Big battles over taxes and Medicaid policy may have dominated the headlines, but tucked inside House Republicans’ budget bill are a series of good-government changes that backers say will make sure only the right people are getting benefits.
The bill would require the Federal Employees Health Benefits program to check marriage and birth certificates to make sure that people claimed on employees’ policies really are part of their family.
It turns out that thousands are not, and booting them off the rolls will save Uncle Sam roughly $1.5 billion over the next decade, according to the Government Accountability Office.
The bill, whose official name is the One Big Beautiful Bill Act, also cancels government payments under Medicaid for gender transition procedures.
According to one study of nearly 50,000 patients who underwent surgery, a quarter of them were on Medicaid.
In the Education Department, the bill would boot people here on special immigration statuses — such as Cuban parolees, refugees and trafficking victims — from being able to receive student aid.
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And it also stiffens rules on obtaining Pell Grants, which help fund college for low-income students.
Applicants would have to report any foreign income they have so it can be counted toward eligibility. They would also face higher requirements to be considered a full-time student: 30 credit hours, up from 12 per year.
Since grants are prorated for part-time students, that means they would either have to increase their course load or else get less money. About 20% would raise their course load, the Congressional Budget Office figures, but roughly 50% would keep lower schedules and see their awards cut.
That change alone will save the government more than $7 billion over the coming decade, CBO said.
Some of the changes are deeply controversial, but others are not.
The checks on people enrolled in the Federal Employees Health Benefits program won bipartisan support when it was brought up as a stand-alone bill in the House Oversight and Government Reform Committee earlier this year.
The committee said one enrollee bilked the government out of more than $150,000 by keeping an ex-spouse on their benefits through 2017, when they had divorced in 1993.
“We’re trying to ensure that people who are on the system are truly eligible, and to remove those that are ineligible,” said Rep. James Comer, chair of the committee.
The bill also tries to cancel double-dipping in Medicaid by doing name and address matching. Republicans said as many as 1.6 million people are improperly enrolled in multiple states at the same time.
Some state Medicaid agencies have also made payments to dead enrollees.
One part of the bill would require more frequent eligibility checks of eligibility of the Medicaid coverage that was expanded under Obamacare, going from once a year to twice a year.
It’s aimed at booting off people whose incomes rise in the months after they enroll in Medicaid, but who don’t drop out of the program.
The change kicks in as of late 2027, and CBO said that it should save $3.8 billion over the next decade.
But the Urban Institute said it will unnecessarily create more “churn” in Medicaid, with people enrolled, ousted midway through the year, then re-enrolled at the start of the next year. The coverage lapses while they’re off Medicaid can leave them less healthy, and the government may end up paying more money to states to manage the administrative costs.
“With more-frequent redeterminations, millions of expansion enrollees, including those in key subgroups like parents and women of reproductive age, would be at greater risk of coverage loss and churn,” the Urban Institute said.
More broadly, the Medicaid changes impose a work requirement for what Republicans term able-bodied unemployed adults, and it blocks states from covering illegal immigrants.
Democrats said the result will be 13.7 million fewer people on Medicaid’s rolls a decade from now than if the GOP bill fails to become law.
“Trump and Republicans in Congress are robbing people in order to hand it over to the rich,” Rep. Alexandria Ocasio-Cortez, New York Democrat, told supporters in an email.
• Stephen Dinan can be reached at sdinan@washingtontimes.com.