Democrats’ push to massively expand Medicaid over the past several years has turned the program into something nearly unrecognizable.
A series of reports have outlined the growing list of problems at the Centers for Medicare and Medicaid Services (CMS), including improper payments, healthcare funds being used for non-medical expenses and able-bodied adults receiving funds meant for Americans who may desperately need it. Former President Joe Biden’s CMS massively expanded Medicaid benefits during his sole term, driving Medicaid spending up from $734 billion at the beginning of his term to $871.7 billion in 2023.
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“The big thing that’s sort of missing is [Medicaid’s] role of covering able-bodied adults in this,” Edmund Haislmaier, a health care policy expert at the Heritage Foundation, told the Daily Caller News Foundation. “Medicaid was originally set up to cover what we would call vulnerable enrollees, basically people who could not work and could not expect to have other sources of income or [medical] coverage. So you’re talking about poor children, low-income senior citizens, and disabled people. That is the core focus, and it’s also been expanded to include poor pregnant women over the years. What happened with the Affordable Care Act (ACA) is it was further expanded [Medicaid] to include able-bodied adults below a certain income level.”
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A provision under the ACA, which was signed into law by former President Barack Obama in March 2010, called for Medicaid to be expanded to provide coverage for adults under age 65 with incomes up to 138% of the federal poverty level. Roughly 35 million able-bodied adults were enrolled in Medicaid programs while not working as of May 2023, according to estimates from the Foundation for Government Accountability, a conservative think tank.
Similarly, the Obama-Biden administration also oversaw sweeping expansions to Medicare coverage by abolishing a rule in 2014 preventing Medicare from funding sex-change surgeries. Obama’s administration also expanded coverage for sex-change procedures in 2016 through their interpretation of Section 1557, a non-discrimination provision of the ACA, which helped pave the way for Medicaid funds to be used to cover sex-change operations in certain states.
From January 2018 to September 2023, 16 states funneled over $165 million toward so-called “gender transition services.”
“The argument that we and others make is ‘look, why is the federal government giving states more money for covering people who have other options, like getting a job and getting coverage privately, and less money for people who need it the most, like disabled people,’” Haislmaier added. “That’s something that should be fixed in reforms.”
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Biden also encouraged states to propose waivers to broaden Medicaid coverage during his presidency, resulting in the CMS approving some states’ requests to use Medicaid funds to pay for non-medical expenses for some individuals, such as rent, air conditioning and food. In April 2024, the federal government approved a request from Massachusetts to use Medicaid funds to pay for up to six months of temporary housing for eligible families and pregnant individuals who are MassHealth members residing in the emergency shelter system.
In the waning weeks of Biden’s presidency, his administration’s CMS also granted Vermont approval to use Medicaid funds to cover the cost of rent for some homeless individuals in the state.
For fiscal year 2025, Medicaid programs are projected to cost roughly $656 billion, according to the Congressional Budget Office.
Notably, the U.S. spends more on healthcare per individual than any other similar country, with health expenditures per person costing $12,555 in 2022, which was over $4,000 higher than any other high-income country. The rate of improper Medicaid payments in 2024 was 5.09% — or $31.10 billion — 79.11% of which was the result of insufficient documentation, according to the CMS.
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House Republicans on Feb. 25 advanced a budget resolution calling for major reductions to overall federal government spending, but Congress has not yet made any specific proposals involving Medicaid. Many Democrats have repeatedly said that Medicaid funding is at risk of potential cuts by Republican lawmakers, despite President Donald Trump recently emphasizing that he does not want to see any drastic changes to the program.
While Republicans on the House Ways and Means Committee circulated a list of possible cuts to Medicaid funding in recent weeks, the potential cuts were primarily focused on removing illegal migrants from eligibility, which they claimed could save up to $35 billion over the course of a decade.
Trump told Fox News’ Sean Hannity during a Feb. 14 interview that Medicaid will not be “touched” aside from cases of fraud or illegal migrants found to be misusing the program. Still, Democratic lawmakers have continued making claims in recent weeks that Medicaid funding is in peril.
Democratic House Minority Leader Hakeem Jeffries claimed in a Feb. 27 post on X that some Americans would have healthcare “ripped away” from them due to House Republicans’ budgetary agenda. Moreover, during Trump’s address to a joint session of Congress on Tuesday, several Democrats attempted to protest the speech by holding up signs that read “Save Medicaid.”
The Biden-Harris administration presided over enormous government spending, which some economists have claimed partially contributed to the rapidly-expanding U.S. federal deficit and widespread inflation. Trump has made weeding out any unnecessary spending and waste at federal agencies a cornerstone of his presidential agenda as part of a wider effort to save American taxpayers money, which has thus far faced massive opposition from Democrats.
In light of Biden’s Medicaid expansions, some Republican lawmakers have called for drastic reforms to CMS in recent weeks, including Republican Texas Rep. Chip Roy, who claimed in a Feb. 26 post on X that Medicaid is being “abused” by able-bodied individuals “gaming the system,” also noting that Congress has the responsibility “reform” the program.
Similarly, Republican Kansas Sen. Roger Marshall wrote in a Feb. 27 social media post that the U.S. “must return Medicaid to its intended purpose of helping those in desperate need,” and North Carolina Republican Rep. Greg Murphy wrote in Thursday social media post that possible reforms to Medicaid are about “prohibiting able-bodied individuals from abusing the program and states like California getting their Medicaid house in order.”
“Republicans have not been as good about reforming [Medicaid] as they should be,” Haislmaier told the DCNF. “They have been more about budget cutting. What you need to do with this is not approach it as a budget issue, you need to approach it as ‘how do we reform this program to better serve people who need it?’ And frankly, to move off of it the people who don’t need it.”
The CMS did not respond to a request for comment from the DCNF.
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First published by the Daily Caller News Foundation.
