Centers for Medicare & Medicaid Services leadership is pushing back against Congressional Budget Office estimates that predict millions of Americans could lose health insurance coverage under proposed Republican budget legislation. The ongoing debate highlights fundamental disagreements about healthcare policy implementation and coverage projections.
CMS Leadership Disputes Coverage Loss Estimates
During a comprehensive interview at Aspen Ideas: Health, CMS chief of staff and Deputy Administrator Stephanie Carlton revealed that the agency has not developed internal projections regarding potential insurance coverage losses from the Republican budget bill currently advancing through Congress. This admission comes as healthcare policy experts scrutinize the potential impact of proposed Medicaid and Affordable Care Act changes.
Carlton specifically addressed Congressional Budget Office predictions that nearly 11 million Americans could lose healthcare coverage due to modifications in Medicaid eligibility and ACA provisions. Rather than accepting these projections at face value, she questioned the accuracy of CBO estimates, citing historical precedents where the office’s predictions proved incorrect CMS.
“I think the CBO makes the best estimates possible,” Carlton explained. “They’re really well-meaning folks that have a really hard job, which is estimating the effects of bills that Congress puts before them. They don’t always get it right, and they’ll be the first to tell you that.”
Historical Accuracy Concerns With CBO Projections
To support her skepticism, Carlton referenced past CBO miscalculations, particularly regarding Medicare Advantage enrollment predictions. She highlighted how the CBO incorrectly estimated that Medicare Advantage enrollment would be reduced by half due to ACA changes. This estimate originated from an April 2010 analysis by the CMS chief actuary, which the CBO later cited in March 2012 and was subsequently mentioned during a vice presidential debate.
These historical inaccuracies have become ammunition for Republican lawmakers who have increasingly criticized the CBO during budget discussions. Some Republicans have labeled the office as biased and irrelevant, particularly when defending what they call the “big, beautiful bill.”
Medicaid Work Requirements and Administrative Challenges
The Trump administration’s focus on eliminating waste, fraud, and abuse in government programs extends to proposed Medicaid work requirements. Under the new legislation, eligible Americans would need to demonstrate their continued eligibility for Medicaid coverage through work-related activities.
Carlton emphasized that vulnerable Americans will have adequate opportunities to prove their eligibility under the new work requirements system. However, she declined to provide specific estimates about potential coverage losses if the legislation passes, stating that CMS has not conducted independent projections.
“Obviously it’s a moving target,” she noted. “There’s a House version, there’s a Senate version that’s still being finalized, so we’ll see where they eventually land.”
Learning From Previous Work Requirement Failures
Critics of work requirements point to documented failures in states that have already implemented similar programs. In Arkansas, work requirements resulted in 18,000 people losing healthcare coverage before a federal judge declared the program illegal. Georgia’s implementation faced significant challenges with digital infrastructure, creating increased administrative burdens and higher taxpayer costs.
Despite these setbacks, CMS leadership believes current federal and state governments are better positioned to successfully implement work requirements. The proposed requirements would mandate that enrollees work, participate in job training, or complete approved volunteer assignments for 80 hours monthly.
“It’s a quick timeline that Congress is asking states to comply with, but we really believe the technology is there,” Carlton explained. She added that reporting requirements would differ significantly from previous demonstration projects, incorporating lessons learned from Arkansas and Georgia experiences.
Technology Integration in Healthcare Policy
Technology advancement represents a cornerstone of the Make America Healthy Again (MAHA) strategy. Throughout her interview, Carlton repeatedly emphasized CMS priorities for better technology utilization over the next four years. Department of Health and Human Services Secretary Robert F. Kennedy Jr. has also advocated for increased consumer-facing technology adoption.
During recent House committee testimony, Kennedy announced plans for one of the largest advertising campaigns in HHS history, specifically targeting wearable device adoption among Americans.
“We think wearables are key to the MAHA agenda and my vision is every American is wearing a wearable in four years,” Kennedy stated, noting that wearable device costs represent a fraction of GLP-1 drug expenses for weight management.
Patient Data Access and Healthcare Innovation
CMS plans to expand patient access to healthcare data through various initiatives, including enhancements to Blue Button 2.0. This application programming interface contains Medicare Part A, B, and D data for over 60 million Americans. The agency is working to reduce data access delays that currently limit patients’ ability to retrieve their information quickly.
Future plans include allowing patients greater access to provider data and enabling patients to grant app developers access to comprehensive health data ecosystems. When combined with generative artificial intelligence applications and genetic information, these initiatives could provide highly personalized health recommendations to improve patient outcomes.
Pharmacy Benefit Manager Reform Initiatives
Separately, CMS Administrator Dr. Mehmet Oz has indicated openness to ending traditional rebate practices between drug manufacturers and pharmacy benefit managers. During discussions with alternative pharmacy benefit managers, Dr. Oz suggested that major PBMs might consider abandoning current rebate systems that occur after prescription fulfillment.
According to Bloomberg reports, Dr. Oz believes the three largest PBMs “might actually consider doing away with” the established rebate system, potentially reshaping pharmaceutical pricing structures.
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