Medicaid’s shocking transformation under prior Democrat rule has diverted billions from the vulnerable to fund gender transitions for minors and healthcare for illegal immigrants.
At a Glance
- Medicaid spending ballooned from $734 billion to $871.7 billion during Biden’s term
- Approximately 35 million able-bodied adults enrolled in Medicaid without working as of May 2023
- 16 states spent over $165 million on gender transition services from 2018 to 2023
- Improper Medicaid payments in 2024 amounted to $31.10 billion
From Safety Net to Bloated Bureaucracy
President Trump’s administration now faces the daunting challenge of repairing a Medicaid system that Democrats have expanded beyond recognition. What was once designed as a targeted safety net for America’s most vulnerable has morphed into a $871.7 billion behemoth that increasingly serves able-bodied adults who could obtain private coverage through employment. The fundamental question now confronting policymakers is whether Medicaid should return to its original mission or continue its unsustainable expansion that diverts resources from those most in need.
This transformation didn’t happen by accident. The Affordable Care Act’s provision allowing states to expand Medicaid to adults with incomes up to 138% of the poverty level has dramatically altered the program’s focus. With 40 states plus Washington, D.C. now having adopted expansion, millions of able-bodied adults have been added to the rolls. The result? A system increasingly stretched thin, with funds distributed to those who have other options rather than concentrated on the truly needy.
The Fiscal Nightmare
The financial implications of Medicaid expansion are staggering. Congress is now considering reducing Medicaid spending to fund expiring tax cuts, with two scenarios under consideration. In the first scenario, if the enhanced federal match rate is eliminated but states maintain expansion, federal spending would decrease by 10% while state spending would increase by 17% over ten years. In the second scenario, if states drop expansion altogether, 20 million people would lose coverage while federal spending would decrease by 25%.
The financial disaster extends beyond just coverage numbers. Improper Medicaid payments in 2024 amounted to $31.10 billion, primarily due to insufficient documentation. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) has demonstrated troubling mismanagement, allowing states to direct Medicaid funds toward politically-motivated purposes rather than essential healthcare for those truly in need. The Trump administration faces the challenge of bringing this runaway spending under control while ensuring that the truly vulnerable aren’t left behind.
From Healthcare to Social Engineering
Perhaps most alarming is how Democrats have weaponized Medicaid to advance radical social policies. From 2018 to 2023, sixteen states spent over $165 million on gender transition services, including irreversible procedures for minors. Additionally, Biden-era policies expanded Medicaid coverage to illegal immigrants, diverting resources away from American citizens in need. These ideologically-driven expansions occurred while approximately 35 million able-bodied adults remained enrolled in Medicaid without working as of May 2023.
“The big thing that’s sort of missing is [Medicaid’s] role of covering able-bodied adults in this” – Edmund Haislmaier
House Republicans have proposed sensible reforms, focusing on removing illegal migrants from Medicaid eligibility and implementing work requirements for able-bodied adults. These measures would help refocus the program on its original purpose while encouraging self-sufficiency. With Medicaid programs projected to cost $656 billion in fiscal year 2025 and the U.S. already spending more on healthcare per person than any other high-income country, reform is not just fiscally responsible — it’s imperative for the program’s survival.
The Path Forward Under President Trump
The Trump administration now has the opportunity to restore Medicaid to its original purpose as a safety net for the truly vulnerable. This means implementing reforms that prioritize the disabled, elderly, and impoverished children over able-bodied adults who could obtain private coverage. It means ending the use of Medicaid dollars for controversial gender transition procedures, especially for minors. And it means ensuring that American taxpayer money benefits American citizens, not illegal immigrants who have violated our laws to enter the country.
“Republicans have not been as good about reforming [Medicaid] as they should be” – Edmund Haislmaier
The stakes couldn’t be higher. With the national debt soaring and inflation continuing to burden American families, Medicaid reform represents a critical opportunity to demonstrate fiscal responsibility while protecting the truly vulnerable. By returning Medicaid to its core mission, President Trump can cut wasteful spending, encourage self-sufficiency, and ensure that our healthcare safety net remains available for those who truly have nowhere else to turn.
