GOPs Medicaid trims wont tame the beast heres how to restore sanity

This week, House Republicans are laboring to pass proposals to reform Medicaid, the fast-growing system of federal funding for states to deliver health care to low-income Americans, as part of President Trump’s “big beautiful” budget bill.Their proposal creates the appearance of generating substantial savings by nudging states to restrict enrollment — notably by mandating an 80-hour-per-month work requirement for able-bodied adults to receive the benefit.Liberals responded to the House’s modest proposals with predictable outrage.Matthew Yglesias called it a “war on the poor,” arguing that the bill’s cuts “will cause 8.6 million people to lose their health insurance.”Massachusetts Rep.Lori Trahan deemed it “federal overreach, plain and simple, with devastating consequences for the people we represent.”Critics’ outrage is surely overblown: From 2003 to 2023, Medicaid’s annual cost to federal taxpayers surged from $161 billion to $616 billion.The Republicans’ proposals would merely slow the program’s further spending growth over the coming decade, from 4.6% per year to 3.7% — and even that reduction in growth is likely to overestimate the savings that would occur.To offset the cost of extending the 2017 tax cuts, the House GOP has attempted to maximize the Congressional Budget Office’s estimate of savings resulting from its proposed reforms to Medicaid.But CBO estimates don’t account for likely hurdles to implementation, such as states finding ways to evade intended cost controls.Given such hurdles, the savings and coverage loss are both much less than they’re cracked up to be.This is by design — and it reflects the GOP’s tiny majorities in both houses of Congress, combined with political pressure from governors and health-care providers who stand to lose revenues.Take those work requirements: The bill allows part-time “community engagement” activities to satisfy the obligation — and states have proven adept at using ...