I drew on Kim Strassel’s paragraph defending the big, beautiful bill against the charge that it guts Medicaid in her column her “Big, Beautiful Distortions” in my post “About that bill.” I am guessing it is she who expands on that paragraph in the excellent Journal editorial “No One is ‘Gutting’ the Safety Net.”
In the editorial, she notes (assuming it is she), “annual spending on the health entitlement will grow over the next decade even with the bill’s roughly $1 trillion in estimated savings. Medicaid spending has risen by roughly 60% since 2019, and the bill’s intent is to try to bend Medicaid’s trajectory closer to the bad old days of 2020.” Here is the heart of what she has to say (I have added the link to the Foundation for Government Accountability):
Democrats and some Republicans have offered cynical distortions that pregnant women in poverty and disabled children will suffer. But Republicans are trying to address the program’s enormous ObamaCare expansion to prime-age adults above the poverty line, and note the details of those who will allegedly lose coverage.
CBO, in an letter last month about the House bill, said 4.8 million won’t comply with the bill’s part-time work requirement. That should be a warning about the country’s social condition. The work requirement doesn’t apply to anyone who is disabled, pregnant or caring for a child younger than age 14. Volunteering 20 hours a week or enrolled in school? You can get Medicaid.
Don’t buy the Democratic talking point that the working poor will be lost in red tape as they try to prove they’re on the job. States have handled work requirements in food stamps and cash assistance for decades.
As the Foundation for Government Accountability notes, when Arkansas experimented with such requirements in Medicaid, “enrollees only had to report work once, and it was easy to do so.” The state cross-referenced wage and employment data and folks could also self-attest online or call a hot line. The Democratic position is that Medicaid should be a free universal benefit for men who refuse to work.
The other main provision is tamping down state scams to hoover up more federal dollars. The main losers here are large hospital systems that have been doing well on the largesse.
The GOP bill also includes sensible measures such as asking states to check their Medicaid expansion rolls every six months and more scrutiny on ObamaCare subsidies. That is necessary because the Biden Administration waved millions onto health entitlements. The Paragon Institute estimates that 6.4 million people are enrolled in fully subsidized ObamaCare plans but don’t meet the eligibility criteria. Apparently this is what Democrats support.
The bill’s changes to food stamps are also modest and rooted in the tenet that work is central to upward mobility. As a refresher, the program currently requires able-bodied adults without dependents to work about 20 hours a week—or lose benefits after three months. That 90-day dispensation allows those who suffer a setback time to get back on their feet. But here is the not at all radical reform proposition: More of those who rely on benefits for longer need to be working. The GOP bill would expand the current work requirement to cover more able-bodied adults, including some parents with older children in school and those in their 50s and early 60s….
As the editorial subhead has it, “The GOP will have to rebut the Democratic and media distortions about their reforms or lose the 2026 election.” You better believe it. Whole thing here. Ramesh Ponnuru adds a footnote here at NR.
