No, the One, Big, Beautiful Bill Did Not Strip Millions of Their Health Care

According to the Left, removing fraud and corruption from Medicaid is going to strip millions of Americans of health care coverage. Oh, please.

These were many of the same people who said giving tens of billions of dollars in handouts to insurance companies to cover phantom enrollees was worth shutting down the government over.

Are we really going to trust their judgment?

Every fact and figure the Left is relying on for their claim about Medicaid coverage losses comes from the same source: the Congressional Budget Office (CBO), whose Medicaid coverage forecasting record is bad enough that no one should accept their predictions at face value.

What’s behind the projection

CBO projects that Medicaid provisions in the One, Big, Beautiful Bill will result in millions fewer people on the program’s rolls by 2034. Democrats have rounded that projection up into an alarmist claim: “Republicans are kicking people off their health care.”

Let’s dig a little deeper: Of the people CBO counts as coverage losses, a significant share are:

• illegal aliens who should never have been on Medicaid in the first place
• individuals double-counted because they’re enrolled in more than one state
• dually eligible beneficiaries who keep their coverage through Medicare

If you then layer in the largest single group affected—able-bodied, working-age adults who fail to meet a modest work or community-engagement requirement—and the picture looks a lot less like a health care crisis and a lot more like a program finally being asked to serve the people it was built for. This is a work requirement, by the way, that is supported by a majority of Americans, even in blue states like Maryland, Wisconsin, Virginia, and Minnesota.

CBO has been wrong about this before—badly

Before anyone hangs their argument on a CBO projection, it’s worth remembering how CBO performed the last time it tried to guess how many people would gain or lose Medicaid coverage.

In 2010, CBO predicted that ObamaCare’s Medicaid expansion would add 13 million able-bodied adults to the program if every state adopted it. By 2019, only about two-thirds of states had expanded Medicaid, yet enrollment had already climbed past 19.5 million—an error rate of roughly 130 percent. CBO admitted it had badly underestimated how many people would sign up.

In 2017, CBO predicted that repealing ObamaCare’s individual mandate would cause 13 million Americans to lose coverage. That never happened. Two years later, both private insurance and Medicaid enrollment came in higher than CBO’s own baseline, not lower.

There’s a likely partisan reason for this pattern of misses. As FGA research highlighted, nearly 80 percent of CBO staff with matched voter registrations are registered Democrats, compared with roughly 12 percent Republicans. Inside the CBO health division, the team that produces Medicaid coverage estimates, more than 93 percent are registered Democrats and not a single staff member is a registered Republican. No one should be making the claim that CBO is neutral.

CBO’s models also skip over what actually happens when people leave Medicaid. In 2005, Tennessee cut 170,000 adults from its Medicaid expansion program. Researchers who studied the aftermath found a comparable jump in private insurance coverage, along with gains in job searches, labor force participation, and employment. People who lost a government check found jobs and coverage on their own. CBO’s estimates never account for that shift.

The One, Big, Beautiful Bill refocuses Medicaid on the truly needy

Setting the CBO drama aside, the One, Big, Beautiful Bill was a historic refocus of the safety net onto the people who truly need it.

Medicaid was built as a safety net for the elderly, pregnant women, low-income children, and people with disabilities. ObamaCare’s expansion opened the floodgates to able-bodied adults, and states blew through every enrollment projection attached to it. “Experts” once predicted 6.5 million able-bodied adults would ever sign up. Actual enrollment hit 19 million. By 2023, total Medicaid enrollment nationwide had topped 100 million people for the first time. Expansion costs that same year reached $139 billion, roughly triple what was projected, and total expansion spending has now topped $1 trillion in less than a decade.

The Obama and Biden administrations made the problem worse. Both administrations stretched Medicaid’s minimum eligibility check to once every 12 months into a maximum, and Biden’s “streamlining” rule barred states from using information that would have helped catch ineligible enrollees.

The One, Big, Beautiful Bill undoes that damage. It rescinds the Biden streamlining rule, requires more frequent eligibility checks, closes loopholes states used to game provider taxes and state-directed payments, bars illegal aliens from the program, and fines states with high payment error rates.

How is any of that stripping Americans of their health care coverage?

The rural hospital argument doesn’t hold up either

Critics also claim the law will bankrupt rural hospitals and limit Americans’ access to health care. If rural hospitals are closing, it’s not the One, Big, Beautiful Bill’s fault.

It’s Medicaid expansion that’s been draining hospitals dry.

Medicaid reimburses hospitals at roughly 60 cents for every dollar of care, and expansion pushed able-bodied adults off private insurance and onto Medicaid by the millions, costing hospitals money on every visit. Four of the five states with the most rural hospitals at risk of closure are expansion states, and expansion has slashed hospital profits by 67 percent in expansion states overall, with rural facilities in states like Louisiana and Montana reporting losses on a majority of their services.

The most common target of the hospital-closure claims is the law’s reform of provider taxes, a scheme states used to tax their own hospitals, draw down inflated federal matching funds, and hand the money back. It is predominantly urban, not rural, hospitals that utilize this payment scheme. And when Democrats released a list of hospitals they predicted would close under the law, several of those hospitals spoke up to correct the record. Wayne HealthCare in rural Ohio said it faced no risk of closing or cutting services. A rural Illinois hospital CEO on the same list said there was “no immediate concern.”

Importantly, the law pairs its reforms with a five-year, $50 billion Rural Health Transformation Program, a lifeline for rural health care that Medicaid expansion never delivered despite years of promises.

Bottom line

Millions of Americans are not losing their health care because of the One, Big, Beautiful Bill.

What’s actually happening is that a program drowning in improper enrollment, double-counted beneficiaries, and able-bodied adults who aren’t working is finally being thrown a lifeline.

By repeating CBO’s doomsday projections without asking any further questions, policymakers aren’t protecting the truly needy—they’re protecting a broken status quo.