In a recent letter to top Democrats, the Congressional Budget Office claimed that the Republicans’ One Big Beautiful Bill Act would kick millions of people off their health insurance. That warning is misleading.
Millions of people are improperly enrolled in Medicaid and taxpayer-subsidized plans through Obamacare’s exchanges. Republicans are rightly trying to bring some integrity to these programs and ensure that only those needy individuals who are eligible for publicly funded health coverage under the law can claim it.
CBO predicts that the bill will boot 10.9 million people off Medicaid or the exchanges. Another 5.1 million people will supposedly lose marketplace coverage if the Biden administration’s enhanced premium subsidies for exchange coverage expire, as scheduled, at the end of the year.
Those estimates are likely overstated. Even so, many of those potential coverage losses represent people currently claiming benefits to which they are not legally entitled.
Consider the extent of improper enrollment in the exchanges. Between 4 and 5 million people last year signed up for taxpayer-subsidized exchange plans they didn’t qualify for, according to the Centers for Medicare and Medicaid Services. Federal taxpayers spent as much as $20 billion on their coverage.
Medicaid is also rife with waste, fraud, and abuse. The Affordable Care Act expanded eligibility to able-bodied adults earning up to 138% of the federal poverty line. But an estimated 5 million enrollees in the expansion group are actually ineligible due to factors such as age, income, and immigration status, according to research from the Paragon Health Institute. They’re receiving taxpayer-funded coverage anyway.
Some people with Medicaid are double- or triple-insured. Up to 29 million individuals during the Biden administration “were enrolled in some combination of exchange plans, Medicaid, and employer coverage,” Paragon’s Brian Blase recently noted.
Meanwhile, health insurers over three years received at least $4.3 billion in extra payments for patients enrolled in more than one state Medicaid program, according to a March analysis from the Wall Street Journal. Other people are signed up for Medicaid but don’t know it.
NEARLY 11 MILLION UNINSURED UNDER ONE BIG BEAUTIFUL BILL ACT, CBO SAYS
Considering the extent of enrollment fraud, it’s no wonder Medicaid spent roughly $1.1 trillion in improper payments over the past decade, according to Paragon’s research.
Congress has a duty to safeguard taxpayer funds. Kvetching about coverage losses among people who are legally ineligible for the coverage they currently claim does not square with that duty.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes.