Fact-Checking Rouzer: Medicaid Cuts Disguised as 'Reform'

David Rouzer’s recent comments on the GOP’s Budget Resolution and Medicaid funding deserve a deeper dive. His rhetoric about eliminating “waste, fraud, and abuse” to protect legitimate recipients sounds nice—but when you follow the money and check the facts, the story shifts.

Rouzer claims that the House Budget Resolution doesn’t cut Medicaid benefits but instead proposes $880 billion in “common sense reforms.” That number represents over 10% of projected federal Medicaid spending for the next decade. According to the Kaiser Family Foundation, this scale of savings would almost certainly require eligibility cuts, benefit reductions, or capped federal funding—none of which leave recipients untouched.

He leans heavily on a GAO report stating that Medicaid had an estimated $81 billion in improper payments in FY2022. But here’s the nuance Rouzer leaves out: “improper payments” doesn’t mean fraud. It includes overpayments, underpayments, and payments lacking adequate documentation. Many are simple administrative errors—not evidence of malicious abuse.

Yet Rouzer uses this flawed interpretation to suggest that eliminating all improper payments—something no agency has ever accomplished—would save $810 billion over 10 years. That’s a convenient narrative, but it’s not supported by reality. As the GAO itself notes, Medicaid has been on its “high-risk list” since 2003 due to its size and complexity. It’s not a matter of snapping fingers and magically fixing $81 billion annually.

The federal government has long grappled with improper payments across all programs. In FY2023 alone, it reported over $236 billion in improper payments, and not all of that comes from Medicaid. This is a systemic issue—singling out Medicaid while claiming it can be “reformed” painlessly is misleading.

The Budget Resolution Rouzer supports doesn’t specify protections for beneficiaries. It simply tells the Energy and Commerce Committee to find $880 billion in savings. Without specifics, those savings could come from capped allotments to states (like block grants), tightening eligibility, or reducing provider payments—measures that historically lead to service reductions and administrative delays.

So when Rouzer insists, “The goal is to strengthen, secure, and sustain Medicaid,” we need to ask: strengthen it for whom? Because if the only tangible outcome is cost savings, and the only means are cuts, the people most in need of care are likely the ones who’ll pay the price.

Medicaid is the primary source of health coverage for more than 82 million Americans, especially children, people with disabilities, and seniors in long-term care. Reforms should be evidence-based, targeted, and transparent—not masked behind vague language and massive dollar signs.

We’ve heard this song before: claim to protect while quietly dismantling. If lawmakers truly want to reduce waste, they should invest in program integrity, support frontline administrative staff, and streamline eligibility systems—not pass vague mandates for massive cuts and call it reform.

Bottom line: Rouzer’s “no-cuts” promise doesn’t hold up to scrutiny. The numbers, history, and expert analysis all point to a budget blueprint that, if enacted, would put essential care out of reach for many of North Carolina’s most vulnerable residents. That’s not strengthening Medicaid. That’s abandoning it.

Hold Rouzer accountable. Call 202-225-2731 and DEMAND ANSWERS!