The White House is defending itself over the projected millions of Medicaid recipients expected to lose their health care coverage under President Donald Trump’s signature tax and spending legislation.
White House adviser Kevin Hassett downplayed those concerns during a July 6 interview on CBS’ “Face the Nation,” referring to estimates produced by the nonpartisan Congressional Budget Office.
“If you look at the CBO numbers, if you look at the big numbers, they say that people are going to lose insurance, about 5 million of those are people who have other insurance,” he said. “There are people who have two types of insurance. And so, therefore, if they lose one, they’re still insured.”
The White House pointed PolitiFact to a June 24 CBO analysis of a version of the bill the House passed before it moved to the Senate. The White House said it was using this assessment because the CBO hadn’t produced an equivalent Medicaid analysis of the version that eventually passed both chambers and Trump signed July 4.
This fact-check turned out to be more complicated than we’d expected, because Hassett exaggerated what CBO said — but the part of CBO’s analysis that he accurately quoted needs some additional context.
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CBO projected that 2.9 million people who might lose Medicaid coverage could fall back on existing coverage, either from Medicare or from Medicaid coverage in another state. Getting close to Hassett’s 5 million figure requires including an additional 1.6 million people — people who lost Medicaid but who CBO says would qualify for “other forms of subsidized coverage,” such as a plan under the Affordable Care Act, but likely would not sign up.
This last group doesn’t have existing coverage that would make them “still insured” when their Medicaid coverage is lost.
The 1.6 million people in this category may find they can’t afford those alternatives, or they may not know these alternatives exist, said Benjamin D. Sommers, a Harvard University professor of health care economics and medicine.
“It’s not particularly relevant that they had theoretical coverage options they either couldn’t afford or didn’t know about,” Sommers said.
Here’s the further complication: While Hassett explicitly cited CBO’s analysis to get to the 2.9 million figure, we found it’s not clear that all 2.9 million would be able to fall back on other insurance. This would move the figure even further from the 5 million Hassett cited.
What CBO’s analysis said
The CBO has analyzed the version of Trump’s legislation that was enacted into law. It projected that the final law’s changes to several health care programs — Medicaid, the Children’s Health Insurance Program, the Affordable Care Act marketplace and Medicare — would collectively increase the number of uninsured Americans by 11.8 million in 2034, compared with current law.
That analysis didn’t break out the losses to Medicaid alone, which is what Hassett cited. So to assess his statement, we’ll use the most recent CBO analysis that singled out coverage losses under Medicaid, which was the one the White House pointed us to.
In all, CBO projected that Medicaid enrollment would drop by 10.5 million. Of that number, it said, 7.8 million newly unenrolled Medicaid recipients would become uninsured.
The rest of the people losing Medicaid coverage — 2.7 million to 2.9 million, depending on rounding errors and interactions between the programs — would fall into two categories.
About 1.3 million people, CBO said, would lose Medicaid but remain on Medicare. And about 1.6 million would lose Medicaid in one state but retain it in another. (Our reporting produced uncertainty about whether the full 1.6 million would genuinely have another state’s Medicaid coverage to fall back on, but we will address that in a moment.)
Regardless, counting these two groups gets the figure to 2.9 million, short of Hassett’s 5 million.
Adding another group gets close to 5 million
Hassett can get closer to 5 million by counting a third group: another 1.6 million people who CBO said stand to lose Medicaid, would be eligible for other types of coverage, but — for any number of reasons — would not sign up for them. This would bring the count to about 4.5 million.
But including this additional group of 1.6 million people is questionable.
A person in this category is analogous to a worker who’s covered by their employer’s health insurance and then is fired. The worker isn’t already covered by other insurance; they would have to seek out other alternatives.
So a person in this category wouldn’t “still” be insured, as Hassett said. They’d have to locate the insurance, be accepted, and be able to pay for it.
“The 1.6 million would include someone earning $20,000 a year who loses free Medicaid coverage and then decides they can’t afford $300 a month for their employer insurance premium,” Sommers said.
Questions about the CBO analysis
The biggest wrinkle we found in CBO’s figures involves the 1.6 million people who would lose Medicaid in one state but retain it in another — more than half of the 2.9 million people CBO said would fall back on other coverage.
CBO counts these people as still being insured if they lose Medicaid in one state. But Medicaid generally prohibits people from being covered in two states at once. How can this be?
Experts say the numbers likely reflect recipients who moved from one state to another and signed up for Medicaid in the new state and didn’t remember to formally cancel their old coverage.
This was especially a problem during the coronavirus pandemic, because Medicaid was prevented from terminating beneficiaries, said Leighton Ku, the director of George Washington University’s Center for Health Policy Research. Records have been brought up to date since, he said, but probably haven’t fully caught up.
In March, The Wall Street Journal reported that in the three-year period from 2019 to 2021 — under the since-tightened pandemic-era rules — 660,000 Medicaid recipients were listed as being active in more than one state. It’s unclear how many double listings have been removed since then.
But if the person who moves loses coverage in their new state, experts say, then they can’t simply go back to being covered in their former state. And if CBO’s 1.6 million figure included only people losing Medicaid from their former state, then those changes wouldn’t be attributable to Trump’s legislation, because the process of clearing up outdated information has been ongoing for several years.
The other group CBO counts as remaining insured after losing Medicaid are 1.3 million people who are simultaneously covered by Medicare, the mandatory insurer for Americans over 65. People in this group are known as “dual eligibles.”
CBO is correct that this group will remain insured, but they could still face stiff repercussions.
“Traditional Medicare has roughly 20% cost-sharing,” Sommers said. “For people who have both Medicaid and Medicare, Medicaid covers those costs. Also, traditional Medicare has no out-of-pocket cap, meaning someone can rack up tens of thousands of dollars of costs if they have a catastrophic illness, which Medicaid would cover if they have both.”
All told, “the loss of Medicaid eligibility means they will have to pay more for Medicare services and they might lose long-term care or other services that Medicare doesn’t cover,” Ku said.
Our ruling
Hassett said that CBO found that of the people expected to lose Medicaid coverage under Trump’s bill, “about 5 million … have other insurance,” meaning that “if they lose one (type of insurance), they’re still insured.”
CBO’s analysis supports Hassett up to 2.9 million people — people who stand to lose Medicaid but who, according to CBO, would retain either Medicare or Medicaid in another state.
Getting close to 5 million requires counting another 1.6 million that CBO says would have access to other types of coverage but not sign up for it. But this group of 1.6 million would not “have other insurance” at the point when they lose Medicaid. They would have to find the new insurance, and have the income to pay for it, neither of which is guaranteed.
Complicating matters further, experts question whether all of the 2.9 million people CBO says will remain insured after losing Medicaid will really have usable insurance. And for those who remain on Medicare, their coverage will be significantly diminished.
The statement contains an element of truth but ignores information that would lead to a different conclusion. We rate it Mostly False.
