In recent years, Americans have learned a hard truth: “Fool me once, shame on you; fool me twice, shame on me.” During COVID-19, we were told to trust the experts, obey mandates, and silence our dissent. Over time, the truth emerged—much of what we were sold was false, and the price we paid in lives, education, and finances from their false narrative scam was extreme.
Now, many of those same voices are repeating another falsehood: that cutting Medicaid will cause Americans to die.
Recently, Rep. Chip Roy (R-Texas) and 19 House conservatives called for “structural reforms” to Medicaid in a letter supporting the GOP’s reconciliation bill. The bill proposes ending the enhanced federal match for Medicaid expansion and equalizing matching rates for work-capable adults. This would contribute to $880 billion in less expected spending than otherwise over the next decade. Predictably, the media and progressive lawmakers responded with panic. House Minority Leader Hakeem Jeffries declared that such reforms would cause “people to die.”
But repeating a lie doesn’t make it true.
Medicaid is failing. Cutting its excesses and restoring its core purpose isn’t cruelty—it’s compassion. Structural reform is the only path forward if we want to protect the truly vulnerable and improve access to care.
Medicaid was created in 1965 as a safety net for the most vulnerable: low-income children, pregnant women, people with disabilities, and the elderly. But that mission has been lost. Starting with the ACA, followed by the emergency declaration for COVID-19 and thereafter, the federal government greatly expanded Medicaid enrollment. They expanded eligibility standards and suspended verification—millions of healthy, working-age adults were added to the program, many of whom no longer qualify.
Millions of Americans were thrown out of work by the Biden administration lockdowns and thus lost their employer-supported health insurance. Biden allowed them to enroll in Medicaid. According to the Bureau of Labor Statistics, at least 63% of these adults have returned to work and regained access to employer-sponsored insurance. Yet they remain on Medicaid, straining the program and crowding out those who truly need help.
As a result, access to health care has plummeted. After the ACA’s Medicaid expansion, wait times to see a primary care doctor in mid-sized cities rose from 99 to 122 days. Under the Biden administration, that delay has reached 132 days. Meanwhile, nearly one-third of physicians refuse new Medicaid patients due to low payments and excessive red tape. In Texas, fewer than half do.
This leads to death-by-queue—patients with government “coverage” die waiting in line (a queue) for care. According to the British Medical Journal, even a one-month delay in cancer diagnosis raises the risk of death. Medicaid patients are now waiting four months or longer.
This is what we call the healthcare seesaw: as more people are given government health insurance, Medicaid or Tricare, access to care declines. COVID-era policies forced millions of non-vulnerable Americans onto the rolls, diverting the system’s limited resources away from those it was designed to serve, those who truly need help.
The seesaw can be rebalanced. By reinstating eligibility reviews and narrowing enrollment to the medically vulnerable, we can improve care for those who need it most. Fewer enrollees mean shorter wait times, more participating providers, and better outcomes.
This reform doesn’t hurt the poor and medically vulnerable—it helps them.
Medicaid’s dysfunction is not just about who is covered. It’s also about how the money is spent. Nearly half of U.S. healthcare spending—more than $2 trillion annually—is wasted on what we call BURRDEN: Bureaucracy, Unnecessary Rules and Regulations, interfering Directives, and Enforcement for Non-compliance.
This is bureaucratic diversion—where dollars meant for care are redirected into bloated administrative systems. Between 1970 and 2024, while the number of physicians increased 150 percent, the number of healthcare bureaucrats expanded more than 4,400 percent! As Brian Blase of the Paragon Health Institute and economist Paul Winfree noted recently, Medicaid is plagued by improper payments, waste, and misaligned incentives that reward states for expanding rolls rather than delivering outcomes.
As bureaucracy grows, care shrinks. This is another healthcare seesaw: more red tape (BURRDEN), less healing. Cutting bureaucratic waste would allow more dollars to reach doctors and patients—where they belong.
Let’s be clear: Medicaid is broken. It’s bloated, mismanaged, and failing the very people it was built to protect. The solution is not more funding and empty coverage promises—it’s structural reform.
Congress is right to demand eligibility checks, spending caps, and funding flexibility. Approaches like block grants to states and consumer-directed models, including no-limit Health Savings Accounts, can get medical care where and when it is needed by empowering patients, rewarding providers, and reducing waste.
In contrast to the dire warnings, Medicaid reform will not kill Americans. It will save lives—by restoring access, improving quality, and directing limited resources to the truly medically vulnerable.
We were fooled once, by our own government, no less! There won’t be a second time.
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.
image, Pixabay license.
Jesus Christ is King
Comments are closed.