The CBO Breakdown on Medicaid Losses, Increase in Uninsured – FactCheck.org

The Congressional Budget Office estimated that the House version of the One Big Beautiful Bill Act would reduce Medicaid enrollment and cause millions of people to become uninsured by 2034. It didn’t say that “5 million” of the people who are “going to lose insurance” would have “other insurance” so “they’re still insured,” as National Economic Council Director Kevin Hassett misleadingly claimed.

Hassett was talking about some of the estimated changes to Medicaid coverage and access to other types of health insurance. But he exaggerated the number who the CBO said would still retain some coverage, and his remark may leave the mistaken impression that he was addressing the CBO’s estimate of the increase in the uninsured.

Some who are expected to lose Medicaid coverage will not be left entirely uninsured. For example, the figure that Hassett cited includes individuals the CBO said would lose Medicaid but keep their Medicare benefits. And Hassett’s figure includes people expected to be unenrolled from Medicaid in one state but remain enrolled in another state – meaning they wouldn’t actually lose Medicaid.

But Hassett also counted individuals the CBO said would lose Medicaid and not obtain other coverage for which they were eligible. That group wouldn’t still be insured, as Hassett claimed. Experts told us there are several reasons, such as affordability, why an uninsured person may not enroll in a health plan available to them.

Hassett, who directs the NEC for the Trump administration, made his claim during a July 6 “Face the Nation” interview, in which he criticized the CBO’s analysis of the legislation backed by congressional Republicans. The GOP-led House passed a Senate-approved version of the One Big Beautiful Bill Act, and President Donald Trump signed it into law on July 4.

Weijia Jiang, who was hosting the CBS show, asked Hassett to comment on “the CBO’s projections that as many as 12 million Americans could lose Medicaid coverage because of this law.” In response, Hassett said: “[I]f 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. They’re people who have two types of insurance. And so, therefore, if they lose one, they’re still insured.”

Jiang may have been referring to a CBO estimate that, under a Senate version of the bill, 11.8 million people would become uninsured in 2034 — although not all of them would be people who lost Medicaid.

But Hassett’s response to her question also isn’t what the CBO reported.

What the CBO Said About Medicaid

A White House official told us that Hassett was referring to the CBO’s analysis of a House version of the bill. Under that proposed bill — which was different from the Senate version that became law — the CBO estimated that Medicaid enrollment would decrease by 10.5 million in 2034, and that 7.8 million people would be left wholly uninsured because of Medicaid-related provisions in the bill.

The 10.5 million figure included 1.3 million individuals who have both Medicaid and Medicare, but are projected to lose their Medicaid coverage. “They would retain Medicare coverage and not become uninsured,” the CBO said.

Meanwhile, the agency said the “10.5 million figure also reflects a reduction of 1.6 million people enrolled in Medicaid in more than one state; those enrollees would maintain Medicaid coverage in their home state.”

In addition, the CBO said that 1.6 million of the 7.8 million people estimated to become uninsured due to the bill’s Medicaid policies “would have access to, but would not take up, other forms of subsidized coverage,” such as employer-sponsored health insurance or a health plan available through insurance marketplaces established by the Affordable Care Act.

That 1.6 million “also includes people who would remain eligible for Medicaid but would not enroll,” the CBO said.

Why Hassett’s Claim Is Misleading

Adding those three figures together produces a total of 4.5 million, which is close to the 5 million that Hassett cited. But his figure is misleading.

For one, the 1.6 million people that the CBO said would lose Medicaid and not obtain alternative coverage means they wouldn’t “have other insurance,” as Hassett said. 

The White House official we contacted argued that these are people who “will voluntarily forgo insurance coverage available to them,” but the CBO didn’t elaborate on why those people wouldn’t “take up” other insurance. There are multiple reasons why an uninsured person who qualifies for a health plan may not enroll.

“Surveys of Americans without insurance show that most either don’t think coverage is affordable or don’t know what programs they’re eligible for,” Dr. Benjamin Sommers, a Harvard University professor of health care economics and medicine, told us in an email.

Sommers used an example of an employee making $20,000 annually who loses free Medicaid coverage but can’t afford to pay a $300 monthly premium for an insurance plan offered by an employer. He also emphasized that some people “will be losing Medicaid – even though they’re still eligible – because this law creates a lot more red tape” in the form of paperwork that has to be filed twice a year to document that beneficiaries meet new work requirements.

“This law makes getting into and keeping Medicaid much harder, even for those who are already working and should still be eligible,” he said.

Also, the CBO didn’t say that the 1.6 million people who would be unenrolled from Medicaid in one state, but still have it in another, are “going to lose insurance.” Those people are essentially being double-counted on the Medicaid rolls, which is why unenrolling them in one of the states only appears to reduce the number of people on Medicaid.

“This number is about Medicaid enrollment and has nothing to do with the increase in the uninsured under the Medicaid and [Children’s Health Insurance Program] provisions under the law,” Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, told us in an email.

Park said that people sometimes end up being enrolled in Medicaid in two states because of paperwork issues and delays in disenrolling people after they have moved from one state to another. 

Akeiisa Coleman, senior program officer for Medicaid at the Commonwealth Fund, told us that beneficiaries “may not be aware” that they “are required to notify the state they are moving.”

As for the other 1.3 million people the CBO said would remain insured under Medicare but not Medicaid, they could still be negatively affected, experts told us.

“Medicaid helps to cover services not covered by original Medicare, such as dental, home and community based services, and transportation to doctor’s appointments, which are services provided to Medicaid recipients in most states,” Gretchen Jacobson, vice president for the Medicare program at the Commonwealth Fund, told us in an email. 

She said, “Medicaid also helps to cover Medicare’s premiums and cost-sharing requirements, which helps to make basic preventive and acute care medical services affordable for low-income people.”

Park also noted that seniors enrolled in Medicare Savings Programs administered through Medicaid automatically become eligible for Medicare’s Low Income Subsidy, which reduces the cost of Medicare’s prescription drug coverage and helps beneficiaries pay for prescriptions.

And Sommers added that “traditional Medicare has no out-of-pocket cap, meaning someone can rack up tens of thousands of dollars of costs if they have a catastrophe illness, which Medicaid would cover if they have both.”

Therefore, “the 1.3 million dual eligibles who would lose Medicaid under this law would thus face higher costs and less access to needed care,” Park said.

How Many Uninsured?

The CBO ultimately projected that the House bill would cause the uninsured population in 2034 to grow by a total of 10.9 million people. That includes the 7.8 million individuals it said would become uninsured because of Medicaid changes in the bill, as well as 3.1 million more estimated to lose coverage due to other health insurance changes in the legislation.

Under a modified Senate version of that bill, the CBO said the number of people without insurance would increase to 11.8 million people in 2034. (An estimate based on the final legislation that became law is not yet available.)

But the agency didn’t say that “5 million” people who would lose Medicaid or other health insurance under either bill “have two types of insurance” so that “if they lose one, they’re still insured,” as Hassett claimed. His figure refers to changes to Medicaid enrollment and access to other insurance, not the change in the uninsured.

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