Josh Hawley’s false compassion for Medicaid

Medicaid and other means-tested social-welfare spending are the largest contributors to the ever-ballooning federal deficit. Social Security and Medicare are often cited as the main fiscal problems, but welfare programs are by far the bigger fiscal burden. Since the War on Poverty began in 1967, welfare payments to the bottom income quintile have surged 780% in real terms, from $7,352 to $64,700 per household, outpacing average household income growth by 9.2 times. The program has expanded by over 50% since 2019 and is projected to exceed a trillion dollars annually by 2030, according to Congressional Budget Office estimates.

This explosion in spending is unsustainable and could lead to a debt crisis that risks market volatility, currency devaluation, and inflation spikes while severely disrupting economic growth. Drastic tax hikes would likely follow. The program would face insolvency. States would begin to ration care, and benefits would be reduced. The very people Hawley purports to champion would be hurt the most. 

Medicaid’s enrollment surge following the passage of the Affordable Care Act and the COVID-19 pandemic also indicates its unsustainability. As of 2023, Medicaid enrolled 82 million individuals, or roughly 24% of the U.S. population, a significant increase from 65 million in 2013 and 28 million in 2000. 

The exponential acceleration in growth in the past two decades is driven by a combination of bad policy decisions that expanded eligibility and reduced accountability. Obamacare allowed states to expand Medicaid to non-elderly adults with incomes up to 138% of the federal poverty level. The CBO estimates this added $150 billion annually to federal Medicaid spending by 2023, a sizable chunk of the program’s $648 billion overall cost. COVID-19 policy further padded the rolls. Lax eligibility verification in the form of minimal annual checks, presumptive eligibility, and auto-enrollment prioritizes access over accuracy. 

Medicaid’s sprawl comes with significant social consequences, particularly in relation to the participation of young, able-bodied men in the workforce. Alarmingly, only 36% of prime work-age adults in the bottom income quintile were employed in 2022, down from 68% in 1967. Labor force participation among low-income men aged 25-54 fell from 90% in 1970 to 78% in 2023. Meanwhile, welfare payments, including Medicaid, surged by 780%, and enrollees often avoided earning too much to retain benefits. Reduced incentives to work have unsurprisingly led to fewer able-bodied men working. The work requirement in the House bill is eminently reasonable, encouraging able-bodied adults to engage in employment or training while maintaining access to essential benefits.

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Fewer men working means fewer men getting married. Non-working men are less likely to marry, contributing to a rise in single-parent households. This destabilizes communities, with child poverty rates higher in those households than in two-parent homes. 

The system Hawley is fighting to maintain with Trump’s apparent backing is hurtling the nation toward a fiscal disaster and disintegrating the social fabric. The senator speaks of “delivering on America’s promise for America’s working people” by ignoring calls to cut Medicaid. But his efforts, draped in false compassion, all but ensure a more difficult path for the working class to achieve the American dream.