Hawkeye Reporter

Senator Chuck Grassley of Iowa addressed the Senate on Wednesday, outlining proposed reforms in a bill aimed at maintaining and improving the Medicaid program. The bill, referred to as the One Big Beautiful Bill, seeks to implement new integrity measures within Medicaid without reducing benefits for those who need them.

“Contrary to misinformation campaigns seeking to stop common-sense Medicaid reforms from getting to the President’s desk, the One Big Beautiful Bill does not take away Medicaid from those who need it,” Grassley said. “In fact, the bill will strengthen the Medicaid program, so that it can continue to serve the vulnerable populations it was designed to serve.”

Grassley provided context on federal spending for Medicaid under this legislation. He noted that with its passage, total expenditures would exceed $7.4 trillion over ten years. While annual growth in spending would slow compared to projections without reform, costs are still expected to rise by two to three percent annually.

“A sizable majority of Americans support efforts to stop wasteful spending that drains resources for people who truly need this safety net and puts an unfair burden on taxpayers,” he said.

Citing data from 2015 through 2024, Grassley stated that improper federal Medicaid payments totaled more than $560 billion during that period. Some independent estimates place this figure closer to $1.1 trillion.

He referenced his previous work updating the False Claims Act: “Since my reforms were enacted, the federal government has recovered more than $78 billion lost to fraud – much of it in government health care programs – and saved billions more by deterring would-be fraudsters.”

Grassley detailed several provisions included in the new bill:

- Reducing duplicate enrollment.

- Ensuring deceased individuals and providers are not listed as active enrollees.

- Reducing erroneous excess provider payments.

- Requiring states to check eligibility for enrollees twice per year rather than once.

“These provisions alone save over $94 billion, according to the non-partisan Congressional Budget Office (CBO),” he said.

Additional measures focus on verifying premium tax credits received through federal marketplaces and recovering any excessive subsidies distributed due to income discrepancies. Grassley reported discovering that over 40 percent of excessive subsidy payments since 2016—totaling more than $10 billion—had not been recouped because of safe harbor rules.

“This excessive waste will end in this bill and save over $60 billion, according to CBO,” he said.

The proposal also delays regulations affecting nursing homes and state programs. Grassley advocated for oversight but argued against federally mandated staffing requirements, suggesting collaboration with providers instead.

“Delaying the nursing home staffing mandate rule and so-called ‘streamlining eligibility rule’ saves over $187 billion, according to CBO,” he added.

The legislation further includes restrictions on access for individuals without verified citizenship or immigration status: “We prohibit federal financial support under Medicaid for individuals who don’t have verified citizenship, nationality or satisfactory immigration status.” This measure is projected by CBO estimates to save over $163 billion.

Grassley concluded by stating: “As I’ve illustrated, we establish commonsense program integrity measures and stop wasteful spending. We delay costly regulations that hurt patients and providers, especially those living in rural America. We stop Medicaid and Medicare resources from going to illegal aliens. Most importantly, we preserve the Medicaid program for those who most need it.”