When Senate Minority Leader Chuck Schumer (D-N.Y.) took to the Senate floor July 30, he laid out the cornerstone of congressional Democrats’ strategy for the possible federal government shutdown that became a reality at midnight on September 30.

“These programs provide healthcare and dignity for 134 million Americans. They are a lifeline. They are sacrosanct. But today, Medicare and Medicaid are facing their greatest threat because Donald Trump and Congressional Republicans want to decimate these programs,” Schumer told the Senate. “The Republicans’ ‘Big, Ugly Betrayal,’ their so-called BBB, codified the largest cut to Medicaid in history. Imagine calling a bill beautiful that cuts Medicaid more than any other bill in the past. How cruel. How heartless.”

“How much of a bubble are our Republican friends in, not knowing what people go through to try to get decent healthcare? It included over $1 trillion in healthcare cuts that will rip away health care from more than 15 million Americans, all to pay for tax breaks to billionaires,” Schumer claimed.

That claim of unprecedented cuts in federal health care spending imposed by President Donald Trump’s One Big Beautiful Bill Act (OBBBA) of 2025 remains the centerpiece of Democratic shutdown strategy: Unless Republicans agree to cancel those alleged health care spending cuts, Democrats refuse to agree to reopen the government at current spending levels set by President Joe Biden in his final year in the Oval Office.

By contrast, House and Senate Republicans’ position is simple: Keep the government open for seven weeks to allow Members to complete work on nine outstanding Fiscal Year 2026 appropriation bills. The GOP’s continuing resolution (CR) to do so passed the House but has failed multiple times in the Senate because the upper chamber requires 60 votes for spending measures. As a result, the 52 Republican senators backing it (Kentucky Republican Rand Paul is voting with Schumer) must be joined by eight Democrats. Only three have done so as the GOP CR was defeated four times in the first few days of the shutdown.

But analyses by think tank health care experts from across the ideological spectrum suggest Schumer has put Democrats in a position based on a misrepresentation of the facts about federal health care spending in general and the impact of Trump’s OBBBA on Medicare, Medicaid, and related programs.

What nobody contests is the immensity of health care spending in the national government’s social safety net in comparison to the rest of the nearly $7 trillion annual federal budget. Open the Books (OTB) expressed it this way in an October 2 “reality check” data analysis:

“The amount of money that flows through programs like Medicare and Social Security is mind-bogglingly large and dwarves the savings claimed by this year’s recissions actions and DOGE cuts. As a point of clarity, the supposed ‘cuts’ to Medicaid that are part of the shutdown debate are not cuts at all but a slowdown in the rate of the growth in spending.

“Of the $6.9 trillion in spending from 2024, $912 billion went to Medicare and $1.5 trillion went to Social Security. Defense accounted for $872 billion while interest payments on the national debt exceeded our defense budget for the first time and topped $892 billion.”

The most basic fact misrepresented by Schumer is that federal health care spending is not being cut; the rate is increasing less quickly under OBBBA than previously projected. In other words, federal taxpayers continue to spend more on health care but not quite as much more as was planned by Trump’s predecessor.

As a Paragon Health Institute report shows, the Biden administration exploded federal health care spending with “temporary” health care tax credits during the COVID pandemic, changes in Medicaid and Medicare regulations that enabled rapidly increasing enrollment, and indirect payment of health care benefits through states, especially California.

The Congressional Budget Office (CBO) Medicaid annual spending projection at the outset of the Biden administration in 2021 put the program’s expected spending in 2025 at approximately $540 billion; by the end of the Biden era in 2025, that annual total was more than $650 million.

The 10-year CBO projection in 2021 was total Medicaid spending in 2034 at $870 billion, but by 2025, the total was almost $1 trillion. The huge increases under Biden were a product of three factors, according to Paragon:

“Medicaid increased much more than projected for three primary reasons. First, the Biden administration maintained the COVID public health emergency for much longer than expected — leaving a legacy of higher enrollment in the program. Second, the Biden administration took several actions that made it more difficult for states to remove ineligible enrollees.

“And third, the Biden administration exacerbated state Medicaid money laundering techniques. This led to a substantial increase in corporate welfare in the program, most notably escalating revenues through the provider tax scam so states could reward hospitals and insurers with excessive Medicaid rates through state-directed payments.”

Thus, Medicaid projected spending will increase under Trump’s OBBBA from $540 billion in 2025 to $840 billion in 2034, which compares with the Biden projection of $660 billion in 2025 to $980 billion in 2034. In other words, annual Medicaid spending will increase by approximately $300 billion under Trump based on the CBO’s 10-year projection versus an increase of approximately $320 billion under the Biden CBO 10-year projection.

The OBBBA does require significant programmatic changes in Medicaid, but, as the liberal Urban Institute explained in an August analysis, they don’t begin to take effect until 2027. Those include more frequent eligibility checks by states, which administer the program, work or schooling requirements, and ending states’ ability to raise taxes on providers and then seeking federal matching funds. Higher shared out-of-pocket costs on beneficiaries don’t kick in until 2029.

A key factor in the future of Medicaid spending is how effective the OBBBA changes are against the rampant waste, fraud, and abuse that have afflicted federal health care spending on Medicare and Medicaid for decades. As OTB put it in that October 2 data analysis:

“Health care spending in the United States is grossly inefficient and fraudulent at a large scale. In June, the Department of Justice charged 324 defendants for defrauding Medicare of $14.6 billion. Meanwhile, last year, the Wall Street Journal reported that insurers ‘pocketed $50 billion from Medicare for diseases no doctor treated.’

“Open the Books has consistently exposed improper payments in federal health care programs. [The Center for Medicare and Medicaid Services] CMS estimates it made $140 billion in improper payments in 2024 alone. Health care inefficiencies go beyond government programs. The Peter Peterson Foundation estimates that 25 percent of all health care spending in the United States, nearly $935 billion, is wasteful.”

And earlier this year, the Trump White House issued a fact sheet that captured the most illustrative facts:

• “FACT: The U.S. Government Accountability Office estimates taxpayers lose as much as $521 billion annually to fraud — and most of that is within entitlement programs, such as Medicare and Medicaid.
• “FACT: Over the past two decades, the federal government has made an estimated $2.7 trillion in ‘improper payments’ — the majority of which come in the form of ‘payments to deceased individuals or those who no longer [are] eligible for government programs.’
• “FACT: The Social Security Administration made an estimated $72 billion in improper payments between 2015 and 2022.
• “FACT: The Centers for Medicare & Medicaid Services estimated it made $140+ billion in improper payments in 2024 alone.”

Schumer has said nothing about how he would end such costly waste and fraud, even as the federal government shutdown enters its second week.