Congress is inching closer to extending the 2017 tax cuts for American households and small businesses. But you can count on the left to look for any stumbling blocks to stall President Trump’s "Big Beautiful Bill."
They’ve landed on a strategy of fearmongering over Medicaid to drive opposition to tax cuts. They especially like to gin up fear among racial minorities over common-sense Medicaid reforms.
Americans should know the truth. Right here — and now.
Conservatives aim to strengthen the entitlement program while allowing Americans to keep the tax cuts they’ve enjoyed for the past six years.
By rightsizing Medicaid, this public health program will be available to those who truly need it, not a jackpot for thieves and fraudsters or those who simply should not qualify.
Medicaid is a federal-state healthcare program covering about a quarter of Americans.
The program is meant for poor and vulnerable people, particularly pregnant women, children, and the disabled.
Does anyone really believe that America is home to nearly 80 million poor people?
Herein is the first truth. . .
Not every person on Medicaid is vulnerable enough to need the aid.
Some 36.8 million people were living in poverty, according to the Census Bureau in 2023, but Medicaid enrolled 79.3 million people.
Clearly, tens of millions of people receive Medicaid benefits, who are not poor by the government’s measure.
This massive increase in Medicaid’s enrollment is not accidental. Medicaid enrollment skyrocketed by 80% from 2000, when just 44.3 million people were enrolled.
The rolls were expanded to include many people living above the poverty line during the Obama and COVID-19 eras.
President Barack Obama’s signature Affordable Care Act (ACA) gave many single, young, and able-bodied adults living above the poverty line access to Medicaid.
Adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) gained coverage.
Recall Pajama Boy? He’s probably on Medicaid.
President Obama also incentivized states to expand their Medicaid rolls by upping federally matched dollars for enrollment increases.
Additionally, some states qualified able-bodied adults solely on their income without consideration of their assets.
As Dr. Mehmet Oz, the head of the U.S. Centers for Medicare and Medicaid Services (CMS), explained this week, "Because we pay 90 percent of the money for the able-bodied person and only, let's say, 65 percent for a traditionally Medicaid poor, young, old or disabled person, it actually moves money to the able-bodied population."
Then came COVID-19.
It’s understandable that our social safety net was temporarily expanded to support Americans who found themselves out of work and out of healthcare coverage due to pandemic mitigation measures.
Medicaid enrollment grew as eligibility verification for Medicaid was restricted during this time and people were encouraged to apply.
Congress also required that Medicaid programs keep people continuously enrolled through the end of the public health emergency to receive enhanced federal funding.
However, what should have been a temporary safety net expansion morphed into a permanent, swollen entitlement.
Filling Medicaid with able-bodied, childless individuals pits them against the disabled, pregnant women, and poor children.
Let’s look at the numbers.
Late last year, 37.6 million children were enrolled in Medicaid.
That comprises 34% of the total enrollees.
Yet, only 14% of spending from Medicaid goes to children.
Meanwhile, adult enrollees — who gained coverage under the ACA Medicaid expansion, as well as low-income parents — account for 43% of all enrollees and 34% of spending.
Congress and the Trump administration should reform eligibility and end the incentives for states to cover able-bodied childless adults as a first step to rightsizing the program.
As Heritage scholar Nina Owcharenko Schaefer proposed, "Congress should replace the higher ACA match rate for able-bodied, childless adults with the standard match rate."
Some able-bodied adults do need healthcare support, and as Americans, we are willing to provide it with the expectation that they seek employment toward financial independence.
However, there is no federally mandated work requirement for the Medicaid program.
States that sought to implement work requirements faced pushback from the Biden administration. That must change.
With over 7 million available jobs, policymakers should encourage unemployed and labor force dropouts on Medicaid to find work as a condition to keep their benefits. Americans agree.
According to recent polling from the Kaiser Family Foundation (KFF), 62% of adults support work requirements.
That support jumps to 77% when Americans understand that work requirements could allow Medicaid to be reserved for groups like the elderly, people with disabilities, and low-income children.
Americans value Medicaid and recognize that they or someone they know benefits from the program. Yet, they want it to provide support to those who truly need the program and want Congress to make changes to do so.
The left would have Americans believe that Medicaid is untouchable but won’t admit that the swollen Medicaid rolls have made the program unworkable for the truly needy.
Reconciliation offers a prime opportunity to make it right.
Patrice Onwuka is the director of the Center for Economic Opportunity at Independent Women and co-host of WMAL’s O’Connor & Company. Read More of Her Reports — Here.
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