President Donald Trump on Sept. 22, 2025, in a press conference

Obstetricians have long advised their pregnant patients that Tylenol is the safest option to reduce fever or pain. President Donald Trump stood before a national audience on Sept. 22 and contradicted that.

“Don’t take Tylenol,” Trump said during an hourlong White House press conference that included his leading health appointees. “There’s no downside. Don’t take it. You’ll be uncomfortable. It won’t be as easy, maybe, but don’t take it. If you’re pregnant, don’t take Tylenol.”

His advice has no clear basis in research and contradicts long-standing science and medical guidance. And there are downsides to avoiding acetaminophen, the active ingredient in Tylenol, when it is needed. Untreated fever during pregnancy can harm a mom and baby, medical experts warn. Untreated pain is a drawback, too.

Trump’s advice is based onÌýÌýthat acetaminophen use during pregnancy increases a child’s risk of autism — a stance that he and Robert F. Kennedy Jr., the longtime anti-vaccine activist who is now Trump’s Health and Human Services secretary, touted throughout the announcement.

Although some studies have found that children exposed to acetaminophen during pregnancy were more likely to have autism symptoms or be diagnosed with autism, other studies found no such association. Association isÌýnot the same as causation. That means that research showing an association between Tylenol and autism doesn’t mean the medicationÌýcausedÌý²¹³Ü³Ù¾±²õ³¾.

The Food and Drug Administration’sÌýÌýon the topic said as much.

“It is important to note that while an association between acetaminophen and neurological conditions has been described in many studies, a causal relationship has not been established and there are contrary studies in the scientific literature,” it said. “It is also noted that acetaminophen is the only over-the-counter drug approved for use to treat fevers during pregnancy, and high fevers in pregnant women can pose a risk to their children.”

The White House declined to provide data showing there are no downsides to avoiding Tylenol use. It provided a statement from White House press secretary Karoline Leavitt in which she cited “a connection” between acetaminophen use during pregnancy and autism as the reason for the guidance.

“The Trump Administration does not believe popping more pills is always the answer for better health,” Leavitt said.

Leavitt also shared on the social platform XÌýÌýfrom Andrea Baccarelli, dean of the Harvard T.H. Chan School of Public Health, who said his research “found evidence of an association” between prenatal acetaminophen exposure and neurodevelopmental disorders in children. Baccarelli warned of the risks of high fever and advocated for cautious acetaminophen use during pregnancy — not blanket avoidance.

The Risks of Untreated Fever During Pregnancy

Maternal and prenatal care groups, including theÌýÌýand theÌý, support the use of acetaminophen during pregnancy.

They Trump’s remarks.

There’s good reason for that: Acetaminophen is one of few safe options pregnant patients have to treat fever and manage pain.

Trump acknowledged this during the press conference.

“Sadly, first question: What can you take instead?” he said. “There’s not an alternative.” He said that other medicines such as aspirin and Advil “are absolutely proven bad.”

In 2020,ÌýÌýadvised that nonsteroidal anti-inflammatory drugs, or NSAIDs, which include common pain relievers such as Advil (also known as ibuprofen), Aleve (or naproxen), and aspirin shouldn’t be used during pregnancy after 20 weeks of gestation.

Those medications aren’t recommended during pregnancy because they could harm fetal development, Salena Zanotti, a Cleveland Clinic obstetrician and gynecologist,Ìý.

Untreated fevers during pregnancy come with their own risks.

±õ²ÔÌý, Steven Fleischman, the association’s president, said the Trump administration’s anti-Tylenol advice sends a “harmful and confusing message” to pregnant patients.

“Maternal fever, headaches as an early sign of preeclampsia, and pain are all managed with the therapeutic use of acetaminophen, making acetaminophen essential to the people who need it,” Fleischman said.

Christopher Zahn, ACOG’s chief of clinical practice,ÌýsaidÌýpregnant patients should talk with their doctors about the benefits and risks of available treatments. Avoiding treating medical conditions that call for acetaminophen is “far more dangerous than theoretical concerns based on inconclusive reviews of conflicting science,” Zahn said.

Similarly, the Society for Maternal-Fetal Medicine said that untreated fever and pain during pregnancy carry “significant maternal and infant health risks.”

“Untreated fever, particularly in the first trimester, increases the risk of miscarriage, birth defects, and premature birth, and untreated pain can lead to maternal depression, anxiety, and high blood pressure,” itÌýsaid.

Research on these risks goes back more than a decade: AÌýÌýof available evidence on fevers during pregnancy found “substantial evidence” that maternal fever might negatively affect fetal health in the short and long term, including increasing the risks of neural tube defects, congenital heart defects, and oral clefts.

The Centers for Disease Control and Prevention ÌýthatÌýfeverÌýduring pregnancy to including birth defects.

, aÌýnonprofit that provides information about the benefits and risks of medications and other exposures during pregnancy and while breastfeeding,ÌýwarnsÌýthat a fever-caused increase in body temperature during early pregnancy , including a small chance for birth defects. Some studies Ìýthat fevers are associated with increased chances of a child having attention-deficit/hyperactivity disorder or autism.

Kenvue, Tylenol’s parent company, said acetaminophen is “the safest pain reliever” option available throughout pregnancy.

“Without it, women face dangerous choices: suffer through conditions like fever that are potentially harmful to both mom and baby or use riskier alternatives,” the company’s statement said. “High fevers and pain are widely recognized as potential risks to a pregnancy if left untreated.”

Tylenol, responding to the news attentionÌý, cited the ACOG position on acetaminophen use during pregnancy and highlighted a section of the Tylenol label that encourages people who are pregnant or breastfeeding to talk to a health professional.

“Your doctor is the best person to advise whether taking medication is right for you based on your specific health needs,” the video said.

Our Ruling

Trump said “there’s no downside” to avoiding Tylenol use during pregnancy.

Researchers have long documented health risks associated with untreated fevers during pregnancy. They can lead to increased risk of birth defects and other pregnancy complications, particularly in the first trimester. Untreated pain can lead to maternal depression and anxiety. These risks outweigh conflicting research into possible links between the drug and autism, according to maternal and fetal health organizations.

Doctors and researchers have found acetaminophen to be a safe pain and fever reducer during pregnancy. By comparison, other over-the-counter pain relievers come with documented risks, making Tylenol one of the only options available to pregnant mothers.

We rate Trump’s statement Pants on Fire!

Sources

Emailed statement from Kenvue, Sept. 22, 2025

Emailed statement from the American College of Obstetricians and Gynecologists, Sept. 22, 2025

Emailed statement from the Society for Maternal-Fetal Medicine, Sept. 22, 2025

Emailed statement from White House press secretary Karoline Leavitt, Sept. 22, 2025

White House press secretary Karoline Leavitt’sÌý, Sept. 22, 2025

±Ê´Ç±ô¾±³Ù¾±¹ó²¹³¦³Ù,Ìý“,” Sept. 15, 2025

°Õ²â±ô±ð²Ô´Ç±ôÌý, Sept. 22, 2025

Cleveland Clinic, “” March 17, 2025

Email interview with Christopher Zahn, American College of Obstetricians and Gynecologists’ chief of clinical practice, Sept. 10, 2025

Centers for Disease Control and Prevention, “,” Sept. 17, 2024

Centers for Disease Control and Prevention, “,” June 25, 2024

Centers for Disease Control and Prevention, “,” June 17, 2024

MotherToBaby, “,” Feb. 1, 2025

Food and Drug Administration, “,” Jan. 19, 2016

Food and Drug Administration, “,” Sept. 22, 2025

American Journal of Obstetrics & Gynecology, “,” March 2017

American College of Obstetricians and Gynecologists,Ìý“,” accessed Sept. 22, 2025

Vogue, “,” Sept. 22, 2025

The HIPAA Journal, “,” Jan. 22, 2025

Pediatrics, “,” March 1, 2014

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But should people extend this same skepticism to pediatricians who advise vaccines for children? Health and Human Services Secretary Robert F. Kennedy Jr. said financial bonuses are driving such recommendations.

“Doctors are being paid to vaccinate, not to evaluate,” Kennedy said in an Ìýposted on the social platform X. “They’re pressured to follow the money, not the science.”

Doctors and public health officials have beenÌýÌýÌý.

A close look at the process by which vaccines are administered shows pediatric practices make little profit —Ìýand sometimes lose money —Ìýon vaccines. Four experienced pediatricians told us evidence-based science and medicine drive pediatricians’ childhood vaccination recommendations. Years of research and vaccine safety data also bolster these recommendations.

Christoph Diasio, a pediatrician at Sandhills Pediatrics in North Carolina, said the argument that doctors profit off vaccines is counterintuitive.

“If it was really about all the money, it would be better for kids to be sick so you’d see more sick children and get to take care of more sick children, right?” he said.

Is Your Pediatrician Profiting Off Childhood Vaccines?

It costs money to stock, store, and administer a vaccine.

Pediatricians sometimes store thousands of dollars’ worth of vaccines in specialized medical-grade refrigeration units, which can be expensive. They pay to insure vaccines in case anything happens to them. Some practices buy thermostats that monitor vaccines’ temperature and backup generators to run the refrigerators in the event of a power outage. They also pay nursing staff to administer vaccines.

“Vaccines are hugely expensive,” said Jesse Hackell, a retired general pediatrician and the chair of the American Academy of Pediatrics’ Committee on Pediatric Workforce. “We lay out a lot of money up front.”

When a child with private insurance gets a vaccine, the pediatrician is paid for the vaccine product and its administration, Hackell said.

Many pediatricians also participate in a Ìýthat provides vaccines free of charge to eligible children whose parents can’t afford them. Participating in that programÌýÌýbecause even though they get the vaccines for free, pediatricians store and insure them, and Medicaid reimbursements often don’t cover the costs. But many choose to participate and provide those vaccines anyway because it’s valuable for patients, Hackell said.

When discussing vaccine recommendations, pediatricians don’t make different recommendations based on how or if a child is insured, he said.

Jason Terk, a pediatrician at Cook Children’s Health Care System in Texas, said a practice’s ability to make a profit on vaccines depends on its situation.

Terk’s practice is part of a larger pediatric health care system, which means it doesn’t lose money on vaccines and makes a small profit, he said. Some small independent practices might not be able to secure terms with insurance companies that adequately pay for vaccines.

Suzanne Berman, a pediatrician at Plateau Pediatrics, a rural health clinic in Crossville, Tennessee, said that 75% of her practice’s patients have Medicaid and qualify for the Vaccines for Children program, which the practice loses money on. When she factored in private insurance companies’ payments, she estimated her practice roughly breaks even on vaccination.

“The goal is to not lose money on vaccines,” Terk said.

So What’s Driving Your Pediatrician’s Vaccine Recommendations?

Pediatricians typically recommend parents vaccinate their children following either the American Academy of Pediatrics’ or the Centers for Disease Control and Prevention’s recommended vaccine schedule.

Diasio said the driving force behind pediatric vaccine recommendations is straightforward: Trained physicians have seen kids die of vaccine-preventable diseases.

“I saw kids who died of invasive pneumococcal disease, which is what the Prevnar vaccine protects against,” Diasio said. “We remember those kids; we wouldn’t wish that on anyone.”

Still, your pediatrician will consider your child’s health holistically before making vaccine recommendations.

For example, a few children —Ìý less than 1% — have medical reasons they cannot receive a particular vaccine, Hackell said. This could include children with severe allergies to certain vaccine components or children who are immunosuppressed and could be at higher risk from live virus vaccines such as the measles or chickenpox vaccine.

“When people have questions about whether their kids should get vaccines, they really need to talk to their child’s doctor,” Diasio said. “Don’t get lost down a rabbit hole of the internet or on social media, which is programmed and refined to do whatever it can to keep you online longer.”

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En algún momento, puede que recuerden las vacunas contra la gripe. Vacunarte. Vacunarlos. ¿Debería hacerlo? ¿Puedo hacerlo? ¿Sigue vigente?

En medio de las polémicas políticas sobre las vacunas y las entidades del gobierno que las supervisan, es comprensible preguntarse qué ocurre con la vacuna contra la gripe de la temporada 2025-26.

En resumen: Sí, la vacuna contra la gripe sigue vigente. Y cuatro médicos con los que hablamos recomendaron vacunarse este año.

Las siguientes son respuestas a algunas preguntas frecuentes:

He oído que la administración Trump podría estar cambiando las recomendaciones sobre vacunas. ¿Aplica esto a la vacuna contra la gripe?

No ha habido cambios sustanciales en la recomendación del gobierno federal sobre la vacuna contra la gripe: los (CDC) siguen diciendo que las personas de deberían vacunarse contra la gripe cada año.

Esto significa que la mayoría de las aseguradoras la cubrirán y que pronto estará ampliamente disponible.

El Secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., quien se ha opuesto a las vacunas, coincidió en que la mayoría de las personas . Siguió una recomendación de la junta que asesora al gobierno federal sobre políticas de vacunación; el que él mismo reemplazó por completo.

El panel votó en contra de recomendar las vacunas multidosis contra la gripe que contenían timerosal, un conservante que de la mayoría de las vacunas, incluidas la mayoría de las vacunas contra la gripe.

¿Quiénes no deben vacunarse contra la gripe?

Los médicos reconocieron que siempre hay excepciones a las directrices generales. Por ejemplo, las personas con a los componentes de la vacuna contra la gripe no deben vacunarse con dosis que contengan esas sustancias.

Deberías hablar sobre tu estado de salud con tu médico.

¿La vacuna contra la gripe de esta temporada es diferente a la de la temporada pasada?

Sí. La vacuna contra la gripe se actualiza siempre para la próxima temporada de gripe, pero los cambios . Al igual que la del año pasado, la vacuna de este año se conoce como una vacuna de tres componentes o que protege contra tres virus de la gripe: dos virus de la gripe A y uno de la gripe B.

Esta vez, la vacuna se modificó para combatir una cepa específica del virus de la gripe A/H3N2 que se prevé que circule esta temporada, explicó Ryan Maves, profesor de medicina en la Universidad de Wake Forest y miembro de la Infectious Disease Society of America. Estos cambios con las de la Organización Mundial de la Salud (OMS).

¿Cuál es el mejor momento para vacunarse?

Septiembre, octubre o principios de noviembre. Esto le da tiempo al cuerpo para protectores al comienzo de la temporada de gripe y garantiza que la protección no disminuya antes de que termine.

En el país, la infección por influenza suele alcanzar su punto máximo en febrero, por lo que conviene asegurarse de estar vacunado y de que la protección se mantenga sólida durante febrero y marzo, según explicó William Schaffner, profesor de enfermedades infecciosas en el Centro Médico de la Universidad de Vanderbilt.

¿La vacuna contra la gripe de esta temporada garantiza la protección contra la cepa de influenza que circula?

¿Garantiza la protección total? No.

¿Reduce el riesgo de muerte? Sí.

Al igual que la vacuna contra covid-19, las vacunas contra la gripe son las más eficaces para “protegernos de las consecuencias más graves de la influenza”, afirmó Schaffner. Esto significa que son eficaces para prevenir que una persona tenga que ser hospitalizada a causa de la gripe, y para rprevenir la muerte.

“Una vacuna contra la gripe puede no garantizar una protección perfecta contra la gripe, pero omitirla simplemente garantiza que no se tendrá ninguna protección”, afirmó Benjamin Lee, pediatra especialista en enfermedades infecciosas del Hospital Infantil de la Universidad de Vermont y profesor asociado de la Facultad de Medicina Larner de la universidad.

¿Estará disponible la vacuna contra la gripe este año?

Todo indica que sí.

La Administraci’on de Drogas y Alimentos (FDA) Ìýemitió sus recomendaciones sobre la fórmula a utilizar a los fabricantes de vacunas el 13 de marzo, con la suficiente antelación como para que la agencia esperara que hubiera un . Las personas y los lugares que administran las vacunas contra la gripe deberían recibirlas pronto, normalmente a partir de septiembre, según Flor Muñoz, profesora asociada de pediatría y enfermedades infecciosas del Baylor College of Medicine.

He oído que Kennedy canceló para el desarrollo de vacunas. ¿Podría esto afectar a futuras vacunas contra la gripe?

Kennedy anunció que cancelaba la financiación para el desarrollo de la vacuna de ARNm. Algunas empresas vacunas combinadas de ARNm contra la gripe y covid-19, pero actualmente no hay vacunas de ARNm contra la gripe aprobadas.

Aun así, expertos afirmaron que los cambios del gobierno federal —recortes de financiación, de vacunas, de los procedimientos existentes— están aumentando la incertidumbre.

FUENTES

Entrevista con Flor Muñoz, profesora asociada de pediatría y enfermedades infecciosas en la Facultad de Medicina de Baylor, 4 de agosto de 2025.

Entrevista con Ryan Maves, profesor de medicina en la Universidad de Wake Forest y director médico del Programa de Trasplantes de Enfermedades Infecciosas de la Universidad de Wake Forest, 4 de agosto de 2025.

Entrevista con William Schaffner, profesor de enfermedades infecciosas en el Centro Médico de la Universidad de Vanderbilt, 4 de agosto de 2025.

Entrevista por correo electrónico con Benjamin Lee, pediatra especializado en enfermedades infecciosas en el Hospital Infantil de la Universidad de Vermont y profesor asociado en la Facultad de Medicina Larner de la Universidad de Vermont, 3 de agosto de 2025.

PolitiFact, “,” June 26, 2025.

Pharmacy Times,Ìý,” June 26, 2025.

CNN, “,” March 13, 2025.

PolitiFact, “” June 18, 2025.

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Food and Drug Administration, “,” March 13, 2025.

The Infectious Diseases Society of America, “,” 2025.

Pharmacy Times, “,” April 2, 2025.

CIDRAP, “,” March 14, 2025.

U.S. Centers for Disease Control and Prevention, “,” Sept. 17, 2024.

U.S. Centers for Disease Control and Prevention, “,” July 2, 2025.

U.S. Centers for Disease Control and Prevention, “,” July 2, 2025.

U.S. Centers for Disease Control and Prevention, “Trivalent Influenza Vaccines,” Sept. 10, 2024.

CNN, “,” Feb. 28, 2025.

The Associated Press, “,” Aug. 5, 2025.

NBC News, “,” May 27, 2025.

NBC News, “” Feb. 28, 2025.

U.S. Centers for Disease Control and Prevention, “,” May 2, 2025.

U.S. Centers for Disease Control and Prevention, “,” Aug. 8, 2025.

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UnitedHealthcare, “,” accessed Aug. 11, 2025.

U.S. Centers for Disease Control and Prevention, “,” accessed Aug. 11, 2025.

U.S. Centers for Disease Control and Prevention, “,” accessed Aug. 11, 2025.

Cleveland Clinic, “” Aug. 5, 2025.

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This story can be republished for free (details).

Somewhere, at some point, you might remember flu shots. Get your flu shot. Get their flu shots. Or should you? Can you? Is that still a thing?

Amid political chatter about vaccines and the government entities that oversee them, it’s understandable to wonder where all this leaves the 2025-26 flu vaccine.

In short: Yes, the flu shot is still a thing. And four doctors we spoke to said they recommend you get your flu shot this year. (See the source list below this article.)

Here are some answers to common questions:

Q: I heard the Trump administration could be changing vaccine recommendations. Does that apply to the flu vaccine?

There have been no substantial changes to the federal government’s flu vaccine recommendation: The that people and up should get an annual flu vaccine.

That means most insurers will cover it, and it should soon be widely available.

Health and Human Services Secretary Robert F. Kennedy Jr., who has opposed vaccines, . He followed a recommendation from the board that advises the federal government on vaccine policy; Kennedy replaced the members with his own.

The panel voted against recommending multidose flu shots that contained the preservative thimerosal, but the preservative had from most vaccines, including most flu shots.

Q: Who should not get the flu shot?

Doctors acknowledged there are always exceptions to broad guidance. For example, people with to flu vaccine components should not get vaccines that contain those components.

You should discuss your health situation with your physician for personalized guidance.

Q: Is this season’s flu shot different from last season’s?

Yes. The flu shot was updated for the upcoming flu season, but the changes . Like last year’s flu shot, this year’s vaccine is known as a three-component or that protects against three influenza viruses — two influenza A viruses and one influenza B virus.

This season’s vaccine was altered to target a specific strain of the influenza A/H3N2 virus expected to circulate this season, said Ryan Maves, a professor of medicine at Wake Forest University and a member of the Infectious Diseases Society of America. Those with what the World Health Organization .

Q: When is the best time to get vaccinated?

September, October, or early November. This allows your body time its protective antibodies as flu season begins and ensures your protection doesn’t wane before it ends.

In the U.S., influenza infection typically peaks in February, so you want to make sure you’re vaccinated and your protection is still strong through February and into March, said William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.

Q: Is this season’s flu vaccine guaranteed to protect against the influenza strain that’s circulating?

Guarantee all protection? No.

Reduce risk of death? Yes.

Similar to the covid-19 vaccine, flu vaccines are best at “protecting us from the most severe consequences of influenza,” Schaffner said. That means the flu vaccine is most effective at keeping people out of the hospital or the intensive care unit and keeping people from dying.

“A flu vaccine may not guarantee perfect protection against the flu, but skipping your flu shot simply guarantees you’ll have no protection at all,” said Benjamin Lee, a pediatric infectious diseases physician at the University of Vermont Children’s Hospital and an associate professor at the University of Vermont Larner College of Medicine.

Q: Will the flu shot be readily available this year?

All signs point to yes.

The FDA passed its formula recommendations to vaccine manufacturers March 13 — early enough that the agency expected there would be “.” The people and places that administer flu shots should have them soon, typically beginning in September, said Flor Muñoz, a Baylor College of Medicine associate professor of pediatrics and infectious diseases.

Q: I heard Kennedy canceled for vaccine development. Could this affect future flu vaccines?

Kennedy announced the for mRNA vaccine development. Some companies have been shots, but there are currently no approved mRNA flu vaccines.

Still, experts said the federal government’s changes — funding cuts, , from existing procedures — are increasing uncertainty.

SOURCES

Interview with Flor Muñoz, an associate professor of pediatrics and infectious diseases at Baylor College of Medicine, Aug. 4, 2025.

Interview with Ryan Maves, a professor of medicine at Wake Forest University and the medical director of the transplant Infectious Diseases Program at Wake Forest University, Aug. 4, 2025.

Interview with William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, Aug. 4, 2025.

Email interview with Benjamin Lee, a pediatric infectious diseases physician at the University of Vermont Children’s Hospital and an associate professor at the University of Vermont Larner College of Medicine, Aug. 3, 2025.

PolitiFact, “,” June 26, 2025.

Pharmacy Times, ,” June 26, 2025.

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PolitiFact, “” June 18, 2025.

World Health Organization, “,” Feb. 28, 2025.

Food and Drug Administration, “,” March 13, 2025.

The Infectious Diseases Society of America, “,” 2025.

Pharmacy Times, “,” April 2, 2025.

CIDRAP, “,” March 14, 2025.

U.S. Centers for Disease Control and Prevention, “,” Sept. 17, 2024.

U.S. Centers for Disease Control and Prevention, “,” July 2, 2025.

U.S. Centers for Disease Control and Prevention, “,” July 2, 2025.

U.S. Centers for Disease Control and Prevention, “Trivalent Influenza Vaccines,” Sept. 10, 2024.

CNN, “,” Feb. 28, 2025.

The Associated Press, “,” Aug. 5, 2025.

NBC News, “,” May 27, 2025.

NBC News, “” Feb. 28, 2025.

U.S. Centers for Disease Control and Prevention, “,” May 2, 2025.

U.S. Centers for Disease Control and Prevention, “,” Aug. 8, 2025.

MedPage Today, “,” Aug. 7, 2025.

The Associated Press, “,” May 7, 2025.

U.S. Department of Health and Human Services, “,” Aug. 5, 2025.

CBC, “,” Aug. 8, 2025.

NBC News, “,” Feb. 27, 2025.

Louisiana Blue, “,” accessed Aug. 11, 2025.

Florida Blue, “,” accessed Aug. 11, 2025.

Aetna, “,” accessed Aug. 11, 2025.

UnitedHealthcare, “,” accessed Aug. 11, 2025.

U.S. Centers for Disease Control and Prevention, “,” accessed Aug. 11, 2025.

U.S. Centers for Disease Control and Prevention, “,” accessed Aug. 11, 2025.

Cleveland Clinic, “” Aug. 5, 2025.

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House Democratic leader Hakeem Jeffries said that a Republican budget measure would “set in motion the largest cut to Medicaid in American history,” and that Republicans are hiding the consequences.

“The Republicans are lying to the American people about Medicaid,” . “I can’t say it any other way. Republicans are lying. Prove me wrong.”

Republicans said Democrats were distorting the Republican budget. , “The word ‘Medicaid’ is not even in this bill.” House Speaker Mike Johnson that Republicans don’t want to cut Medicaid, “and the Democrats have been lying about it.”

Republicans are looking for massive budget savings to meet their goal of fully extending President Donald Trump’s 2017 tax cuts. This is a separate process from Congress’ need to pass a continuing resolution to keep the government running by March 14 or face a federal government shutdown.

Here’s what we know so far about potential Medicaid cuts.

The House GOP Budget Plan Seeks $880 Billion in Cuts

Medicaid serves about . The health care program for low-income people is paid for by the federal government and partly by states. , home to Johnson and Scalise, has one of the highest state proportions of Medicaid enrollees.

The adopted Feb. 25 opens the door to slashing Medicaid, even though it doesn’t name the program. The plan directs the House Energy and Commerce Committee to find ways to cut the deficit by at least $880 billion over the next decade.

The committee has jurisdiction over Medicaid, Medicare, and the Children’s Health Insurance Program, in addition to much smaller programs. to children in families that earn too much money to qualify for Medicaid.

Republicans ruled out cuts to Medicare, the health insurance program for seniors that leaders cut at their political peril. Medicare is about , and Medicaid is about 8.6%.

When Medicare is set aside, Medicaid accounts for 93% of the funding under the committee’s jurisdiction, the nonpartisan Congressional Budget Office found in a . That means it is impossible for the committee to find enough cuts that don’t affect Medicaid.

“It’s a fantasy to imply that federal Medicaid assistance won’t be cut very deeply,” said Allison Orris, an expert on Medicaid policy at the Center on Budget and Policy Priorities, a left-leaning think tank.

After Medicaid, the next-largest program under the committee’s jurisdiction is CHIP. Lawmakers don’t appear to be planning to wipe out CHIP, but even if they did, they would be only a “fraction of the way there,” said Joan Alker, an expert on Medicaid and CHIP at Georgetown University.

If Medicare cuts are off the table, the only way to achieve $880 billion in savings is through big Medicaid cuts, said Larry Levitt, executive vice president for health policy at Â鶹ŮÓÅ, the health policy research, polling, and news organization that includes Â鶹ŮÓÅ Health News.

Andy Schneider, a professor at Georgetown University who served in the Obama administration as a senior adviser at the Centers for Medicare & Medicaid Services, said even if the committee eliminated all those “other” programs entirely it could achieve only $381 billion in savings — about 43% of the target.

“In short, if they don’t want to cut Medicaid [or CHIP], and they don’t want to cut Medicare, the goal of cutting $880 billion is impossible,” Schneider said.

The $880 billion cut is not a done deal. House Republicans were able to pass their budget package, but Senate Republicans are taking a different approach, without proposing such significant cuts.

Any finalized budget blueprint would need Senate Republicans’ buy-in. Sen. Josh Hawley (R-Mo.) is among Republicans who have ; he , “I would not do severe cuts to Medicaid.”

The numbers are starting points that may lead to negotiation among at least Republicans, said Joseph Antos, a health care expert at the conservative American Enterprise Institute. “We are a long way from final legislation, so it’s not possible to predict how much any program will be cut,” he said.

“If the bill also includes extending the [Trump 2017] tax cuts, we are probably months away from seeing real language,” Antos said.

Once the House and Senate have reached an agreement on language and the resolution passes both chambers, the committees will work on detailed cuts. To enact such cuts, both chambers would need to approve a separate bill and receive Trump’s signature.

Why Eliminating Fraud Doesn’t Solve the Problem

Republican leaders have deflected concerns about Medicaid cuts by talking about a different target: Medicaid fraud.

“I’m not going to touch Social Security, Medicare, Medicaid. Now, we’re going to get fraud out of there,” Trump told Fox News’ Maria Bartiromo , in keeping with his campaign rhetoric that he would protect those programs.

At the same time, Trump on his Truth Social platform “The House Resolution implements my FULL America First Agenda, EVERYTHING, not just parts of it!”

Would eliminating fraud solve the Medicaid problem? No.

On CNN, cutting fraud, waste, and abuse would result in “part of the savings to accomplish this mission.” He said the government loses $50 billion a year in Medicaid payments “just in fraud alone.”

Johnson conflated “fraud” with “improper payments.” The , the nonpartisan investigative arm that examines the use of public funds, in improper payments in Medicaid and the same amount in Medicare in fiscal 2023.

Those improper payments were made in an incorrect amount (overpayment or underpayment), should not have been made at all, or had missing or insufficient documentation. But that doesn’t mean that there was $50 billion in Medicaid fraud, which would involve obtaining something through willful misrepresentation.

The system used to identify improper payments is not designed to measure fraud, so we don’t know what percentage of improper payments were losses due to fraud, said Schneider, the former Obama administration health adviser.

Plus, it’s a drop in the overall bucket of the potential $880 billion in cuts.

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His claims decrying vaccines have roiled scientists and medical experts and stoked anger over whether his work harms children. He has made suggestions about the cause of covid-19 that he acknowledges sound racist and antisemitic.

Bolstered by his famous name and family’s legacy, his campaign of conspiracy theories has gained an electoral andÌý. He is running as an independent — having abandoned his pursuit of the Democratic Party nomination — andÌýraisedÌý. A political action committee pledged to spend between $10 million and $15 million to get his name on the ballot in 10 states.

Even though he spent the past two decades as a prominent leader of the anti-vaccine movement, Kennedy rejects a blanket “anti-vax” label that heÌýÌýin July makes him “look crazy, like a conspiracy theorist.”

But Kennedy draws bogus conclusions from scientific work. He employs “circumstantial evidence” as if it is proof. In TV,Ìý,Ìýand political appearances for his campaign in 2023, Kennedy steadfastly maintained:

• Vaccines cause autism.
• No childhood vaccines “have ever been tested in a safety study pre-licensing.”
• There is “tremendous circumstantial evidence” that psychiatric drugs cause mass shootings, and the National Institutes of Health refuses to research the link out of deference to pharmaceutical companies.
• Ivermectin and hydroxychloroquine were discredited as covid-19 treatments so covid vaccines could be granted emergency use authorization, a win for Big Pharma.
• Exposure to the pesticide atrazine contributes to gender dysphoria in children.
• Ìý“targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.”

For Kennedy, the conspiracies aren’t limited to public health. Ìý“members of the CIA” were involved in the assassination of his uncle, John F. Kennedy.ÌýÌý“believe that (Sirhan) Sirhan’s bullets ever hit my father,” former Attorney General Robert F. Kennedy.ÌýÌýthe 2004 presidential election was stolen from Democratic candidate John Kerry.

Ìý, includingÌý, have documented why those claims, andÌýÌý, are false, speculative, or conspiracy-minded.

Kennedy has sat for numerous interviews and dismissed the critics, not with the grievance and bluster of former President Donald Trump, but with a calm demeanor. He amplifies the alleged plot and repeats dubious scientific evidence and historical detail.

Will his approach translate to votes? ±õ²ÔÌý of a three-way matchup between President Joe Biden, Trump, and Kennedy, Kennedy pulled 16% to 22% of respondents.

Kennedy’s movement exemplifies the resonance of conspiratorial views. Misinformers with organized efforts are rewarded with money and loyalty. But that doesn’t make the claims true.

Robert F. Kennedy Jr.’s campaign based on false theories is PolitiFact’s 2023 Lie of the Year.

How an Environmental Fighter Took Up Vaccines

Kennedy, the third of 11 children, was 9 when he was picked up on Nov. 22, 1963, from Sidwell Friends School in Washington, D.C., because Lee Harvey Oswald had shot and killed Uncle Jack. He was 14 when he learned that his father had been shot by Sirhan Sirhan following a victory speech after the California Democratic presidential primary.

RFK Jr., who turns 70 in January, wouldn’t begin to publicly doubt the government’s findings about the assassinations untilÌý.

As a teenager, heÌý. He was expelled from two boarding schools andÌý for marijuana possession. None of that slowed an elite path through higher education, including Harvard University for his bachelor’s degree and the University of Virginia for his law degree.

HeÌýÌýas an assistant district attorney in Manhattan in 1982 but failed the bar exam and resigned the next year. Two months later, he was arrested for heroin possession after falling ill on a flight. HisÌýÌýinvolved a drug treatment program, aÌý,Ìýand volunteer work with a local anglers’ association that patrolled the Hudson River for evidence of pollution that could lead to lawsuits.

Kennedy’s involvement with Hudson Riverkeeper and the Natural Resources Defense Council ushered in a long chapter of environmental litigation and advocacy.

An outdoorsman and falconer, Kennedy sued companies and government agencies over pollution in the Hudson River and its watershed. (He joined the New York barÌý.) He earned a master’s degree in environmental law at Pace University, where he started aÌýÌýto primarily assist Riverkeeper’s legal work. He helped negotiate a 1997 agreement that protected upstate New York reservoirs supplying New York City’s drinking water.

In 1999, Kennedy founded the Waterkeeper Alliance, an international group of local river and bay-keeper organizations that act as their “community’s coast guard,” he toldÌý. He stayed with the groupÌý, when he left “to devote himself, full-time, to other issues.”

On Joe Rogan’s podcast in June, Kennedy said that virtually all of his litigation involved “some scientific controversy. And so, I’m comfortable with reading science and I know how to read it critically.”

PolitiFact did not receive a response from Kennedy’s campaign for this story.

He became concerned about mercury pollution from coal-burning power plants;ÌýmethylmercuryÌýcan , posing a risk to humans and wildlife. As he traveled around the country,Ìý,Ìýwomen started appearing in the front rows of his mercury lectures.

“They would say to me in kind of a respectful but vaguely scolding way, ‘If you’re really interested in mercury contamination exposure to children, you need to look at the vaccines,’” Kennedy told Rogan, whose showÌý an episode.

Kennedy said the women sounded “rational” as they explained a link between their children’s autism and vaccines. “They weren’t excitable,” he said. “And they had done their research, and I was like, ‘I should be listening to these people, even if they’re wrong.’”

He did more than listen. In June 2005, Rolling Stone and Salon co-published Kennedy’s article “Deadly Immunity.” Kennedy toldÌýÌýabout a study that revealed a mercury-based additive once used in vaccines, thimerosal, “may have caused autism in thousands of kids.” Kennedy alleged that preeminent health agencies — the Centers for Disease Control and Prevention, the Food and Drug Administration, the World Health Organization — had colluded with vaccine manufacturers “to conceal the data.”

Kennedy’s premiseÌýÌýÌýas inaccurate and missing context. He left out the ultimate conclusion of the , by Thomas Verstraeten, which said “no consistent significant associations were found between [thimerosal-containing vaccines] and neurodevelopmental outcomes.”

Kennedy didn’t clearly state that,Ìý, thimerosalÌýwas not being usedÌýin childhood vaccines when his article was published. He also misrepresented the comments of health agency leaders at a June 2000 meeting, pullingÌýcertainÌýportions of a 286-page transcript thatÌýappeared to supportÌýKennedy’s collusion narrative.

Scientists who have studied thimerosal have found no evidence that the additive, used to prevent germ growth, causes harm, according to aÌý about thimerosal. Unlike the mercury in some fish, the CDC says, thimerosal “doesn’t stay in the body, and is unlikely to make us sick.”ÌýÌýÌýhas not established a link between thimerosal and autism.

By the end of July 2005, Kennedy’s Salon article had been appended with five correction notes. In 2011, SalonÌý. ItÌý.

Salon’s retraction was part of a broader conspiracy of caving “under pressure from the pharmaceutical industry,” Kennedy told Rogan. The then-Salon editorÌý, saying they “caved to pressure from the incontrovertible truth and our journalistic consciences.”

Kennedy has not wavered in his belief: “Well, I do believe that autism does come from vaccines,” ÌýFox News’ Jesse Watters in July.

David Remnick, editor of The New Yorker, interviewedÌýKennedyÌýfor a . Noting that Kennedy was focusing more on vaccine testing rather than outright opposition, Remnick asked him whether he was having second thoughts.

“I’ve read the science on autism and I can tell you, if you want to know,” Kennedy said. “David, you’ve got to answer this question: If it didn’t come from the vaccines, then where is it coming from?”

How Covid-19 Helped RFK Jr.’s Vaccine-Skeptical Crusade

In 2016, KennedyÌý to address mercury in fish, medicines, and vaccines. In 2018,ÌýÌýChildren’s Health Defense, a legal advocacy group that works “aggressively to eliminate harmful exposures,” its website says.

Since at least 2019, Children’s Health Defense has supported andÌýÌýchallenging vaccination requirements,Ìý,Ìýand social media companies’ misinformation policies (including aÌý against Facebook and The Poynter Institute, which owns PolitiFact).

From the beginning, the group hasÌýsolicitedÌýstories about children “injured” by environmental toxins or vaccines. This year, it launched a national bus tour to collect testimonials. The organization also produces documentary-style films and books, including Kennedy’s “The Wuhan Cover-Up and the Terrifying Bioweapons Arms Race” and “The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health.”

In 2020, Children’s Health Defense and the anti-vaccine movement turned attention to the emerging public health crisis.

Kolina Koltai, a senior researcher at Bellingcat, an investigative journalism group, had seen anti-vaccine groups try to seize on Zika and Ebola outbreaks, with little success. But the covid-19 pandemic provided “the exact scenario” needed to create mass dissent: widespread fear and an information vacuum.

Children’s Health DefenseÌýÌýÌýin March and April 2020 claiming the “viral terror” was an attempt to enact the “global immunization agenda” and a “dream come true” for dictators. The group echoed these points in ads and social media posts and grew its audience, includingÌý.

On X, then known as Twitter, Children’s Health Defense outperformed news outlets that met NewsGuard’s criteria for trustworthiness from the third quarter of 2020 to the fourth quarter of 2021, according to Ìýby the German Marshall Fund think tank, even as Children’s Health Defense published Ìýabout covid-19 and vaccines.

In 2019, Children’s Health DefenseÌýreportedÌýit had , and paid Kennedy a $255,000 salary. Its revenue grew 440% through 2021, according toÌý, hitting $15.99 million. Kennedy’s salary increased to $497,013. (Its 2022 form 990 for tax disclosure is not yet public. Kennedy has been on leave from the organization since he entered the presidential race in April.)

On social media, the message had limits. Meta removed Kennedy’s personal Instagram account inÌýÌýfor spreading false claims about covid-19 and vaccines, the company said, but left his Facebook account active. A year and a half later, Meta banned Children’s Health Defense’s main Facebook and Instagram accounts for “repeatedly” violating its medical misinformation policies.ÌýÌýÌýÌýÌýÌý.

As the group’s face, Kennedy became a leader of a movement opposed to masks and stay-at-home orders, said David H. Gorski, managing editor of Science-Based Medicine and a professor of surgery and oncology at the Wayne State University School of Medicine.

“The pandemic produced a new generation of anti-vaxxers who had either not been prominent before or who were not really anti-vax before,” Gorski said. “But none of them had the same cultural cachet that comes with being a Kennedy that RFK Jr. has.”

Rallying a crowd before the Lincoln Memorial on Jan. 23, 2022, Kennedy protested covid-19 countermeasures alongside commentator Lara Logan and anti-vaccineÌý. The crowdÌýÌýÌýreading “Nuremberg Trials 2.0” and “free choice, no masks, no tests, no vax.” When Kennedy took the stage, mention of his role with Children’s Health Defense prompted anÌý.

In his speech, KennedyÌýÌýto denounce the “turnkey totalitarianism” of a society that requires vaccinations to travel, uses digital currency and 5G, and is monitored by Microsoft Corp. co-founder Bill Gates’ satellites: “Even in Hitler’s Germany, you could cross the Alps into Switzerland. You could hide in an attic like Anne Frank did.”

Days later, facing criticism fromÌý, the actor Cheryl Hines,Ìý, and Holocaust memorial organizations, Kennedy issued aÌýÌýfor his comments.

Asked about his wife’s comment onÌý, he said his remarks were taken out of context but that he had to apologize because of his family.

Recycle. Repeat. Repeat.

When he’s asked about his views, Kennedy calmly searchesÌýhis rhetorical laboratory for recycled talking points, selective research findings, the impression of voluminous valid studies, speculation, and inarguable authority from his experience. He refers to institutions, researchers, and reports, by name, in quick succession, shifting points before interviewers can note what was misleading or cherry-picked.

There is power in repetition. Take his persistent claim that vaccines are not safety-tested.

• In July, he told “,” “Vaccines are the only medical product that is not safety-tested prior to licensure.”
• OnÌýÌýon PBS NewsHour, Kennedy said vaccines are “the only medical product or medical device that is allowed to get a license without engaging in safety tests.”
• On Dec. 15, heÌý’s Kasie Hunt that no childhood vaccines have “ever been tested in a safety study pre-licensing.”

This is false. Vaccines, including theÌý, areÌýÌýbefore they are licensed. Researchers gather initial safety data and information about side effects during phase 1 clinical trials on groups of 20 to 100 people. If no safety concerns are identified, subsequent phasesÌýÌýof larger numbers of volunteers to evaluate a vaccine’s effectiveness and monitor side effects.

Kennedy sometimes says that some vaccines weren’t tested against inactive injections or placebos. That has an element of truth: If using a placebo would disadvantage or potentially endanger a patient, researchers might test new vaccinesÌýÌýwith known side effects.

But vaccines are among “the most tested and vetted” pharmaceutical products given to children, said Patricia Stinchfield, a pediatric nurse practitioner and the president of the National Foundation for Infectious Diseases.

Kennedy encourages parents to research questions on their own, saying doctors and other experts are invariably compromised.

“They are taking as gospel what the CDC tells them,” Kennedy said on Bari Weiss’ Ìýin June.

Public health agencies have been “serving the mercantile interests of the pharmaceutical companies, and you cannot believe anything that they say,” Kennedy said.

Experts fret that the Kennedy name carries weight.

“When he steps forward and he says the government’s lying to you, the FDA is lying to you, the CDC is lying to you, he has credence, because he’s seen as someone who is a product of the government,” said Paul Offit, a pediatrics professor in the Children’s Hospital of Philadelphia’s infectious diseases division and the director of the hospital’s Vaccine Education Center. “He’s like a whistleblower in that sense. He’s been behind the scenes, so he knows what it looks like, and he’s telling you that you’re being lied to.”

Kennedy name-drops studies that don’t support his commentary. When speaking with Rogan, Kennedy encouraged the podcaster’s staff to show a particular 2010 study that found that exposure to the herbicide atrazine caused some male frogs to develop female sex organs and become infertile.

Kennedy has repeatedly invoked that frog study to support his position that “we should all be looking at” atrazine and its impact on human beings. The researcher behind the studyÌýÌýin June that Kennedy’s atrazine claims were “speculation” given the vast differences between humans and amphibians.ÌýNo scientific studies in humansÌýlink atrazine exposure to gender dysphoria.

In July, Kennedy floated the idea that covid-19 could have been “ethnically targeted” to “attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.” The claim wasÌý, but Kennedy insisted that it was backed by a July 2020 study by Chinese researchers. Ìýdidn’t find that Chinese people were less affected by the virus. It said one of the virus’s receptors seemed to be absent in the Amish and in Ashkenazi Jews and theorized that genetic factors might increase covid-19 severity.

Five months later, Kennedy invoked the study andÌý: “I can understand why people were disturbed by those remarks. They certainly weren’t antisemitic. … I was talking about a true study, an NIH-funded study.”

“I wish I hadn’t said them, but, you know, what I said was true.”

Kennedy answered using scientific terms (“furin cleave,” “ACE2 receptor”), but he ignoredÌýexplanations foundÌýin the study. He didn’t account for how the original virus has evolved since 2020, or how the study emphasized these potential mutations were rare and would haveÌýlittle to no public health impact.

Public health experts say that racial disparities in covid-19 infection and mortality — in the U.S., Black and Hispanic people often faced more severe covid-19 outcomes — resulted fromÌýsocial and economic inequities, not genetics.

Kennedy says “circumstantial evidence” is enough.

Antidepressants are linked to school shootings, he told listeners on a livestream hosted by Elon Musk. The government should have begun studying the issue years ago, he said, because “there’s tremendous circumstantial evidence that those, like SSRIs and benzos and other drugs, are doing this.”

Experts in psychiatry have ÌýandÌýÌýÌýthat there is no causal relationship between antidepressants and shootings. With 13% of the adult population using antidepressants, experts say that if the link were true they would expect higher rates of violence. Also, theÌýavailable dataÌýon U.S. school shootings shows most shooters were not using psychiatric medicines, which have an anti-violence effect.

Conspiracy Theories, Consequences, and a Presidential Campaign

The anti-censorship candidate frames his first bid for public office as a response to “18 years” of being shunned for his views — partly by the government, but also by private companies.

“You’re protected so much from censorship if you’re running for president,” Ìýconservative Canadian podcaster and psychologistÌýJordan Peterson in June.

In June, Kennedy’s Instagram account wasÌýreinstatedÌý— with a verified badge noting he is a public figure. Meta’s rules on misinformation do not apply to active political candidates. (PolitiFact is a partner of Meta’s Third Party Fact-Checking Program, which seeks to reduce false content on the platform.)

In July, he was invitedÌýÌýbefore the Republican-led House Select Subcommittee on the Weaponization of the Federal Government. He repeated that he had “never been anti-vax,” and railed against the Biden White House forÌýÌýto remove his January 2021 tweet that said Baseball Hall of Famer Hank Aaron’s death was “part of a wave of suspicious deaths among elderly,” weeks after Aaron, 86, received a covid-19 vaccine. The medical examiner’s office said Aaron died from unrelated natural causes.

Throughout 2023, alternative media has embraced Kennedy. He hasÌýÌýpodcasts such as Peterson’s, and has also participated in profiles byÌý,Ìý,ÌýandÌýÌý.

“You’re like, ‘But you’re talking right now. I’m listening to you. I hear your words. You’re not being censored,’” said Whitney Phillips, an assistant professor in the School of Journalism and Communication at the University of Oregon who researches how news media covers conspiracy theories and their proponents. “But a person can believe they’re being censored because they’ve internalized that they’re going to be,” or they know making the claim will land with their audience.

Time will tell whether his message resonates with voters.

Kyle Kondik, managing editor of Sabato’s Crystal Ball at the University of Virginia Center for Politics, said Kennedy may be a “placeholder” for voters who are dissatisfied with Trump and Biden and will take a third option when offered by pollsters.

The only 2024 candidate whose favorability ratings are more positive than negative? , according toÌýFiveThirtyEight. However, a much higher percentage of voters are unfamiliar with him than they are with Trump or Biden — about a quarter — and Kennedy’s favorability edge has decreased as his campaign has gone on.

Nevertheless, third-party candidates historically finish with a fraction of their polling, Kondik said, and voters will likely have more names and parties on their fall ballots, including philosopher Cornel West, physician Jill Stein, and a potential slate from theÌýÌýmovement.

Kennedy was popular with conservative commentators before he became an independent, and he has avoided pointedly criticizing Trump, except on covid-19 lockdowns. When NBC News askedÌýÌýwhat he thought of Trump’s 2020 election lies, Kennedy said he believed Trump lost, but that, in general, people who believe elections were stolen “should be listened to.” Kennedy is one of them. He still says that the 2004 presidential election was “stolen” from Kerry in favor of Republican George W. Bush,Ìý.

American Values 2024 will spendÌýÌýto get Kennedy’s name on the ballot in 10 states including Arizona, California, Indiana, New York, and Texas. Those are five of the toughest states for ballot access, said Richard Winger, co-editor of Ballot Access News.

Four of Kennedy’s siblingsÌýcalledÌýKennedy’s decision to run as an independent to the nation. “Bobby might share the same name as our father, but he does not share the same values, vision or judgment,” the group wrote in a joint statement.

Kennedy brushes it off when asked, saying he has a large family and some members support him.

On her podcast, Weiss asked whether Kennedy worried his position on autism and vaccines would cloud his other positions and cost him votes. His answer ignored his history.

“Show me where I got it wrong,” he said, “and I’ll change.”

In a campaign constructed by lies, that might be the biggest one.

PolitiFact researcher Caryn Baird contributed to this report.​

PolitiFact’s source list can be found .

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Sen. Tom Cotton (R-Ark.) in a tweet on February 6, 2023

More than 60 million people rely on Medicare for health coverage, and raising the alarm about potential cuts to the program is a perennial talking point among both Republicans and Democrats.

On Feb. 6, Sen. Tom Cotton (R-Ark.) took a swing at President Joe Biden on Twitter after Biden tweeted that House Republicans were threatening to cut Social Security and Medicare.

“It’s President Biden who is proposing to cut Medicare Advantage, a program used by almost 4 in 10 Arkansas seniors,” Cotton wrote.

It wasn’t clear from Cotton’s tweet which Biden proposal he was referring to, and his office did not respond to requests for comment.

It's President Biden who is proposing to cut Medicare Advantage, a program used by almost 4 in 10 Arkansas seniors. This would be a mistake.

— Tom Cotton (@TomCottonAR)

Ìýpolicies, administered through Medicare-approved private insurance companies, bundle the traditional Medicare program’s separate hospital, medical, and prescription drug coverage into one plan.

The plans are optional and canÌýÌýwhile offering other benefits, including vision and dental services, that are not included in the original Medicare program.Ìý

About 28 million people, or nearly half of those eligible for Medicare, were enrolled in Medicare Advantage plans in 2022, .

The Centers for Medicare & Medicaid Services recently announced two proposed changes that could affect Medicare Advantage insurers:Ìý

• One is aÌý, set to take effect April 3, that’s intended to increase the government’s ability to audit Medicare Advantage plans and recover past overpayments.Ìý
• The other is anÌýÌýthat would modify Medicare Advantage’s risk adjustment model, which determines how much the government pays insurers for beneficiaries’Ìýreported health conditions.Ìý

Health care policy experts said it is most likely that Cotton’s tweet was referring to theÌýÌýintended to increase the government’s ability to recover overpayments.

The rule change would return billions of dollars to the federal government and is likely to reduce private insurers’Ìýprofits, though experts say the reductions would be minimal compared with overall spending.Ìý

Those companies might, in turn, increase enrollees’Ìýout-of-pocket costs or reduce benefits, experts said. But it is unclear if that will happen.Ìý

Meanwhile, the second change — an annual update to the rates paid to Medicare Advantage insurers — will reduce payments to Medicare Advantage insurers. But the reductions will be offset by other program modifications that are projected to yield a 1% increase in Medicare Advantage spending per person in 2024.

A group that lobbies for Medicare Advantage plans sent aÌýÌýthat said proposed changes would affect 30 million beneficiaries, .

What Is the Proposed Rule Change to Medicare Advantage?

The federal government pays private insurance companies for Medicare Advantage per patient, making adjustments to the amounts based on the health of a beneficiary.

The sicker a Medicare Advantage patient is, the more money a private insurer will receive from the federal government to cover the cost of care. Experts said there’s been a longtime concern that Medicare Advantage insurers have a financial incentive to identify preexisting conditions among enrollees.

Auditors from the federal government review medical files to confirm whether patients have the diseases that their private insurers listed, KHN has reported. These audits showed that private insurers had Ìýfor patients that could not be verified, resulting in millions of dollars of overpayments to .

When overpayments are identified, private insurersÌýÌýthe difference to the federal government.

The administrativeÌýÌýthat would allow the government to recoup overpayments is a new version of a rule , under the Trump administration. The final rule comes after the government Ìýhow to identify and recover overpayments, experts said.

“The essence of this rule is to set up procedures whereby the Medicare program can recoup the overcharge,” said Joseph Antos, a health policy expert at the American Enterprise Institute, a conservative-leaning think tank.

From 2023 through 2032, , the federal government will recover $4.7 billion in overpayments from major insurance companies including Humana, UnitedHealthcare, and Aetna. That money represents about one-fifth of 1% of federal payments to Medicare Advantage plans during that period,Ìý, director of Medicare’s Center for Program Integrity.

Though the rule change is expected to reduce private health insurance companies’Ìýrevenues from Medicare Advantage plans, the Department of Health and Human Services doesn’t consider that to be a “cut.”Ìý

“Auditing plans and recouping funds puts money back in the Medicare trust funds when big insurance companies get caught taking advantage of the Medicare program,” Kamara Jones, a spokesperson for the department, told PolitiFact. This is about “holding our seniors’ health care to the standard they deserve.”

CMS is also requiredÌýÌýÌýto ensure accurate payments and prevent fraud, waste, and abuse.Ìý

Experts said they would not characterize the rule change as a “cut.”Ìý

The federal government is attempting to avoid paying more than it should, said Paul Ginsburg, a senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “To me, that is simply running the program better and more efficiently to protect the integrity of the federal funds being used for it.”

How Will Enrollees Be Affected?

It’s difficult to determine whether Medicare Advantage enrollees will feel the rule changes.Ìý

“My read of the evidence is that reductions in payments to Medicare Advantage plans are largely borne by the plans themselves, either through lower profits or cost reductions,” said Matthew Fiedler, a senior fellow with the University of Southern California-Brookings Schaeffer Initiative for Health Policy.

A Ìýfrom Avalere, a health care consulting company, found that the rule change could result in beneficiaries facing higher costs or fewer plan options or benefits.

Because private insurers’Ìýprofits will be reduced, companies could pass along those costs to enrollees in small ways, including slight increases in insurance premiums or out-of-pocket costs and, in some cases, fewer benefits, the American Enterprise Institute’s Antos said.

Antos said he did not expect drastic cost increases or benefit reductions that would encourage enrollees to turn to non-Medicare Advantage plans.

Ìýthat the other proposed 2024 updates to the way Medicare Advantage insurers will be paid will result in about a 3% reduction in payments to Medicare Advantage insurers in 2024. But the agency said that other modifications to the Medicare Advantage program would offset that reduction and yield a 1% increase in spending per person in 2024.

An insurers’Ìýlobbying group saidÌýCMS did not provide adequate information about how it arrived at the 1% figure. “Consequently, there is no way to validate the accuracy” of that estimate, a spokesperson said.

The proposed 2024 adjustments are not a cut, but are part of “the routine annual process of implementing the law as far as how Medicare Advantage plans are paid,” USC’sÌýGinsburg said.Ìý

Our Ruling

Cotton said, “It’s President Biden who is proposing to cut Medicare Advantage.”

Experts said Cotton likely was referring to a recent rule change that allows the government to recover overpayments to insurers and is expected to reduce insurers’Ìýprofits. Those companies might, in turn, raise enrollees’Ìýout-of-pocket costs or reduce benefits. It is unclear whether that will happen.Ìý

Another proposed change, an annual update to the rates paid to Medicare Advantage insurers, will reduce payments to insurers. But reductions will be offset by other changes that are expected to yield a 1% increase in payments to insurers per person in 2024.Ìý

Experts say it’s inaccurate to characterize the changes as a “cut” to Medicare Advantage. We rate it False.

PolitiFact researcher Caryn Baird contributed to this report.

Sources

Ìýby Sen. Tom Cotton, Feb. 6, 2023

Federal Register,Ìý“,” Feb. 1, 2023Ìý

The New York Times,Ìý“, Jan. 30, 2023

Avalere,Ìý“,” Aug. 23, 2022

Axios,Ìý“,” Jan. 30, 2023

KHN,Ìý“CMS Signals That Medicare Advantage Payments Will Decline in 2024,” Feb. 2, 2023Ìý

Â鶹ŮÓÅ,Ìý“,” Nov. 10, 2022

Â鶹ŮÓÅ,Ìý“,” Jan. 19, 2023

Stat,Ìý“,” Feb. 1, 2023

Fierce Healthcare,Ìý“,” Oct. 29, 2018

Centers for Medicare &ÌýMedicaid Services,Ìý“,” accessed Feb. 9, 2023

NPR,Ìý“,” Nov. 21, 2022

KHN,Ìý“Medicare Failed to Recover up to $125 Million in Overpayments, Records Show,” Jan. 6, 2017

Fierce Healthcare,Ìý“,” Jan. 30, 2023

Interview with Joseph Antos, senior fellow and Wilson H. Taylor scholar in health care and retirement policy at the American Enterprise Institute, Feb. 9, 2023

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