The White House and some key Republican lawmakers are defending the Medicaid cuts in their budget reconciliation bill, but their defense relies on some highly questionable numbers — and has sparked some politically potent outrage.
The Congressional Budget Office has estimated that the Medicaid rolls would shrink by more than 10 million by 2034 as a result of the Republican reconciliation bill, with 7.6 million going uninsured, including 4.8 million who would lose coverage because of new work requirements.
In his Sunday interview with “Meet the Press,” Speaker Mike Johnson denied that the GOP bill will cut Medicaid and claimed that the 4.8 million people projected to lose coverage because of the bill “will not lose their Medicaid unless they choose to do so.” Johnson argued that the work requirements imposed by the bill and additional paperwork that will be needed to gain or maintain eligibility are “common sense” steps, and he disputed the idea that the changes would be too “cumbersome.”
“There are no Medicaid cuts in the Big Beautiful Bill. We're not cutting Medicaid. What we're doing is strengthening the program,” Johnson said.
President Donald Trump’s budget director, Russell Vought, made similar claims in a Sunday interview with CNN. “This bill will preserve and protect the programs, the social safety net, but it will make it much more common sense,” Vought said, adding, “No one will lose coverage as a result of this bill.”
The White House followed up Monday with a similar statement arguing that Republicans are simply trying to defend the social safety net by eliminating undocumented immigrants and citizens who refuse to work from federal programs. The White House says the Medicaid rolls will shrink because 1.4 million undocumented immigrants will lose coverage, along with 4.8 million “able-bodied adults” who refuse to work.
Questionable number: The estimate of “able-bodied people who refuse to work” appears to be weak, and The Washington Post’s Glenn Kessler says there is likely no sound basis for concluding that there are 4.8 million loafers sucking up healthcare from the comfort of their parents’ couches.
Republicans are assuming that CBO’s estimate of 4.8 million people losing Medicaid coverage as a result of new, more stringent work requirements in the healthcare program created by the GOP bill are all currently non-working. While CBO has provided no clarifying details, that’s highly unlikely to be true.
Instead, according to KFF and other experts, the reductions in Medicaid coverage will be driven in large part by the monitoring system for the work requirements. A significant number of people on Medicaid will simply fail to complete the paperwork required to verify their status, resulting in a loss of coverage.
Writing about Medicaid reform last week, journalist Charles Lane summed up how work requirements successfully reduced enrollment in two states in the handful of places they have been tried. “Under Georgia’s Medicaid work requirement, a model for the one in the GOP bill, only 7,000 out of 110,000 people who were subject to it in 2023 managed to navigate the paperwork verifying their employment status,” Lane wrote. “When Arkansas tried a work requirement in 2018, similar bureaucratic hassles led to 18,000 adults losing coverage over four months, until a federal court halted the program.”
The potential for a political firestorm: Iowa Sen. Joni Ernst highlighted just how dangerous a powder keg this could be for Republicans — and just how callous a defense of cutting Medicaid can be. At a town hall meeting on Friday, some in the crowd yelled, “People are going to die!” as the lawmaker discussed cuts in the healthcare program that aids millions of low-income Americans. “Well, we all are going to die,” Ernst replied.
She then doubled down on her mockery. On Saturday, she recorded herself walking through a graveyard as she offered a sarcastic apology. “I made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth,” she said. “So, I apologize, and I’m really, really glad that I did not have to bring up the subject of the tooth fairy as well.”
She then provided some presumably more sincere advice, though none that would help someone needing care in an emergency room: “For those that would like to see eternal and everlasting life, I encourage you to embrace my lord and savior, Jesus Christ.”