Medicaid Spending Keeps Growing — We Need People With Spines to Change Course

Something has gone wrong, and despite our best efforts as conservatives, it keeps getting worse.

Federal Medicaid and CHIP spending is projected to grow from $627 billion in 2025 to nearly $1 trillion by 2036 at an average of 3 percent per year, according to the CBO's February 2026 baseline. The CBO also estimates that the 2025 reconciliation law reduces federal Medicaid spending by more than $900 billion over ten years.

Complicated, isn't it?

In a poll conducted by the group Jefferson Rising, 83 percent of voters agree that "Medicaid funding should not be cut for American citizens, but we should remove illegal immigrants from getting Medicaid benefits." But at the same time, another 83 percent agreed that we need to "Ensure that rural hospitals get the Medicaid funding they need, and only illegal immigrants are removed from getting Medicaid benefits."

The work of the One Big Beautiful Bill has to continue, however, in balancing those books. We may not be able to fully eliminate Medicaid, but we can curtail its growth.

Work requirements are a big help. According to the Kaiser Family Foundation, that provision carries the largest federal savings at about $326 billion over ten years. But fraud and waste are more complicated. 

CMS put the fiscal 2025 Medicaid improper payment rate at 6.12 percent, or $37.39 billion, up from 5.09 percent a year earlier. The same fact sheet says 77.17 percent came from insufficient documentation, which it describes as generally not indicative of fraud or abuse. Missing verification of eligibility is the kind of gap is addressed by six-month renewals.

Last November, CMS said a preliminary audit found multiple states improperly used more than $1 billion in federal Medicaid money on illegal aliens, mostly during 2024 and 2025. California's governor's office denied it and said state-funded coverage programs are legal. The report did not include the audit itself.

Work requirements remain the single most important reform we can continue to push for when it comes to out-of-control Medicaid spending. CMS's June rule has non-pregnant expansion adults 19 to 64 in 43 states, and the D.C., show 80 hours a month of work, community service, a work program, or half-time school by January 1, 2027. Parents of children 13 and under, the medically frail, pregnant or postpartum individuals, and veterans with a total disability rating are among those exempt. A federal judge denied a bid by a coalition of states to block the rule in July, and the rule stays in effect while that case continues.

There is an ugly cost to the savings, however, which is why politicians are hesitant to push for more: The CBO estimates that Medicaid reductions would leave 7.5 million more people uninsured by 2034. Further cuts also mean that rural hospitals would go without vital funding. Most voters who utilize those hospitals are in red parts of the country, leaning Republican when they vote. Especially when it comes to agricultural communities.

But there has to be a push for accountability. We cannot and should not keep throwing money around, trying to buy our way out of the problems that are caused by our own policies. Republicans are more willing than Democrats to push for accountability, but when push comes to shove, even many of the Republicans are too hesitant to be the vote that takes away Medicaid from voters in their district.

We can right this ship, but we need politicians with spines to actually do it. Regardless of which Republicans can handle that responsibility, we know Democrats absolutely don't want to.

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