That’s the dire warning echoing through media headlines and political speeches as Congress and the Trump administration consider tightening eligibility and trimming the Medicaid program. Senator Bernie Sanders and others claim these cuts are heartless, as millions of people will lose coverage.
But the media—and much of the political left—are avoiding reality.
Reducing Medicaid’s bloated rolls isn’t a death sentence. It’s the first step toward saving a healthcare system that overwhelms patients with bureaucracy, starves doctors of payment, and fails to deliver timely care to the truly vulnerable. Medicaid reform is necessary to help address the unsustainable federal budget and improve patient care.
Let’s start with the facts.
In 2024, more than 79 million Americans were enrolled in Medicaid, with another 7 million children on CHIP. That’s nearly one in four Americans on government-run health insurance. Medicaid spending hit $817.7 billion, almost as much as the Department of Defense. That’s over $10,000 per enrollee, a staggering cost that doesn’t match the quality of care received.
Why? Medicaid is no longer targeted at the poor and medically fragile. During the COVID-19 pandemic, Congress expanded eligibility, suspending redetermination reviews. Millions of healthy, work-capable adults were added to the rolls. Today, with the pandemic over and the labor market tighter, the Bureau of Labor Statistics estimates more than 60% of those newly eligible adults are back at work.
Yet they remain on Medicaid, crowding out resources intended for the most vulnerable. This misalignment creates a phenomenon we call the “seesaw effect”—as enrollment increases, access to care decreases.
The seesaw works when enrollment increases, resulting in more money being spent on insurance, as well as complying with and administering federal regulations. Since more healthcare dollars are allocated to nonclinical, bureaucratic processes, fewer dollars are available for patient care. Less money for care without lower prices results in less availability of care.
Evidence of this is what happened after the passage of the Affordable Care Act in 2010. Average wait times to see a primary care physician in mid-sized U.S. cities ballooned from 99 days to 122 days after the ACA expanded Medicaid. Under the Biden administration, it climbed to an unconscionable 132 days.
That’s more than four months to get an appointment—assuming you can even find a doctor who accepts Medicaid. Nationwide, one-third of doctors no longer do. In Texas, fewer than half of physicians are willing to accept new Medicaid patients. Why? Bureaucratic red tape and reimbursement rates often don’t cover basic healthcare costs.
Medicaid patients may have an insurance card, but many still struggle to access care when they need it. In Illinois, medical audits revealed that 752 Medicaid recipients died waiting—literally—from being stuck in bureaucratic queues. We’ve seen the same story unfold at the VA with veterans having Tricare insurance: people given a promise of care, only to die waiting in line. This is not compassion. It’s cruelty masquerading as generosity.
And it’s not just inadequate access—it’s poor stewardship. At least 30% but likely closer to 50% of U.S. healthcare spending is wasted—lost to administrative overhead, compliance burdens, or outright fraud. Medicaid is a prime offender, with limited accountability and massive layers of state and federal bureaucracy siphoning off dollars from care providers.
Let’s be clear: spending more money is not the same as improving care. A system that fails to deliver quality care isn’t solved with more funding—it’s fixed by reforming the system.
The solution starts with responsible, targeted cuts.
Return Medicaid to its original purpose: helping the truly needy—low-income children, pregnant women, seniors, and people with disabilities. Reinstate work requirements for work-capable adults. Allow states more flexibility through block grants or waiver programs. Expand private-market solutions, such as direct primary care and health savings accounts, and promote price and quality transparency through market competition, rather than coercive government mandates.
These reforms will help lower federal spending and improve healthcare access. When fewer healthy people crowd the system unnecessarily, doctors have more time and resources to serve those needing care. By lowering the left side of the “seesaw” through tightening eligibility, we raise the right side—access to real care.
We can do better than an essentially government-run healthcare monopoly that offers the illusion of coverage but fails at the one job that matters: delivering timely care.
True reform doesn’t mean abandoning the poor. It means ensuring they aren’t trapped in a broken system that serves politicians and bureaucrats, not patients and doctors. A free-market approach—rooted in personal responsibility, transparency, and innovation—is how we bring costs down, increase access, and bring compassion back into healthcare.
Don’t believe the scare tactics. The real threat isn’t reform, it’s pretending the current system is working when it isn’t.
Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; former Director of New Mexico Health Insurance Exchange; and co-author with Dr. Ginn of the forthcoming, “Empower Patients – Two Doctors’ Care for Healthcare.” Follow him on X.com at @DrDeaneW or contact him via www.deanewaldman.com.
Vance Ginn, Ph.D., is president of Ginn Economic Consulting, host of the Let People Prosper Show, and previously chief economist of the Trump White House’s OMB. Follow him on X.com at @VanceGinn.
This article was originally published at www.thecentersquare.com
