Kennedy Denies the One Big Beautiful Bill Act’s Spending Cuts to Medicaid

The nonpartisan Congressional Budget Office estimated that the One Big Beautiful Bill Act will reduce federal Medicaid spending by more than $900 billion over a decade. But in a series of congressional hearings last month, Health and Human Services Secretary Robert F. Kennedy Jr. misleadingly claimed that “there are no cuts to Medicaid” as a result of that 2025 law.

Kennedy said there are no cuts to Medicaid under the OBBBA because the CBO also estimated that federal spending on Medicaid will increase by “47% over the next 10 years.” But health policy experts told us that total spending on Medicaid is expected to still grow because of population changes and an increase in healthcare costs.

“[T]he notion that since Medicaid spending overall will continue to rise means that there are no cuts is simply false,” Michael S. Sparer, chair of the department of health policy and management at the Mailman School of Public Health at Columbia University, told us in an email. “The rise in Medicaid spending would be far greater had HR1 not been enacted,” he said, referring to the OBBBA’s assigned bill number.

At the hearings, however, Kennedy repeatedly clashed with Democrats who said that the Republican legislation that President Donald Trump signed into law last summer made cuts to Medicaid and would reduce access to healthcare for millions of people.

For example, during an April 22 Senate Finance Committee hearing on the HHS budget, Democratic Sen. Tina Smith of Minnesota, while talking about mental health services covered by Medicaid, said that the Trump administration and congressional Republicans had “pushed through the biggest cuts to Medicaid in the history of that program.” 

In response, Kennedy said that wasn’t the case. “First of all, there are no cuts in Medicaid,” he said. “I keep saying this. Here’s what the CBO said: In fiscal year 2025, $668 billion. Fiscal year 2036, $981 billion. That’s not a cut. It’s a 47% increase.”

Smith interjected, by saying: “Secretary Kennedy, a trillion dollars in cuts, according to the CBO. Seven million people losing their health insurance because of the Trump administration actions. That’s not debatable.”

Smith was largely correct about what the CBO said. It estimated a more than $900 billion reduction in Medicaid spending and an increase in the uninsured of 7.5 million people over 10 years.

Based on a CBO analysis, KFF, an independent health policy research organization, estimated that the OBBBA reduces federal Medicaid spending by precisely $911 billion. Most of the federal savings, KFF said, come from the law imposing new work requirements on individuals who became eligible for Medicaid due to an expansion of the program under the Affordable Care Act, as well as “limiting states’ ability to raise the state share of Medicaid revenues through provider taxes, restricting state-directed payments to hospitals, nursing facilities, and other providers, and increasing barriers to enrolling in and renewing Medicaid coverage.”

KFF said that those Medicaid spending reductions in the OBBBA would offset some of the costs of another part of the bill, which extended some expiring tax cuts for individuals.

Those spending reductions count as “cuts,” experts in health policy told us.

“By conventional budget scoring methods, including those used by CBO, as well as [Office of Management and Budget] and others, there were very large cuts to Medicaid in OBBBA,” Leighton Ku, director of the Center for Health Policy Research at George Washington University, said in an email. “CBO (and others) compare estimated federal Medicaid expenditures under OBBBA with the amount that would have been spent WITHOUT the legislation.”

Furthermore, Ku said, “A more telling sign of the impact of the cuts is that CBO estimated that the Medicaid and related CHIP cuts will cause the number of uninsured to rise by about 7.5 million people” by 2034. (CHIP is the Children’s Health Insurance Program for families that make too much money to qualify for Medicaid but can’t afford private insurance.)

We reached out to HHS about Kennedy’s claims, but haven’t received a response.

In an April 22 hearing before the Senate Committee on Health, Education, Labor and Pensions, Kennedy said the statement that “we’ve cut Medicaid by a trillion dollars” was a Democratic talking point. He claimed that the CBO “disagrees” with Democrats, and referenced the agency’s estimate that federal spending on Medicaid will increase from more than $600 billion in fiscal 2025 to well over $900 billion 10 years from now. 

But Kennedy “is using smoke and mirrors here — everything gets more expensive over time, especially in health care,” Dr. Benjamin Sommers, a Harvard University professor of health care economics and medicine, told us in an email.

Akeiisa Coleman, senior program officer for Medicaid at the Commonwealth Fund, said in an emailed statement that, despite the projected spending reductions resulting from OBBBA, “federal spending on Medicaid is likely to increase over time to reflect changes in population and the cost of health care.”

Ku called Kennedy’s claim “misleading” because it “ignores the reality of medical care inflation, the aging of the population (which causes medical expenditures to rise even more) and other pressures.” He said “the reality is that people will receive much less health care under Medicaid because of these cuts,” and that “health care providers like hospitals, doctors’ offices and nursing homes will hurt financially because of the loss of revenue.”

Meanwhile, HHS has argued that some spending reductions were part of necessary changes to overhaul the Medicaid program.

“To be clear, HHS is taking steps to ensure Medicaid serves those it is intended to support,” Andrew Nixon, an HHS spokesman, told the Associated Press for an April 23 story about Kennedy’s claims. “These actions are not cuts — they are focused on addressing waste, fraud, and abuse to better position the program for those who rely on it.”

However, Sommers said “this is not simply cutting out waste and abuse,” since the CBO estimates that millions of people will lose health insurance because of eligibility restrictions and other changes that the law made to Medicaid.

“Any reasonable person would interpret that as a sizable cut to the program – particularly if you’re one of the millions of people expected to lose their health insurance under the law,” Sommers said.

We’ve explained before that while Republicans have said they are targeting able-bodied adults with the new Medicaid work requirements, health policy experts say that other groups would lose coverage as well due to paperwork burdens and other Medicaid provisions in the legislation.

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