A recent bill proposed by Republicans aims to make significant cuts to the Medicaid health insurance program for lower-income Americans. However, President Donald Trump claims the legislation only targets “waste, fraud, and abuse.” Let’s break down the facts.
The Bill’s Provisions
The bill includes provisions that could improve detection of ineligible beneficiaries, such as requiring states to confirm Medicaid recipients’ eligibility every six months and verifying enrollees’ addresses. These efforts could save expenditures on ineligible individuals and be classified as waste-prevention measures.
However, other provisions go beyond targeting waste, fraud, and abuse. For instance:
- Work Requirements: The bill requires individuals aged 19-64 receiving Medicaid under the Affordable Care Act expansion to work or participate in qualifying activities for at least 80 hours per month. According to Benjamin D Sommers, a professor of healthcare economics and medicine at Harvard University, “Work requirements are not about waste, fraud, and abuse. They are fundamentally changing the rules of who is eligible for the programme, and they are adding an immense set of bureaucratic obstacles and red tape for eligible people to keep coverage.”
- Immigration: The bill reduces the federal government’s share of Medicaid payments from 90% to 80% for states that cover undocumented people, potentially leading to budgetary pressures that could affect citizens’ benefits.
- Family Planning: The bill bans Medicaid funds spent on nonprofit organisations primarily engaged in family planning or reproductive services, affecting Planned Parenthood and other organisations that provide abortions.
- Cost-Cutting Measures: The bill imposes $35 copays for many types of care and limits retroactive coverage after applying for Medicaid to one month before application.
Expert Opinions
Experts agree that the bill’s changes go beyond Trump’s claims. Leighton Ku, director of George Washington University’s Center for Health Policy Research, states, “Relatively little of the bill is clearly related to trying to reduce fraud or error… The major provisions are not fraud, waste or error by any means. They’re things that reflect policy preferences of the Republican architects.” Robin Rudowitz, vice president and director of the Program on Medicaid and the Uninsured at KFF, adds, “The magnitude of the federal spending reductions and resulting coverage loss go well beyond rooting out fraud and abuse.”
The Verdict
The Congressional Budget Office projects that at least 8.6 million people will lose coverage due to the changes. Given the evidence, it’s clear that the bill does more than just target waste, fraud, and abuse. Trump’s statement is rated false. As Sommers puts it, “The ‘Medicaid savings’ in this bill are primarily from reducing programme enrolment.”