Speaker Mike Johnson defended Donald Trump’s “one big, beautiful bill” that the House passed last week in the middle of the night, claiming the newly added Medicaid work requirements are “moral.” Meanwhile, the legislation will hand the rich a gigantic tax cut.
“We looked at your home state, and the projection is that nearly 200,000 Louisianans will lose their Medicaid coverage… How do you defend that to your constituents?” Face the Nation host Margaret Brennan asked Johnson on Sunday.
“We have not cut Medicaid, and we have not cut SNAP. What we’re doing, Margaret, is working on fraud, waste and abuse, and everyone in Louisiana and around the country understands that that’s a responsibility of Congress,” Johnson said. But the bill will ultimately kick beneficiaries off Medicaid coverage and SNAP benefits, according to multiple estimates.
He went on to claim that it is “moral” to “make young men work.” According to the Kaiser Family Foundation, the vast majority of Medicaid recipients (92 percent) are either already working (64 percent) or may be eligible for an exemption because they are caregivers, in school, or disabled. That leaves just eight percent of Medicaid recipients who say they are retired, cannot find work, or are unemployed for another reason.
“You’ve got about 4.8 million people on Medicaid right now nationwide who are able-bodied workers, young men, for example, who are not working, who are taking advantage of the system,” Johnson claimed. “If you are able to work and you refuse to do so, you are defrauding the system. You’re cheating the system. And no one in the country believes that that’s right. So there’s a moral component to what we’re doing. And when you make young men work, it’s good for them, it’s good for their dignity, it’s good for their self worth, and it’s good for the community that they live in.”
Johnson cited approximately $11 billion in improper SNAP payments to justify his argument, but that total (actually $10.5 billion) includes overpayments as well as underpayments and instances where payments did not comply with regulations — not just fraud.
Trump has also alleged the bill will not cut Medicaid, saying, “We’re not doing any cutting of anything meaningful,” Trump said last week. “The only thing we’re cutting is waste, fraud and abuse. … We’re not changing Medicaid and we’re not changing Medicare and we’re not changing Social Security.”
Analysis by the independent Congressional Budget Office (CBO) projected that approximately 15 million people would lose health coverage by 2034 if all provisions in the House bill are enacted, thanks to Medicaid cuts, not extending tax credits on Affordable Care Act (ACA) marketplace premiums, and other devastating changes to the ACA marketplace. That number includes almost 8 million Americans who would stand to lose Medicaid coverage.
Sweeping changes to Medicaid in the bill would push states to stop using their own funds to cover undocumented immigrants (14 states plus D.C. cover documented and undocumented immigrant children, and seven states plus D.C. cover some undocumented adults, according to PolitiFact). The legislation also bars non-profits like Planned Parenthood, which provide comprehensive reproductive care, from accepting Medicaid funds. And, there are the much-discussed work requirements.
Adding a work requirement for Medicaid coverage would likely drown both states and recipients in administrative red tape while not moving the needle on employment. States would need to set up ways to verify recipients are working or searching for work, which could increase administrative costs. Further, it seems unlikely these requirements would actually help accomplish the GOP’s stated goal to increase the workforce. A study on the implementation of Medicaid work requirements in the state of Arkansas found that it did not increase employment. The study also concluded that people who lost their Medicaid coverage experienced negative consequences in the following year, with half encountering problems paying off medical debt and more than half having delayed care or delayed taking prescribed medications due to cost concerns.
“Work requirements are not about waste, fraud, and abuse — they are fundamentally changing the rules of who is eligible for the program, and they are adding an immense set of bureaucratic obstacles and red tape for eligible people to keep coverage,” Benjamin D. Sommers, a professor of health care economics and medicine at Harvard University’s T. H. Chan School of Public Health and Harvard Medical School, told PolitiFact.
Studies have found that hospitals may close or reduce services amid Medicaid cuts, which total $700 billion in the Republican bill. “Hospitals will be forced to make difficult decisions about whether they will have to reduce services, reduce staff, and potentially consider closing their doors,” said Colleen Kincaid, vice president of media relations and strategy at the American Hospital Association.
Another part of the bill would remove Medicaid coverage from people who are also on Medicare — the majority of those people are seniors or disabled individuals. New eligibility requirements mandating recipients prove their eligibility twice a year can also kick people off Medicaid because either they don’t get or submit required paperwork or because the state doesn’t process their paperwork, the left-leaning Center on Budget and Policy Priorities says.
“Relatively little of the bill is clearly related to trying to reduce fraud or error,” Leighton Ku, director of George Washington University’s Center for Health Policy Research, told PolitiFact. “There are some minor provisions about things like looking for dead people who are enrolled or checking addresses. But the major provisions are not fraud, waste or error by any means. They’re things that reflect policy preferences of the Republican architects.”
The bill now heads for the Senate where it faces opposition not just from Democrats but also Republicans. Sen. Josh Hawley has publicly come out against the proposed cuts, and an anonymous GOP senator told The Hill there is a contingency of five to seven Senate Republicans who oppose cuts.
“There’s probably five, six, seven of us who, if you do anything that cuts into benefits, you’re going to have a real problem. The leader is aware of that,” the senator said last week.