Millions would lose Medicaid coverage. Millions would be left without health insurance. Signing up for health plans on the Affordable Care Act marketplaces would be harder and more expensive.

President Donald Trump’s domestic policy legislation, the One Big Beautiful Bill Act that cleared the House in May and now moves to the Senate, could also be called Obamacare Repeal Lite, its critics say. In addition to causing millions of Americans to lose their coverage under Medicaid, the health program for low-income and disabled people, the measure includes the most substantial rollback of the ACA since Trump’s Republican allies tried to pass legislation in 2017 that would have largely repealed President Barack Obama’s signature domestic accomplishment.

One difference today is that Republicans aren’t describing their legislation as a repeal of the ACA, after the 2017 effort cost them control of the House the following year. Instead, they say the bill would merely reduce “waste, fraud, and abuse” in Medicaid and other government health programs.

“In a way, this is their ACA repeal wish list without advertising it as Obamacare repeal,” said Philip Rocco, an associate professor of political science at Marquette University in Milwaukee and co-author of the book “Obamacare Wars: Federalism, State Politics, and the Affordable Care Act.”

The GOP, Rocco said, learned eight years ago that the “headline of Obamacare repeal is really bad politics.”

Democrats have tried to frame Trump’s One Big Beautiful Bill Act as an assault on Americans’ health care, just as they did with the 2017 legislation.

“They are essentially repealing parts of the Affordable Care Act,” Rep. Frank Pallone Jr. (D-N.J.) said as the House debated the measure in May. “This bill will destroy the health care system of this country.”

Nearly two-thirds of adults have a favorable view of the ACA, according to polling by KFF, a national health information nonprofit that includes KFF Health News.

In contrast, about half of people polled also say there are major problems with waste, fraud, and abuse in government health programs, including Medicaid, KFF found.

“We are not cutting Medicaid,” House Speaker Mike Johnson said May 25 on CNN’s “State of the Union,” describing the bill’s changes as affecting only immigrants living in the U.S. without authorization and “able-bodied workers” whom he claimed are on Medicaid but don’t work.

The program is “intended for the most vulnerable populations of Americans, which is pregnant women and young single mothers, the disabled, the elderly,” he said. “They are protected in what we’re doing because we’re preserving the resources for those who need it most.”

The 2025 legislation wouldn’t cut as deeply into health programs as the failed 2017 bill, which would have led to about 32 million Americans losing insurance coverage, the Congressional Budget Office estimated at the time. By contrast, the One Big Beautiful Bill Act, with provisions that affect Medicaid and ACA enrollees, would leave nearly 9 million more people without health insurance by 2034, according to the CBO.

That number rises to nearly 14 million if Congress doesn’t extend premium subsidies for Obamacare plans that were enhanced during the pandemic to help more people buy insurance on government marketplaces, the CBO says. Without congressional action, the more generous subsidies will expire at the end of the year and most ACA enrollees will see their premiums rise sharply.

The increased financial assistance led to a record 24 million people enrolled in ACA marketplace plans this year, and health insurance experts predict a large reduction without the enhanced subsidies.

Loss of those enhanced subsidies, coupled with other changes set in the House bill, will mean “the ACA will still be there, but it will be devastating for the program,” said Katie Keith, founding director of the Center for Health Policy and the Law at Georgetown University.

Republicans argue that ACA subsidies are a separate issue from the One Big Beautiful Bill Act and accuse Democrats of conflating them.

The House-passed bill also makes a number of ACA changes, including shortening by a month the annual open enrollment period and eliminating policies from Joe Biden’s presidency that allowed many low-income people to sign up year-round.

New paperwork hurdles the House bill creates are also expected to result in people dropping or losing ACA coverage, according to the CBO.

For example, the bill would end most automatic reenrollment, which was used by more than 10 million people this year. Instead, most ACA enrollees would need to provide updated information, including on income and immigration status, to the federal and state ACA marketplaces every year, starting in August, well before open enrollment.

Studies show that additional administrative hurdles lead to people dropping coverage, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“Not only do people drop out of the process, but it tends to be healthier, younger, lower-income folks who drop out,” she said. “That’s dumb because they go uninsured. Also, it is bad for the insurance market.”

Supporters of the provision say it’s necessary to combat fraudulent enrollment by ensuring that ACA beneficiaries still want coverage every year or that they are not being enrolled without their permission by rogue sales agents. Most of the Medicaid coverage reductions in the bill, the CBO says, are due to new work requirements and directives for the 21 million adults added to the program since 2014 under an expansion authorized by the ACA.

One new requirement is that those beneficiaries prove their eligibility every six months, instead of once a year, the norm in most states.

That would add costs for states and probably lead to people who are still eligible falling off Medicaid, said Oregon Medicaid Director Emma Sandoe. Oregon has one of the most liberal continuous eligibility policies, allowing anyone age 6 or older to stay on for up to two years without reapplying.

Such policies help ensure people don’t fall off for paperwork reasons and reduce administrative burden for the state, Sandoe said. Requiring more frequent eligibility checks would “limit the ability of folks to get care and receive health services, and that is our primary goal,” Sandoe said.

The 2017 repeal effort was aimed at fulfilling Trump’s promises from his first presidential campaign. That’s not the case now. The health policy provisions of the House bill instead would help to offset the cost of extending about $4 trillion in tax cuts that skew toward wealthier Americans.

The Medicaid changes in the bill would reduce federal spending on the program by about $700 billion over 10 years. CBO has not yet issued an estimate of how much the ACA provisions would save.

Timothy McBride, a health economist at Washington University in St. Louis, said Republican efforts to make it harder for what they term “able-bodied” adults to get Medicaid is code for scaling back Obamacare.

The ACA’s Medicaid expansion has been adopted by 40 states and Washington, D.C. The House bill’s work requirement and added eligibility checks are intended to drive off Medicaid enrollees who Republicans believe never should have been on the program, McBride said. Congress approved the ACA in 2010 with no Republican votes.

Most adult Medicaid enrollees under 65 are already working, studies show. Imposing requirements that people prove they’re working, or that they’re exempt from having to work, to stay on Medicaid will lead to some people losing coverage simply because they don’t fill out paperwork, researchers say.

Manatt Health estimates that about 30% of people added to Medicaid through the ACA expansion would lose coverage, or about 7 million people, said Jocelyn Guyer, senior managing director of the consulting firm.

The bill also would make it harder for people enrolled under Medicaid expansions to get care, because it requires states to charge copayments of up to $35 for some specialist services for those with incomes above the federal poverty level, which is $15,650 for an individual in 2025.

Today, copayments are rare in Medicaid, and when states charge them, they’re typically nominal, usually under $10. Studies show cost sharing in Medicaid leads to worse access to care among beneficiaries.

Christopher Pope, a senior fellow with the conservative Manhattan Institute, acknowledged that some people will lose coverage but rejected the notion that the GOP bill amounts to a full-on assault on the ACA.

He questioned the coverage reductions forecast by the CBO, saying the agency often struggles to accurately predict how states will react to changes in law. He said that some states may make it easy for enrollees to satisfy new work requirements, reducing coverage losses.

By comparison, Pope said, the ACA repeal effort from Trump’s first term a decade ago would have ended the entire Medicaid expansion. “This bill does nothing to stop the top features of Obamacare,” Pope said.

But McBride said that while the number of people losing health insurance under the GOP bill is predicted to be less than the 2017 estimates, it would still eliminate about half the ACA’s coverage gains, which brought the U.S. uninsured rate to historical lows. “It would take us backwards,” he said.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

When people call large insurance brokerages seeking free assistance in choosing Medicare Advantage plans, they’re often offered assurances such as this one from eHealth: “Your benefit advisors will find plans that match your needs — no matter the carrier.”

About a third of enrollees do seek help in making complex decisions about whether to enroll in original Medicare or select among private-sector alternatives, called Medicare Advantage.

Now a blockbuster lawsuit filed May 1 by the federal Department of Justice alleges that insurers Aetna, Elevance Health (formerly Anthem), and Humana paid “hundreds of millions of dollars in kickbacks” to large insurance brokerages — eHealth, GoHealth, and SelectQuote. The payments, made from 2016 to at least 2021, were incentives to steer patients into the insurer’s Medicare Advantage plans, the lawsuit alleges, while also discouraging enrollment of potentially more costly disabled beneficiaries.

Policy experts say the lawsuit will add fuel to long-running concerns about whether Medicare enrollees are being encouraged to select the coverage that is best for them — or the one that makes the most money for the broker.

Medicare Advantage plans, which may include benefits not covered by the original government program, such as vision care or fitness club memberships, already cover more than half of those enrolled in the federal health insurance program for seniors and people with disabilities. The private plans have strong support among Republican lawmakers, but some research shows they cost taxpayers more than traditional Medicare per enrollee.

The plans have also drawn attention for requiring patients to get prior authorization, a process that involves gaining approval for higher-cost care, such as elective surgeries, nursing home stays, or chemotherapy, something rarely required in original Medicare. Medicare Advantage plans are under the microscope for aggressive marketing and sales efforts, as outlined in a recent report from Sen. Ron Wyden (D-Ore.). During the last year of the Biden administration, regulators put in place a rule that reined in some broker payments, although parts of that rule are on hold pending a separate court case filed in Texas by regulation opponents.

The May DOJ case filed in the U.S. District Court for the District of Massachusetts alleges insurers labeled payments as “marketing” or “sponsorship” fees to get around rules that set caps on broker commissions. These payments from insurers, according to the lawsuit, added incentives — often more than $200 per enrollee — for brokers to direct Medicare beneficiaries toward their coverage “regardless of the quality or suitability of the insurers’ plans.” The case joins the DOJ in a previously filed whistleblower lawsuit brought by a then-employee of eHealth.

“In order to influence the market, the Defendant Insurers understood that they needed to make greater, illicit payments in addition to the permitted (but capped) commissions,” the lawsuit alleges.

In one example cited, the lawsuit says insurer Anthem paid broker GoHealth “more than $230 million in kickbacks” from 2017 to at least 2021 in exchange for the brokerage to hit specified sales targets in payments often referred to as “marketing development funds.”

Insurers and brokers named in the case pushed back. Aetna, Humana, Elevance, eHealth, and SelectQuote each sent emailed statements to KFF Health News disputing the allegations and saying they would fight them in court. EHealth spokesperson Will Shanley, for example, wrote that the brokerage “strongly believes the claims are meritless and remains committed to vigorously defending itself.” GoHealth posted online a response denying the allegations.

The DOJ lawsuit is likely to add to the debate over the role of the private sector in Medicare with vivid details often drawn from internal emails among key insurance and brokerage employees. The case alleges that brokers knew that Aetna, for example, saw the payments as a “shortcut” to increase sales, “instead of attracting beneficiaries through policy improvements or other legitimate avenues,” the lawsuit said.

One eHealth executive in a 2021 instant message exchange with a colleague that is cited in the lawsuit allegedly said incentives were needed because the plans themselves fell short: “More money will drive more sales [be]cause your product is dog sh[*]t.”

The DOJ case focuses on large insurance brokerages, which often rely on national marketing efforts to gain customers, rather than mom-and-pop insurance offices.

The filing, which alleges violations under the federal False Claims Act, outlines some of the problems consumers could face because of those payments, including being enrolled or switched into plans without their express permission, and getting coverage that didn’t meet their needs.

A cancer patient, for example, was switched from the original Medicare program into a private-sector managed-care plan by a large brokerage firm, according to the lawsuit, only to get hit with $17,000 in ongoing treatment costs that would have been covered without the change. Another person calling for free advice later discovered she had been enrolled without permission into a plan with a different insurer than she had previously chosen.

Meanwhile, people with disabilities looking to enroll in private-sector Medicare Advantage plans had their calls ignored or rerouted by systems designed to weed out disabled people, especially if they were under age 65, the lawsuit alleges. That’s because the insurers knew that disabled beneficiaries usually cost more to cover than those without medical problems, the case alleges. Medicare plans are not allowed to discriminate against people with disabilities.

Still, private insurers are allowed to offer commissions to brokers — or not.

Congress and regulators, however, concerned about insurers’ potential financial influence over beneficiaries’ choice of plans, set maximum commissions and limited payments for other things, such as administrative costs, to a vaguer standard: their fair market value. (Under the Biden-era rule that’s on hold, administrative fees would have been capped at $100 per enrollment.) On commissions, the national cap in 2021 — the final year cited in the lawsuit — was $539 per enrollment for the initial year, with higher amounts in some states, including California and New Jersey, the lawsuit said.

The allowed commission rates have risen to a maximum in the low $600s per person in most states this year. Those amounts are higher than what brokers earn if a client enrolls in original Medicare and buys a supplemental drug plan, for which the commission is capped at $109 for the initial year.

Some policy experts say that pay structure alone — aside from any of the allegations in the lawsuit — creates an uneven playing field between the private-sector plans and the original program.

“It’s not my intent to paint all agents and brokers with the same brushstroke, but there are significant financial incentives to steer people toward Medicare Advantage in general,” said David Lipschutz, co-director of law and policy at the Center for Medicare Advocacy.

While brokers can be helpful in sorting out complexities, other options are available. Lipschutz suggested that consumers seek information from their federally funded State Health Insurance Assistance Program, which can advise beneficiaries about Medicare options, are not affiliated with insurers, and don’t receive commissions.

While encouraged that the Trump administration filed the case under investigations that began under the Biden administration, policy experts say Congress and insurers need to do more.

“What we see in this lawsuit highlights the terrible incentives that desperately need Congress to reform,” said Brian Connell, a vice president at the Leukemia & Lymphoma Society, an advocacy group.

Right now, however, Congress is embroiled in budget battles amid calls by the Trump administration to drastically cut federal spending.

“It doesn’t seem like it’s high in the queue,” said Zachary Baron, director of the Center for Health Policy and the Law at Georgetown University’s O’Neill Institute. Some members of Congress may push for more changes to Medicare Advantage, Baron said, “but the real question is whether there will be bipartisan interest.”

The large amounts of money that the lawsuit alleges were involved, though, might add legislative momentum.

“This is money not being spent on care, money not going to providers of health care services,” Lipschutz said. “In my mind, it’s a lot of wasted payment. It’s pretty staggering.”

NOW READ: At least one Trump attack dog just killed their career

Tim Winard knew he needed to buy health insurance when he left his management job in manufacturing to launch his own business.

It was the first time he had shopped around for coverage, searching for a plan that would cover him and his wife, who was also between jobs at the time.

“We were so nervous about not being on a company-provided plan,” Winard said.

After speaking with an insurance agent, he decided against enrolling in an Affordable Care Act plan because he was concerned about the potential cost. Instead, he chose a short-term policy, good for six months.

Six months later, Winard was still working on starting his business, so he signed up for another short-term policy with a different insurer that cost about $500 a month.

When he needed a colonoscopy, Winard, 57, called his insurance company. He said a representative told him to go to any facility he wanted for the procedure.

Early last year, he had the colonoscopy at a hospital in Elmhurst, Illinois, not far from his home in Addison.

The procedure went well, and Winard went home right afterward.

Then the bill came.

The Medical Procedure

Periodic colon cancer screening is recommended for people at average risk starting at age 45 and continuing until age 75, according to the U.S. Preventive Services Task Force. In addition to those for preventive purposes, doctors may order colonoscopies to diagnose existing concerns, as was the case for Winard.

There are several ways to screen, including noninvasive stool tests. A colonoscopy allows clinicians to examine and remove any polyps, which are then tested to see whether they are precancerous or malignant.

The Final Bill

$10,723.19, including $1,436 for the anesthesia and $1,039 for the recovery room. After an insurance discount, his plan paid $817.47. Winard was left owing $7,226.71.

The Billing Problem: A Short-Term Plan, With Coverage Caps and Gaps

Short-term, limited-duration insurance policies do not have to follow rules established under the ACA because they are intended to be only temporary coverage.

As Winard experienced, benefits within the plans can vary, with some setting specific dollar caps on certain types of medical care — sometimes far below what it costs. What’s covered can be hard to parse, and the insurer generally gets the last word on interpreting its rules.

While some short-term policies look like comprehensive major medical policies, all come with significant caveats. Most have limits that people accustomed to work-based or comprehensive ACA plans may find surprising.

All short-term insurance carriers, for example, screen applicants for health conditions and can reject them because of health problems or exclude those conditions. Many do not include drug coverage or maternity care.

The fact that short-term plans can cover fewer services, conditions, and patients is why they are generally less expensive than an unsubsidized ACA plan.

“The general trade-off is lower premiums versus what the plans actually cover,” said Cynthia Cox, vice president and director of the program on the ACA at KFF, a health information nonprofit that includes KFF Health News. “But the reason short-term plans are priced lower than a more comprehensive ACA plan is that they can deny people with preexisting conditions and don’t have to cover a lot of essential health benefits.”

Stunned that he owed more than $7,000 for his colonoscopy, Winard contacted his insurance company, Companion Life Insurance of Columbia, South Carolina.

An insurance representative told him in an email that it classified the procedure and all its costs, including the anesthesia, under his policy’s “outpatient surgery facility” benefit.

That benefit, the email said, capped insurance payment “within that facility” to a maximum of $1,000 per day.

That definition surprised Winard, who said he read his policy to mean that there was a cap on what could be charged for the facility itself — not for all the care he received there.

“I interpreted it to be a facility like a recovery room or surgery room,” he said. “They defined it to include any services at an outpatient facility.”

His plan says it covers colon cancer screening at 80% after patients meet their deductible. It also covers 80% of the cost of drugs provided in an outpatient setting.

Winard, who had met his deductible, said he expected he would pay only 20% toward the cost of his colonoscopy. But he also wondered why the screening, performed at Endeavor Health Elmhurst Hospital, was categorized by the insurer as a procedure at an “outpatient” facility.

According to the email Winard received from his insurer, his policy’s $1,000-a-day limit applies to “treatment or services in a state-approved freestanding ambulatory surgery center that is not part of a hospital, or a hospital outpatient surgery facility.”

Elmhurst Health spokesperson Allie Burke said that the hospital has an attached building where same-day outpatient procedures like colonoscopies are performed.

Short-term plans have been sold for decades. But in recent years, they’ve become a political football.

Out of concern that people would choose them over more comprehensive ACA insurance, President Barack Obama’s administration limited short-term plans’ terms to three months. Those rules were lifted in President Donald Trump’s first term, allowing the plans to again be sold as 364-day policies.

President Joe Biden, calling such plans “junk insurance,” restricted the policies to four months — a change that took effect one month after Winard’s procedure. Trump is expected to reverse Biden’s reversal and again make them available for longer durations.

The Resolution

In December, Winard hired an advocate, Linda Michelson, to help him parse his bill. They wrote to the hospital, offering to pay $4,000 if it would settle the entire bill — an amount Michelson said is about four times what Medicare would pay for a colonoscopy. Winard said the hospital declined the offer.

Spencer Walrath, another Elmhurst spokesperson, wrote in an email to KFF Health News that the hospital’s prices “reflect the value of the services we deliver.”

Companion Life did not respond to requests for comment. Scott Wood, who identified himself as a program manager and co-founder of Pivot Health, which markets Companion Life and other insurance plans, said in an interview that there was room for interpretation in the billing and that he had asked Companion Life to take another look.

Shortly after Wood’s comment to KFF Health News, Winard said he was contacted by his insurer. A representative told him that, upon reconsideration, the bill had been adjusted — although he was given no specific explanation as to why.

His new bill showed he owed only $770.

The Takeaway

Short-term plans can be appealing for some people because of the relatively low cost of their premiums, but consumers should read all the plan documents carefully before enrolling. Understand that the plans often won’t cover a full range of benefits, and check to see which services are covered and which are excluded. Check whether a policy includes per-day or per-policy-period dollar caps on coverage or other payout limits.

The federal government offers subsidies based on household income for ACA plans, which can make them comparable in cost to cheaper, short-term plans — but with a wider range of benefits.

In hindsight, Winard said he had not understood the difference between ACA policies and short-term plans.

His advice? Don’t rely solely on marketing materials, and always get a cost estimate, preferably in writing, before a nonemergency procedure like a colonoscopy.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

“On Feb. 25, I voted yes on a budget resolution that protects Social Security, Medicare, and Medicaid while cutting some spending elsewhere.” -- Rep. Nick LaLota (R-N.Y.), in a YouTube video posted March 4, 2025

On Feb. 25, Rep. Nick LaLota (R-N.Y.) voted in favor of a House budget resolution that calls for sharp cuts in spending across a vast array of government areas. Medicaid is among the programs that could be at risk — catapulting it to the center of the political debate.

President Donald Trump has insisted he won’t harm Medicaid, Medicare, and Social Security benefits, saying his administration is looking to root out fraud. But Democrats have pushed back, saying the sheer size of the proposed cuts will result in harm to the Medicaid program, its enrollees, and medical providers.

A KFF tracking poll has found widespread public support for Medicaid, which suggests efforts to cut the program could face political headwinds. KFF is a health information nonprofit that includes KFF Health News.

LaLota, who represents part of Long Island, posted a video for his constituents explaining his position: “I voted yes on a budget resolution that protects Social Security, Medicare, and Medicaid while cutting some spending elsewhere.” Because much of his video focused on Medicaid, we did too. We found that his statement in this regard was layered with mischaracterizations and inaccuracies. Yet, in his video, LaLota advises his constituents to get their information straight from him, saying, “I’ll always be honest with you.”

We asked LaLota’s office for the information he used to back up his statement. The budget resolution makes no cuts to those programs, he wrote in a statement emailed by his communications aide Mary O’Hara. “Rather, it opens the door to protect Medicaid with common-sense solutions which ensure its availability for those Americans who qualify, including the removal of illegals from the rolls, work requirements for able-bodied adults, and the elimination of waste, fraud, and abuse.”

Let’s parse what the resolution does say and do, and the changes it could trigger for Medicaid.

Explaining the Basics

Budget resolutions are not law, but rather blueprints that guide lawmakers on budget-related legislation. The House-passed resolution — approved with 217 Republicans voting for it and 214 Democrats and one Republican against — is just one part of the budget process. The Senate also has a say, so changes are possible.

As written, the resolution seeks broad spending reductions across a range of areas overseen by various committees. It specifically asks the House Committee on Energy and Commerce to submit proposals “to reduce the deficit by not less than $880,000,000,000 [$880 billion] for the period of fiscal years 2025 through 2034.”

It does not say it would protect Medicaid. The word Medicaid is nowhere in the document. It does not prescribe any specific action on the program, such as instituting work requirements for recipients. Lawmakers separately draft legislation to make program adjustments to achieve the spending cut targets.

A little background: Medicaid is a state-federal program that provides medical coverage to lower-income residents, as well as payments to nursing homes for caring for seniors and disabled residents. Medicaid and the closely related Children’s Health Insurance Program cover more than 79 million people.

Medicare is the federal program that provides health insurance for some disabled people and most people over age 65. More than 68 million people are enrolled.

The resolution directs the committee to draft legislative language that would cut spending from areas under its jurisdiction, which include Medicaid and about half of Medicare.

Social Security is mainly overseen in the House by the Committee on Ways and Means. The panel also shares jurisdiction over Medicare with Energy and Commerce.

Policy experts and the Congressional Budget Office have said that, after removing Medicare from consideration, there’s not enough under the committee’s jurisdiction to cut $880 billion without substantially reducing Medicaid spending. (Medicare is generally considered a third rail because its beneficiaries are a powerful voting bloc.)

Indeed, of the $8.8 trillion in projected spending under the committee’s purview for the 10-year period, Medicaid accounts for $8.2 trillion, or 93%.

“Even if the committee eliminated all of non-Medicare and non-Medicaid spending, they would still have to cut Medicaid by well over $700 billion,” said Alice Burns, an associate director of KFF’s Program on Medicaid and the Uninsured.

Adding work requirements — most Medicaid recipients already have jobs — would not yield that level of savings and could increase state costs. Other cuts suggested by Republicans, including capping federal spending per enrollee, reducing federal matching dollars, and eliminating the use of provider taxes, which states use to pay for their share of Medicaid spending, could force states to cut spending or find new revenue sources.

“Cuts to Medicaid could mean eliminating coverage for children, parents, working adults or those who might need long term care; limiting benefits; or cutting payment rates for health plans or providers. These choices could come at a time when state revenue growth is slowing, and most states face requirements to pass balanced budgets,” according to an analysis by Robin Rudowitz, vice president of the KFF Program on Medicaid and the Uninsured.

The downstream effects if the House-passed budget resolution were enacted would be wide-ranging and significantly alter the safety net program, said Edwin Park, a research professor at the Center for Children and Families at Georgetown University.

He noted growing opposition to such large-scale Medicaid cuts from “beneficiaries and parents of children with disabilities, families with parents in nursing homes, and from health care providers.”

“Medicaid cuts are highly unpopular even among Trump voters,” he said.

Opposition to Medicaid cuts helped kill the 2017 attempt to repeal the Affordable Care Act during the first Trump administration, noted Joseph Antos, a senior fellow emeritus at the American Enterprise Institute.

Antos thinks the current spending cut target is unrealistic and will likely not survive the effort to merge the House budget blueprint with what the Senate wishes to do.

“Ultimately, the problem is you can’t take that much out of Medicaid,” Antos said.

LaLota’s focus on immigrants lacking legal status as a way to reduce federal spending on Medicaid is also misleading.

A number of states, including New York, offer coverage to children or adults regardless of immigration status, but they can use only state money to pay for such programs.

“States cannot use federal funding to cover undocumented immigrants,” Burns said. So removing them “won’t do anything for the deficit reduction targets.”

Our Ruling

LaLota said, “On Feb. 25, I voted yes on a budget resolution that protects Social Security, Medicare, and Medicaid while cutting some spending elsewhere.”

His statement is inaccurate and mischaracterizes laws and the language included in the budget resolution, creating a false impression of what his vote supported.

The 32-word sentence that directs the Energy and Commerce Committee to trim $880 billion over 10 years from programs it authorizes does not include any protections, guardrails, or specific directions for the panel to follow.

We rate this claim False.

Sources:

Rep. Nick LaLota, constituent video, March 4, 2025.

Clerk, United States House of Representatives, “Roll Call 50 | Bill Number H. Con. Res. 14,” Feb. 25, 2025.

Newsweek, “Donald Trump Issues Social Security, Medicaid Update,” March 10, 2025.

Rep. Hakeem Jeffries, press release, March 16, 2025.

KFF, February tracking poll, March 7, 2025.

Medicaid.gov, “October 2024 Medicaid & CHIP Enrollment Data Highlights,” accessed March 17, 2025.

Congressional Budget Office, letter to Reps. Brendan Boyle and Frank Pallone, March 5, 2025.

KFF Quick Takes, “As Governors Meet in D.C., Possible Federal Medicaid Cuts Loom as Big State Funding Issue,” Feb. 20, 2025.

KFF, “Key Facts on Health Coverage of Immigrants, Jan. 15, 2025.

Telephone interview with Joseph Antos, senior fellow emeritus, American Enterprise Institute, March 17, 2025.

Telephone interview with Edwin Park, research professor at the Center for Children and Families, Georgetown University, March 17, 2025.

Telephone interview with Alice Burns, associate director, Program on Medicaid and the Uninsured, KFF, March 17, 2025.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

During her annual OB-GYN visit, Callie Anderson asked about getting off the birth control pill.

“We decided the best option for me was an IUD,” she said, referring to an intrauterine device, a long-acting, reversible type of birth control.

Anderson, 25, of Scranton, Pennsylvania, asked her doctor how much it might cost. At the time, she was working in a U.S. senator’s local office and was covered under her father’s insurance through a plan offered to retired state police.

“She told me that IUDs are almost universally covered under insurance but she would send out the prior authorization anyway,” Anderson said.

She said she heard nothing more and assumed that meant it was covered.

After waiting months for an appointment, Anderson had the insertion procedure last March. She paid $25, her copay for an office visit, and everything went well.

“I was probably in the room itself for less than 10 minutes, including taking clothes on and off,” she said.

Then the bill came.

The Medical Procedure

According to Planned Parenthood, IUDs and implantable birth control represented nearly 25% of its contraceptive services provided from October 2021 to September 2022, per the latest data available.

There are two types of IUDs: copper, which Planned Parenthood says can protect against pregnancy for up to 12 years, and hormonal, which can last from three to eight years depending on the brand. Hormonal IUDs can prevent ovulation, and both types affect the movement of sperm, designed to stop them from reaching an egg.

A physician or other practitioner uses a tube to insert the IUD, passing it through the cervix and releasing it into the uterus.

Doctors often recommend over-the-counter drugs for insertion pain, a concern that prompts some patients to avoid IUDs. Last year, federal health officials recommended doctors discuss pain management with patients beforehand, including options such as lidocaine shots and topical anesthetics.

The Final Bill

$14,658: $117 for a pregnancy test, $9,862 for a Skyla IUD, $4,057 for “clinic service,” plus $622 for the doctor’s services.

The Billing Problem: A ‘Grandfathered’ Plan

Anderson got a rare glimpse of what can happen when insurance doesn’t cover contraception.

The Affordable Care Act requires health plans to offer preventive care, including a variety of contraceptives, without cost to the patient.

But Anderson’s plan doesn’t have to comply with the ACA. That’s because it’s considered a “grandfathered” plan, meaning it existed before March 23, 2010, when President Barack Obama signed the ACA into law, and has not changed substantially since then.

It’s unclear how many Americans have such coverage. In its 2020 Employer Health Benefits survey, KFF estimated that about 14% of covered workers were still on “grandfathered” plans.

Anderson said she didn’t know that the plan was grandfathered — and that it did not cover IUDs — until she contacted her insurer after it denied payment. Her doctor with Geisinger, a nonprofit health system in Pennsylvania, was in-network.

“My understanding was Geisinger would reach out to insurance and if there was an issue, they would tell me,” she said.

Mike McMullen, a Geisinger spokesperson, said in an email to KFF Health News that with most insurance plans, “prior authorization is not required for placing birth control devices, however, some insurers may require prior authorization for the procedure.”

He did not specify whether it is the health system’s policy to seek such authorizations for IUDs, nor did he comment on the amount charged.

The Pennsylvania State Troopers Association, which offers some retirees the plan that covered Anderson, did not respond to requests for comment. Highmark Blue Cross Blue Shield, the insurer, referred questions to the state.

Dan Egan, communications director for the state’s Office of Administration, confirmed in an email that the insurance plan is a grandfathered plan “for former Pennsylvania State Troopers Association members who retired prior to January 13, 2018.”

A benefit handbook for the plan identifies it as grandfathered and lists a variety of excluded services. Among them are “contraceptive devices, implants, injections and all related services.”

The $14,658 bill, an amount that typically would be negotiated down by an insurer, was solely Anderson’s responsibility.

“Fourteen thousand dollars is astronomical. I’ve never heard of anything that high” for an IUD, said Danika Severino Wynn, vice president for care and access at the Planned Parenthood Federation of America.

Costs for IUDs vary, depending on the type, where the patient lives, insurance status, the availability of financial assistance, and additional medical factors, Severino Wynn said.

She said most insurers cover the devices, but coverage can vary, too. For instance, some cover only certain types or brands of contraceptives. Generally, an IUD insertion costs $500 to $1,500, she added.

Many providers, including Planned Parenthood, have sliding-scale rates based on income or can set up payment plans for cash-paying or underinsured patients, she said.

According to FAIR Health, a cost estimation tool that uses claims data, an uninsured patient in the Scranton area could expect to be charged $1,183 for an IUD insertion done at an ambulatory surgery center or $4,319 in a hospital outpatient clinic.

The Resolution

Anderson texted and called her insurer and Geisinger multiple times, spending hours on the phone. “I am appalled that no one at Geisinger checked my insurance,” she wrote in one message with staff at her doctor’s office.

She said she felt rebuffed when she asked billing representatives about financial assistance, even after noting the bill was more than 20% of her annual income.

“I wasn’t in therapy at the time, but at the end of this I ended up going to therapy because I was stressed out,” she said. The billing office, she said, “told me that if I didn’t pay in 90 days, it would go to collections, and that was scary to me.”

Eventually, she was put in touch with Geisinger’s financial assistance office, which offered her a self-pay discount knocking $4,211 off the bill. But she still owed more than she could afford, Anderson said.

The final offer? She said a representative told her by phone that if she made one lump payment, Geisinger would give her half off the remaining charges.

She agreed, paying $5,236 in total.

The Takeaway

It’s always best to read your benefit booklet or call your insurer before you undergo a nonemergency medical procedure, to check whether there are any exclusions to coverage. In addition, call and speak with a representative. Ask what you might owe out-of-pocket for the procedure.

While it can be hard to know whether your plan is grandfathered under the ACA, it’s worth checking. Ask your insurance plan, your employer, or the retiree benefits office that offers your coverage. Ask where the plan deviates from ACA rules.

With birth control, “sometimes you have to get really specific and say, ‘I’m looking for this type of IUD,’” Severino Wynn said. “It’s incredibly hard to be an advocate for yourself.”

Most insurance plans offer online calculators or other ways to learn ahead of time what patients will owe.

Be persistent in seeking discounts. Provider charges are almost always higher than what insurers would pay, because they are expected to negotiate lower rates.

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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