Speaker Mike Johnson’s Medicaid claims reignite debate as House bill targets fraud, immigration status, and work requirements.
At a Glance
- Speaker Mike Johnson claims 1.4 million unauthorized immigrants are on Medicaid, but experts say this misrepresents emergency-only coverage rules
- A House-passed reconciliation bill would cut funding to states offering state-funded health coverage to undocumented immigrants
- The Congressional Budget Office projects the bill could reduce Medicaid and CHIP enrollment by over 10 million people by 2034
- Republicans push for work requirements and cite $14 billion in fraud from dual-state Medicaid enrollment
- Critics argue the bill risks reducing healthcare access for low-income Americans and legally enrolled recipients
Who’s Really on Medicaid?
In recent remarks, Speaker Mike Johnson sounded the alarm over what he described as 1.4 million “illegal aliens” on Medicaid. But healthcare policy experts say the claim is misleading. Under federal law, unauthorized immigrants may only receive emergency Medicaid, which constitutes less than 1% of the program’s spending. Most so-called “immigrant Medicaid” recipients are covered under separate, state-funded programs—not federal Medicaid.
“Medicaid is when a state is accepting federal Medicaid dollars in compliance with federal Medicaid coverage rules,” said policy expert Leonardo Cuello. “A state-funded program is by definition not Medicaid.”
Watch a report: Trump seeks to cut Medicaid for 1.4M undocumented immigrants.
The GOP-backed bill would penalize states offering such programs, which some Republican lawmakers have framed as ending Medicaid access for undocumented immigrants—though the policy change doesn’t technically alter federal Medicaid rules.
Fraud or Fiscal Reform?
Speaker Johnson and supporters argue the bill goes beyond immigration. They cite a broader campaign to root out Medicaid fraud and reduce program abuse. “You’re talking about 4.8 million able-bodied workers, young men, for example, who are on Medicaid and not working,” Johnson said. “That is called fraud.”
Dr. Mehmet Oz added that double-enrollment fraud is costing taxpayers billions: “You live in New Jersey, but you move to Pennsylvania, and which state gets your Medicaid? Turns out both states collect money from the federal government.”
Watch a report: Dr. Oz warns Medicaid system needs overhaul.
The Department of Health and Human Services’ Office of Inspector General has identified duplicate enrollments, billing errors, and poor oversight as systemic issues, though there’s debate over how much of that constitutes fraud versus administrative inefficiency.
The Bigger Picture: Work Requirements and Budget Tools
Key among GOP reforms is the push to impose federal work requirements for able-bodied Medicaid recipients—something already implemented in limited ways for programs like SNAP (food stamps). The proposed legislation would make Medicaid eligibility contingent on employment or active job-seeking for non-disabled adults without dependents.
Critics warn that millions could lose coverage under such rules, particularly in states with poor job markets or limited administrative capacity to verify work status.
The vehicle for these reforms is budget reconciliation—a Senate-proof legislative process that bypasses filibusters. Johnson has signaled it will be used aggressively to push Medicaid eligibility and funding changes if Trump is reelected.
Healthcare or Hardship?
While Republicans frame the bill as protecting resources for the truly needy—like seniors, pregnant women, and people with disabilities—the Congressional Budget Office estimates it could reduce Medicaid and CHIP coverage by over 10 million people by 2034. That includes many legally enrolled, low-income Americans who fail new work requirements or live in states affected by federal funding cuts.
“This is about saving Medicaid, not cutting it,” Johnson insisted. But as the Senate considers the bill, the battle lines are clear: fraud prevention and eligibility reform on one side, healthcare access and equity on the other.
