Congressional Republicans claim to have achieved something truly miraculous. Their One Big Beautiful Bill Act, they argue, would cut nearly $800 billion from Medicaid spending over 10 years without causing any Americans to lose health care—or, at least, without making anyone who loses health care worse off.
The Congressional Budget Office estimates that, by imposing Medicaid work requirements, the bill would eventually increase the uninsured population by at least 8.6 million. At first, Republican officials tried to defend this outcome on the grounds that it would affect only lazy people who refuse to work. This is clearly untrue, however. As voluminous research literature shows, work requirements achieve savings by implementing burdensome paperwork obligations that mostly take Medicaid from eligible beneficiaries, not 25-year-old guys who prefer playing video games to getting a job.
Perhaps for that reason, some Republicans in Washington are now making even more audacious claims. On CNN over the weekend, Office of Management and Budget Director Russell Vought insisted that “no one will lose coverage as a result of this bill.” Likewise, Joni Ernst, a Republican senator from Iowa, recently told voters at a town hall, “Everyone says that Medicaid is being cut, people are going to see their benefits cut; that’s not true.” After one attendee shouted, “People will die,” Ernst replied, “We all are going to die,” and later doubled down on her comment on social media, attempting to equate concern that Medicaid cuts could harm people with believing in the tooth fairy.
Officials such as Vought and Ernst have not provided a detailed explanation of their blithe assurances. But there is one center of conservative thought that has attempted to defend these claims: the Wall Street Journal editorial page. Last week, it published an editorial headlined “The Medicaid Scare Campaign.” The thesis is that the Medicaid cuts would “improve healthcare by expanding private insurance options, which provide better access and health outcomes than Medicaid.”
This would be, as they say, huge if true: The GOP has found a way to give low-income Americans better health care while saving hundreds of billions in taxpayer money. The timing is even more remarkable, given that this wondrous solution has come along at precisely the moment when congressional Republicans are desperate for budget savings to partially offset the costs of a regressive and fiscally irresponsible tax cut.
Sadly, a close reading of The Wall Street Journal’s editorial reveals that no such miracle is in the offing. Instead, the argument relies on a series of misunderstandings and non sequiturs to obscure the obvious fact that cutting Medicaid would make poor people sicker and more likely to die.
[Jonathan Chait: The cynical Republican plan to cut Medicaid]
The editorial begins by acknowledging a recent study’s conclusion that Medicaid expansion under the Affordable Care Act reduced mortality by 2.5 percent among low-income American adults. This would imply that taking Medicaid away from people would cause many of them to die. Not so fast, the editorial insists: “The 2.5% difference in mortality for low-income adults between the expansion and non-expansion states wasn’t statistically significant when disabled adults were included.”
The implication is that the lifesaving effect of the Medicaid expansion disappears if you include disabled adults. In fact, Bruce Meyer, a University of Chicago economist and a co-author of the study, told me that the reason the study excluded disabled adults is that they were already eligible for public health insurance before the expansion. The way to measure the effect of a change is to focus on the population that was treated to the change. So either the Wall Street Journal editorial board is misleading its audience intentionally or it does not understand statistics. (Decades of Journal editorials provide ample grounds for both explanations.)
The editorial then suggests that Obamacare has not overcome other social factors that are causing people to die: “What’s clear is that the ObamaCare expansion hasn’t reduced deaths among lower-income, able-bodied adults. U.S. life expectancy remains about the same as it was in 2014 owing largely to increased deaths among such adults from drug overdoses and chronic diseases.”
This passage, like the previous one, is intended to sound like a claim that giving people access to medical care does not reduce their likelihood of suffering a premature death. But that is not really what it’s saying. The editorial is merely noting that the drug epidemic and other factors worked against the effects of the Medicaid expansion. Presumably, if the government had started throwing people off their health insurance at the same time that the drug-overdose epidemic was surging, then life expectancy would have gotten even worse.
The article goes on to explain that Medicaid reimburses doctors and hospitals at a lower rate than private insurance does. That is absolutely correct: In the United States, Medicaid is the cheapest existing way to give people access to medical care. The editorial laments that Medicaid recipients have worse outcomes than people on private insurance do. But the Republican plan isn’t to put Medicaid recipients on private insurance, which would cost money. The plan is to take away even their extremely cheap insurance and leave them with nothing. (Well, not nothing: The editorial notes that the bill would double “the health-savings account contribution limit to $17,100 from $8,550 for families earning up to $150,000.” For reference, in most states, a four-person household must earn less than $45,000 a year to be eligible for Medicaid.)
Finally, the editorial asserts, “The GOP bill is unlikely to cause many Americans to lose Medicaid coverage.” Here is where I would analyze the editorial’s support for this remarkable claim, but there is none. The sentence just floats by itself in a sea of text that bears no relationship to it.
Indeed, the editorial doesn’t even attempt to explain why the official Congressional Budget Office estimate is dramatically wrong. Nor does it engage with the mountain of evidence showing that people who obtain Medicaid coverage tend, naturally enough, to be better off as a result. The near-universal belief that being able to see a doctor and buy medicine makes you healthier is the kind of presumption that would take extraordinary evidence to refute. The Wall Street Journal editorial offers none at all.
Advocates of the House bill have cultivated an aura of condescension toward anybody who states its plain implications. But even the most detailed attempt to substantiate their position consists entirely of deflections and half-truths. If this is the best case that can be made for worrying about the GOP’s plan for Medicaid, then Americans should be worried indeed.