I Was on Medicaid. It Could Collapse If We Don’t Control Spiraling Costs.

I know firsthand that Medicaid is a vital safety net. My family veered in and out of poverty because of my father’s mental illness when I was growing up. We lived in sheds, tents and motor homes. Instability was the only constant. My parents, seven siblings and I spent time on welfare, and several of them receive Medicaid for disabilities and severe mental illness to this day.

I detail in my memoir how the federal Children’s Health Insurance Program, created in 1997 as a companion to and expansion of Medicaid to support poor kids, was key to keeping me from dropping out of college during my freshman year in 2002. A potentially rabid dog bit me, and I needed expensive rabies prevention treatment to avoid a life-threatening condition.

I am grateful to the taxpayers in Missouri, where I was living at the time, who gave me the temporary CHIP support I needed to survive and eventually move on to work in ways that I’ve been able to give back and help others who are struggling.

But for all my appreciation and backing of Medicaid, I also support overhauling the program – including through slowing spending increases – in the way that some Republicans are calling for.

Medicaid, paid for by a combination of federal and state money, is designed to help poor and disabled Americans, yet it has expanded to include many people who are not truly poor or disabled. It has moved away from being a temporary safety net into a permanent web of entrapment for far too many Americans. That’s not healthy for those people, or for a country with debt spiraling upward.

Democrats are charging that the budget reforms President Donald Trump and congressional Republicans are considering would cause deep cuts to Medicaid. But former Trump economic advisors Stephen Moore and Arthur Laffer and former House Speaker Newt Gingrich point out that they would merely slow the growth of Medicaid spending – while still allowing for $168 billion in increased funding over 10 years. This is a more than reasonable proposal, and anyone painting these reforms as otherwise is disingenuous.

The number and type of Americans who currently receive Medicaid differ vastly from enrollment at the beginning of the century. Medicaid today enrolls 79.3 million people (or 23.2% of the U.S. population) compared to just 44.3 million people (15.7% of the total U.S. population) in 2000. This 23.2% is far beyond the 11.1% of Americans below the poverty line today, a percentage that is nearly identical to the 11.3% under the poverty line in 2000.

Yet households are wealthier today than in 2000. The inflation-adjusted median household income in 2000 was $70,020, compared to $80,610 in 2023. If households are wealthier now, why are so many more dependent on this government program?

Medicaid also enrolls millions of healthy (e.g., non-disabled) people who are not working. The Foundation for Government Accountability, a Florida-based conservative think tank that advocates for public spending reforms, estimates that approximately 60% of able-bodied adults currently on Medicaid – roughly 24.6 million people – reported no earned income in both 2019 and 2022. The foundation calculated that, since 2000, “every state has seen its labor force participation rate shrink and their Medicaid enrollment surge upward.”

Medicaid greatly expanded in 2014, when Obamacare broadened eligibility to include many previously excluded able-bodied adults who were not working. Yet in the name of fairness, especially when our current labor market has millions of job openings and a low 4.1% unemployment rate, about 62% of taxpayers favor requiring healthy people receiving public support to work or to be proactively searching for work.

Medicaid and CHIP enrollment increased again by more than 5 million individuals during the early days of the COVID-19 pandemic, from February to August 2020, according to the health policy organization KFF. The COVID era is long over, but Medicaid expansion turned permanent under the Biden administration, which reduced requirements that Medicaid recipients work or look for work.

Then there’s waste, fraud and abuse. The U.S. Government Accountability Office estimates taxpayers lose as much as $50.3 billion in fraudulent Medicaid payments. The Paragon Health Institute, a health care policy research group founded partially by former Trump officials, has estimated that approximately 1 in 4 Medicaid dollars were improper payments. This cannot continue.

Medicaid contributes to the unsustainable path our country is on as it drowns under nearly $37 trillion in debt, amounting to more than $323,000 per taxpayer. America’s current debt-to-GDP ratio is higher than it was during World War II – when the entire globe was on the brink of collapse.

Medicaid was created to help vulnerable people but expanded widely over time beyond the truly vulnerable. It’s time to right the ship, and Trump is the leader doing just that.