant women and young single mothers, the disabled, the elderly.” But, as The New Republic’s Timothy Noah, a Washington Monthly contributing editor, emphasized recently, there is another vulnerable population for which Medicaid was originally intended: the unemployed. When Medicaid began, unemployment was an entrée into the program, though Congress and presidential administrations of both parties have expanded eligibility multiple times to cover more and more of the working class.
Third, able-bodied people who are not working but are receiving Medicaid are not defrauding the government. Such persons are legally eligible.
Republicans, in the One Big Beautiful Bill, want to require that Medicaid recipients spend 80 hours a month working, volunteering, or attending school. They can certainly make the case for such a policy, but that’s not the law today. As Thom Walsh noted in the Washington Monthly on Tuesday (See Medicaid Work Requirements Don’t Work), such a policy would burden small and rural hospitals, likely leading to layoffs of precisely the kind of low-income workers who would end up seeking Medicare in a vicious cycle. (See also Washington Monthly Contributing Editor Anne Kim’s explainer video on Medicaid work requirements.)
Fourth, Johnson isn’t on the level regarding the impact of the proposed requirements. He talks as if they would only ensnare those who aren’t working, but the employed will lose coverage, too.
Johnson tacitly admits this with his flimsy numbers: 4.8 million “able-bodied” plus 1.4 million “illegal aliens” equals 6.2 million people. But, again, the CBO estimated that 7.7 million will lose coverage from all the Medicaid changes: work requirements and reduced payments to states.
The work requirements may have a more severe impact than CBO projects. An analysis by the Center for Budget and Policy Priorities, based on the results of a similar work requirement policy implemented in Arkansas, concluded, “9.7 million to 14.4 million people at risk of losing Medicaid coverage,” in part because “requirements frequently end up pushing eligible people off Medicaid because they don’t receive or submit the necessary paperwork, or because the state fails to process the paperwork.”
It gets worse. On top of the 7.7 million estimate, CBO projects another 900,000 will lose coverage from restrictive rule changes to the Affordable Care Act in the One Big Beautiful Bill. (And the total dollar figure of health coverage spending cuts from both Medicaid and ACA is $912 billion.)
One fundamental health policy change, separate from Medicaid, is not in the One Big Beautiful Bill: a renewal of the Biden administration’s expanded health coverage tax credits enacted in the Inflation Reduction Act. Letting those expire, according to CBO, will mean another 4.2 million people losing coverage. The income eligibility for these credits is higher than that of Medicaid, which means many of those losing coverage will be people who work.
Recently, President Donald Trump was asked by CNN, “Can you guarantee that your voters who supported you in the election, particularly working-class voters, will not lose health insurance under this bill?”
He responded, “Oh, they won’t lose health insurance.” At a minimum, that answer leaves out that working-class voters will lose insurance because of what isn’t in the bill.
Remember when people lost their minds over Barack Obama saying, “If you like your health care plan, you’ll be able to keep your health care plan,” because that didn’t mention how higher minimum requirements for health insurance plans would impact plan availability? Today, you have top Republicans claiming their health policy changes will only curtail “waste, fraud, abuse” when, in fact, they would take away Medicaid eligibility, make it harder for those eligible to access Medicaid benefits and take away tax credits millions use to obtain private coverage.
The One Big Beautiful Bill is one big bait-and-switch.
