Centers for Medicare & Medicaid Services (CMS) chief of staff and Deputy Administrator Stephanie Carlton says the agency hasn’t produced internal projections of how many people could lose health insurance coverage as a result of the passage of Republicans' budget bill rolling through Congress.
During an interview at Aspen Ideas: Health, she downplayed estimates from the Congressional Budget Office (CBO) predicting nearly 11 million Americans would lose coverage from changes to Medicaid and the Affordable Care Act (ACA).
“I think the CBO makes the best estimates possible,” said Carlton. “[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.”
She said in the past the CBO wrongly estimated Medicare Advantage enrollment would be cut in half due to changes to the ACA. That estimate came from an analysis (PDF) by the CMS chief actuary in April 2010, whose work was later cited (PDF) by the CBO in March 2012 and mentioned in a vice presidential debate.
Carlton reiterated President Donald Trump's administration is merely focused on rooting out waste, fraud and abuse, and that eligible and vulnerable Americans will have ample opportunity to prove they belong on Medicaid under new work requirements. But she declined to say how many people would lose coverage if the legislation passes, if she’s confident the CBO is wrong.
“I think we’ve not done our own estimates,” she said. “Obviously it’s a moving target. There’s a House version, there’s a Senate version that’s still being finalized, so we’ll see where they eventually land.”
Some Republicans have slammed the CBO during discussions about the “big, beautiful bill,” calling the office biased and irrelevant.
Opponents to work requirements—which state enrollees must either work, engage in job retraining or complete approved volunteer assignments for 80 hours per month—say the concept has already proved to be a failure. In Arkansas, work requirements led to 18,000 people losing coverage and a judge deeming the program to be illegal. In Georgia, the digital infrastructure in place has increased administrative burden and been costly for taxpayers.
Now, the CMS believes the federal and state governments are better equipped to enforce and carry out work requirements.
“It's a quick timeline that Congress is asking states to comply with, but we really believe the technology is there,” she said, adding some people will be able to earn exemptions to keep their coverage. “I think the reporting requirements will be very, very different than we've seen in some of the demonstrations or pilots that we've seen in some states like Arkansas and Georgia, and we learned a lot from those. If you want to get benefits, we’re making it easy for folks to do that. We’re just asking them to engage in their communities."
Carlton did not give an estimate on how many people today should be kicked off coverage for not adequately engaging in their community.
Technology a cornerstone of MAHA's strategy
In the wide-ranging interview, Carlton frequently noted a priority of the CMS during the next four years is better leveraging technology. Department of Health and Human Services Secretary Robert F. Kennedy Jr. also told a House committee Tuesday he wants Americans to embrace consumer-facing technology more than ever.
“We’re about to launch one of the biggest advertising campaigns in HHS history to encourage Americans to use wearables,” he told lawmakers. “They can take responsibility. They can see, as you know, what food is doing to their glucose levels, their heart rates and a number of other metrics as they eat it, and they can begin to make good judgment about their diet, about their physical activity, about the way they live their lives.
“We think wearables are key to the MAHA agenda and my vision is every American is wearing a wearable in four years,” he added, before noting the cost investment of wearables is a fraction of the cost of GLP-1 drugs for weight loss.
The CMS is hoping to make more data sets available to patients, said Carlton. This includes Blue Button 2.0, an application programming interface containing Medicare Part A, B and D data for more than 60 million Americans. The agency is working to reduce the lag that slows a person’s ability to access these data.
The agency also plans on allowing patients greater access to data from providers and giving patients the ability to grant access for apps to plug into a “data ecosystem.” When coupled with generative AI use cases and genetic information, she said, patients will get highly personalized health recommendations to improve outcomes.
Separately, CMS Administrator Mehmet Oz, M.D., told alternative pharmacy benefit managers Tuesday he is open to ending the practice of drug manufacturers sending PBMs rebates after prescriptions are filled. He said the big three PBMs “might actually consider doing away with” the status quo rebate system, reported Bloomberg.