Medicaid cuts could save thousands of lives

The Hill

02-07-2025

'A lie can travel halfway around the world while the truth is still putting on its shoes,' goes the well-known saying often attributed to Mark Twain. There is no better demonstration of this wisdom than today's falsehoods about Medicaid cuts that are reported, repeated, reposted and retweeted, even as the truth gets but a few eyeballs.
NBC News recently predicted, 'Proposed Medicaid cuts could lead to thousands of deaths.' Other mainstream media claimed similar dire consequences while conflating loss of Medicaid coverage with loss of access to a physician's services.
Yet it should be well-known by now that coverage does not equal care.
For optimal decision-making, physicians and patients need an accurate picture of reality, not ideologically driven disinformation and unscientific statements bruited by the media and government officials. False narratives and fake news cannot be left unchallenged, and that includes the dramatic claims that proposed cuts would 'devastate our healthcare system.'
The Trump administration seeks to make three modifications in the current Medicaid program: cutting illegal immigrants from the program; reducing federal contributions to Medicaid; and adding work requirements for able-bodied adults.
On Feb. 19, 2025, President Trump signed Executive Order 14218, 'Ending Taxpayer Subsidization of Open Borders,' which began a process of removing illegal residents from all forms of taxpayer-funded social, financial and medical (Medicaid) support. States like California and Oregon have made more than 1 million illegals eligible for Medicaid coverage, even though federal laws prohibits their enrollment.
The House version of the budget reconciliation bill cut 13 percent from the Medicaid budget over 10 years, $863 billion from an estimated $7 trillion outlay. Detractors assume the cuts will come from insurance coverage support, implying reduced care. But what about cutting non-clinical, regulatory spending?
From 1970 to 2020, Congress implemented Medicare and Medicaid and passed the Emergency Medical Treatment and Labor Act of 1986; the Unfunded Mandates Reform Act of 1995; the Health Insurance Portability and Accountability Act of 1996; and the Affordable Care Act of 2010, along with other lesser-known laws and numerous healthcare provisions buried in annual Omnibus Budget Reconciliation Acts.
During those 50 years, while the physician supply increased 100 percent, the number of healthcare bureaucrats (who provide no clinical care) increased by 4,400 percent. This massive expansion of the nonclinical workforce diverted trillions of dollars from patient care to federal bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance activities. In fact, half of the $4.8 trillion the U.S. spent on healthcare in 2024 produced no medical care at all.
The massive increase in bureaucratic spending was matched by a corresponding expansion of the regulatory burden imposed on care providers, both individuals and institutions. Not only did the expanded bureaucratic expense suck money away from patient care, it took doctors' time away from patients to comply with administrative paperwork.
In 2024, Washington spent $584 billion on Medicaid and the Children's Health Insurance Program. Presumably, some $292 billion went to bureaucracy taken from patient care. With a goal of cutting Medicaid by about $86 billion a year, removing illegal immigrants from enrollment per Executive Order 14218 would save approximately $10 billion. Regulatory reform such as block grants and DOGE-like bureaucratic simplification should easily cut the remaining $76 billion without impacting patient care at all — unless regulations are more important than people.
As enrollment in Medicaid goes up and spending on both insurance and pointless bureaucracy increases, money to pay for patient care goes down. This produces longer wait times for care; the average maximum wait time to see a primary care physician was 132 days in 2022, a 33 percent increase since Obamacare. This inverse relationship – enrollment up, access to care down – is called the seesaw effect.
So-called 'news' reporting reached a new low when the leftist website Vox described Medicaid as a 'rare bright spot' in U.S. healthcare. In fact, enrollees are experiencing death-by-queue, documented in Medicaid and Tricare. Patients wait so long for care, they often succumb to treatable illness while waiting in line for care that never comes. Even a one-month delay increases mortality in cancer. Imagine the effect of 132 days before seeing the doctor.
Between 2019 and 2023, 20 million Americans were added to Medicaid rolls. Most were not medically vulnerable — they were healthy adults, thrown out of work by Joe Biden's COVID lockdowns.
More than 60 percent of these have returned to work, and most are eligible for employer-supported health insurance. When Newsweek warns that 'millions could lose health insurance' with Medicaid cuts, these are people who shouldn't have Medicaid in the first place. Cutting them will release money that can be used for those who truly need a medical safety net.
Medicaid cuts could make the seesaw reverse its path. Reduced enrollment and cuts to non-clinical spending could shorten wait times, make care more accessible, and reduce death-by-queue. No one in the media has reported this potential benefit from cuts to Medicaid.
Work requirements are also a proposed modification to Medicaid. When work requirements were added to then-President Clinton's entitlement reform bill, the Patient Responsibility and Work Opportunity Reform Act of 1996, opponents emulated Chicken Little, crying that there would be 'blood in the streets' and children would starve to death.
They were wrong. Outcomes data 20 years later showed improvement in every fiscal, employment, nutritional and social metric. A full 60 percent were able to get off the welfare rolls. Today's opponents of work requirements are making dire but similarly false predictions.
Modifications to the Medicaid program will do the opposite of the left's doomsday predictions. Instead of 'Medicaid cuts could lead to thousands of deaths,' the NBC headline should read, 'Medicaid cuts could save thousands of lives.'
Deane Waldman, M.D., MBA, is professor emeritus of pediatrics, pathology, and decision science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; former director of New Mexico Health Insurance Exchange; and author of 13 books, including his latest: 'Empower Patients – Two Doctors' Cure for Healthcare.'