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It’s a sign of how cock-eyed the Washington debate has gotten that Republicans are nervous about the slight slowdown in Medicaid-spending growth in the “Big Beautiful Bill.”
If anything, they’re not cutting Medicaid anywhere near as much as they should.
As the nearby chart shows, Medicaid outlays have positively skyrocketed these last 20 years: The feds spent $160 billion in fiscal year 2003; $591 billion in 2023 — over 3½ times as much.
State-level spending, meanwhile, rose from $108 billion to $280 billion — still a huge rise, but far less drastic.
What’s basically gone on?
Democrats steadily pushing toward universal health coverage at taxpayer expense, with Republicans sometimes pausing the march.
(It’s Bernie Sanders’ “Medicare for all” plan, except using the program originally intended to cover the poor, not the one designed for the elderly.)
In the process, Medicaid’s grown from covering the poor to covering the near-poor and even the not-really-poor-at-all — in the process displacing private insurance more than it’s actually expanding the share of the population that’s covered.
(That displacement has been sped up by the way the ObamaCare law and countless other progressive moves have made the private insurance market ever-more dysfunctional.)
Also added in: illegal immigants, as well as legal ones who aren’t supposed to become public charges.
All in a program so poorly designed that the only two major audits done in recent years both suggested that a full quarter of the spending is improper — whether on “beneficiaries” who don’t actually qualify, to “providers” who don’t, or in a truly vast amount of outright, criminal fraud.
Dems don’t want to discuss any of these ugly details; instead, they fall back on treating any opposition to their drive as “kicking people off health insurance.”
Hence their endless claims that the BBB “will deprive 13.7 million poor and vulnerable Americans of health insurance.”
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In fact, the bill’s extremely modest reforms (eventually) do things like deny coverage to illegal immigrants, reduce federal subsidies for states to give Medicaid to people above the poverty line, require more frequent eligibility checks and impose a “work requirement” of just 80 hours a month on able-bodied recipients.
What’s wrong with insisting that the able-bodied work to receive public charity?
Or cracking down on how states like New York and California openly use Medicaid accounting scams to grab extra billions a year from the feds?
All too many Republicans flinch from trying to make that case; a few even grandstand by copying Democrats’ dishonest arguments.
And so, as the Cato Institute’s Dominik Lett notes, Medicaid has been the fastest-growing part of the federal budget this past decade because its “funding scheme actively rewards overspending, resulting in programmatic bloat, wasted taxpayer dollars, and fraud.”
It costs the taxpayers more than does national defense.
The House-passed “Big Beautiful Bill” barely begins to change Medicaid’s course; as the Senate takes up the measure, cross your fingers that it’ll do more to rein in this madness — not less.