In the upcoming budget reconciliation battle, congressional Republicans and President Donald Trump have an opportunity to reform Medicaid to protect benefits for those who need them most while ending the perverse incentive for states to place more able-bodied workers in the program.

To help pay for an extension of his 2017 tax cuts and deliver on border and defense priorities, President Trump has endorsed identifying and cutting waste, fraud, and abuse in mandatory federal spending programs, including Medicaid. Elected Democrats and the corporate media have cast this as a cold-hearted effort to kick disabled and truly needy individuals out of the program, but the facts paint a decidedly different picture.

While Medicaid is not facing the same insolvency crisis as Social Security and Medicare, its costs have exploded over the past two decades. The Paragon Health Institute (PHE) reported that projected Medicaid baseline spending (the annual cost of the Medicaid program under current laws and policies) increased by 8.6 percent, or $685 billion, from 2023 to 2024 alone due to Biden administration policies, including the effective removal of work requirements. As Republican Representatives Andy Harris of Maryland, Chip Roy of Texas, and Eric Burlison of Missouri pointed out in a March 10 Fox News op-ed, Medicaid spending has grown by 51 percent in just the past five years.

Biden’s expansion of Medicaid was itself a continuation of the expansion of the program through the Affordable Care Act (Obamacare). That law dramatically expanded the number of people eligible and incentivized states to add more beneficiaries by offering enhanced federal funding, covering 100 percent of costs initially and 90 percent permanently for newly eligible enrollees.

Importantly, as the Kaiser Family Foundation (KFF) notes, under Obamacare’s Medicaid expansion, the federal government covers a higher percentage of costs for able-bodied adults (up to 90 percent) compared to disabled individuals (between 50 to 78 percent, depending on the state).

In other words, the more able-bodied adults that states add to Medicaid, the more money they receive from the federal government.

The results of this change have been predictably disastrous. A Foundation for Government Accountability (FGA) report last July concluded that “the focus of the Medicaid program has shifted from the truly needy to able-bodied adults.” In 2022, there were 41 million able-bodied adults on Medicaid, compared to just over 6 million in 2000 and 11 million in 2010, the year Obamacare was signed into law.

Moreover, state Medicaid programs have prioritized enrolling able-bodied adults over the disabled to maximize their share of federal funding. As FGA put it, “As millions of able-bodied adults have flooded the Medicaid rolls nationwide, the truly needy—those the program was designed for—have been shoved to the back of the line.”

This skyrocketing enrollment has gone hand-in-hand with declining workforce participation – particularly among young men. A CNBC report from last September found that about 6.8 million, or 10.5 percent of American men aged 25-54, considered to be in their prime working years, are “neither working nor looking for employment.”

Another study from the American Enterprise Institute (AEI) found that “44 percent of non-disabled working age Medicaid recipients without children worked at least 80 hours.” For comparison, “72 percent of non-disabled working age adults without children who do not receive Medicaid worked at least 80 hours in the same month.”

Even without changing any eligibility requirements, Medicaid is heavy with waste and bureaucratic bloat. The Paragon Health Institute has estimated that Medicaid “issued nearly $1.1 trillion in improper payments over the past decade.”

It is these improper payments and freeloaders on the system that Trump and congressional Republicans are looking to target – and rightly so. Reps. Roy and Burlison point out in their op-ed that “reimplementing Clinton-era work requirements alone would save roughly $120 billion over 10 years and put more workers back in our economy.”

House Speaker Mike Johnson has also called for reforms. “You don’t want able-bodied workers on a program that is intended, for example, for single mothers with two small children who [are] just trying to make it,” Johnson wrote in a memo earlier this year, according to Newsweek. “That is what Medicaid is for. Not for 29-year-old males sitting on their couches playing video games.”

“We’re going to find those guys, and we’re going to send them back to work,” he continued. “That’s what everybody supports, that’s what the Republicans are for.”

Policy experts have made similar arguments. Rachel Barkley, representing a group called Able Americans, has called on Congress to end the higher matching rate for healthy adults. Congress, according to Barkley, should “prioritize funding for Medicaid’s intended enrollees.”

“It would be a mistake to implement broad across-the-board Medicaid cuts that apply equally to an enrollee with a disability as it would an able-bodied adult enrollee,” Barkley, who is herself a quadriplegic, argued in The Hill last month.

The budget reconciliation process now underway presents a prime opportunity for Republicans to enact such changes. Under this special parliamentary process, Republicans will only need 51 votes in the Senate (rather than the usual 60) to implement changes to Medicaid as part of the budgetary process.

The liberal establishment will surely continue to sound the alarm about “cuts” to the program. But as Republican leaders have made clear, for those who truly need Medicaid, these “cuts” are addition by subtraction.

AMAC Newsline contributor Matt Lamb is an associate editor for The College Fix. He previously worked for Students for Life of America, Students for Life Action, and Turning Point USA. He previously interned for Open the Books. His writing has also appeared in the Washington Examiner, The Federalist, LifeSiteNews, Human Life Review, Headline USA, and other outlets. The opinions expressed are his own. Follow him @mattlamb22 on X.