Democrats believe they’ve found a potent issue in GOP Medicaid reform. They are hammering at Republican lawmakers, accusing them of not aggressively opposing potential “cuts” in the federal program, which offers health care to the indigent.

Republicans, trying to defuse the point, have responded with statements insisting that they’re engaged with the Trump White House to minimize problems for their home states and districts. Some have offered that abrupt reductions in federal funding would not only disrupt care for those who rely on Medicaid but could also destabilize public and private health care providers.

Such perfunctory remarks hardly satisfy liberal critics, who have been shrilly defensive in the midst of President Donald Trump’s onslaught. But it’s worth putting this controversy in some perspective.

Trump has vowed not to touch entitlement programs, but Democrats latched on to the issue after House Republicans passed a budget blueprint that orders the Energy and Commerce Committee to find $880 billion in savings from Medicare over the next decade. Democrats argue that could short the states in billions in federal funds. In fact, however, there will be no “cuts” — at least not in the traditional meaning of the term.

Baseline budget projections from the General Accounting Office, The Wall Street Journal noted, project spending on Medicare to increase $2.4 trillion through 2035, so “shaving $880 billion from that baseline would still amount to a $1.5 trillion increase in Medicaid spending.”

Only in Washington is a 2% auto-pilot annual spending increase called a “cut.”

Medicaid spending has exploded in recent years, the Journal highlights, growing “207% since 2008” — far in excess of Social Security and Medicare growth. That’s largely because Democrats — in their piecemeal attempts to nationalize the health care industry — have repeatedly expanded eligibility requirements to rope in middle-class families, intentionally making it more politically dangerous to reform.

What started as a program created for the poor now serves as primary health insurance for many workers capable of supporting themselves. In some states, for instance, nearly 1 in 4 residents is on Medicaid while the federal poverty rate of 11% didn’t even come close to that ratio in 2023.

Reform is not synonymous with throwing the poor out on the street to fend for themselves. A work requirement for able-bodied recipients is politically popular and would save $120 billion over a decade, according to a House report. Tightening improper payments could save even more. The General Accounting Office found that Medicaid and Medicare issued $100 billion in payments that should not have been made in fiscal 2023. That’s $1 trillion over 10 years.

Obviously there are savings to be had by more stringent accounting controls and eligibility requirements.

Congress does nobody any favors — least of all, those who truly need Medicaid — by ignoring the fate of fiscally unsustainable entitlement programs. But whatever direction congressional Republicans take — and that remains uncertain — actual budget “cuts” to Medicaid are exceedingly unlikely.

— From Tribune News Service