By Melissa O’Rourke
Democrats have slammed the Medicaid provisions in the Republicans’ One Big Beautiful Bill Act as “draconian,” but a closer look at the policy changes reveals that reforms are far more modest than the rhetoric suggests.
Signed into law by President Donald Trump on July 4, the GOP’s sweeping tax and spending package projects over $1 trillion in savings from Medicaid reforms. While Democrats have portrayed the changes as an unprecedented assault on the health care system, they ignore the explosive surge in Medicaid spending over the past decade and mischaracterize reforms that mainly target a widely exploited funding loophole and nonworking, able-bodied enrollees.
“What we’re seeing from the left and special interest groups are blanket fear-based arguments against the proposal,” Nina Owcharenko Schaefer, director of the Center for Health and Welfare Policy at the Heritage Foundation, told the Daily Caller News Foundation. “These are just common-sense changes that tighten up the existing structure of the Medicaid program, weed out fraud, waste and abuse, and help the system function better.” (RELATED: EXCLUSIVE: Marsha Blackburn Pushes Back On Dems’ ‘Fearmongering’ About Trump’s ‘Beautiful’ Law)
Democrats have seized on Medicaid as a central issue ahead of the midterm elections, aiming to persuade voters that the GOP-led changes threaten healthcare coverage, particularly for the most vulnerable. House Minority Leader Hakeem Jeffries called the new law “the largest assault on Medicaid and healthcare in American history,” while many other Democratic lawmakers have claimed “people will die” as a result of the changes.
However, policy experts say such statements give a misleading impression. Medicaid spending is still expected to grow over the next decade, but at a slower rate than previously projected.
“It’s not the draconian cuts that the left is talking about,” Hayden Dublois, data and analytics director at the Foundation for Government Accountability (FGA), told the DCNF. “Medicaid spending will still grow during the budget window, but will just grow a little less than it otherwise would have.”
Jeremy Nighohossian, a senior fellow and economist at the Competitive Enterprise Institute, told the DCNF that the government spends a staggering 51% more on Medicaid today than it did in 2019.
“When I read the criticism saying Medicaid cuts are too big, I notice that no one ever talks about how fast it grew over the last seven years, and I think that’s probably deliberate,” said Nighohossian. “In light of recent growth in Medicaid, I don’t think the One Big Beautiful Bill’s provisions are excessive.”
Just a day before the bill’s passage, a rural hospital in Nebraska announced that it would be shutting down, citing “anticipated federal budget cuts to Medicaid.” Democrat Sen. Bernie Sanders of Vermont warned it would be the “first of many hospitals to close” because of the “horrific cuts.”
Yet, many of the key reforms — including the crackdown on “provider taxes,” which critics describe as a gimmick used by states to inflate Medicaid costs and extract more federal dollars — will not take effect until 2028.
The federal government matches a portion of each state’s Medicaid expenditures. To maximize this match, many states tax hospitals and other healthcare providers, then return that money to them as Medicaid payments, creating the appearance of higher state Medicaid spending.
“Provider taxes are basically funding gimmicks and legalized money laundering that allow states to scheme federal taxpayers into footing the bill for bailouts to hospitals,” said Dublois.
While Congress technically prohibits this kind of recycling of funds from federal matching, existing rules presume compliance if states keep provider taxes at or below 6% of net patient revenues. The new rule does not ban provider taxes or change federal matching rates, but simply lowers the threshold for federal review — from 6% to 3.5% — making it harder for states to exploit the loophole. (RELATED: Trump’s ‘Big Beautiful Bill’ May Not Be The Deficit Disaster Critics Claim — Here’s Why)
“It’s arguable even to call these cuts,” said Nighohossian. “All the [Big Beautiful Bill Act] does is say, if you do tax at a higher rate, then we’re going to look at it and make sure you’re not just obviously gaming the system.”
While some governors have warned they can’t afford the changes, Nighohossian pointed out that state governments contributed a higher proportion of their economies to Medicaid in the 2010s than they do now.
“States have contributed more to Medicaid in the past, so they clearly have the budget capacity if they want to mitigate some of the impact of the federal changes,” said Nighohossian.
Another hotly contested provision is the new Medicaid work requirement. Starting in 2027, states will be required to track that able-bodied adult Medicaid recipients complete at least 80 hours per month of work, volunteering, education or job training, as well as more frequent eligibility checks.
Democrats such as New Jersey Rep. Frank Pallone, ranking member of the House Energy and Commerce Committee, have claimed that work requirements “will result in millions of Americans losing health care coverage and getting sicker due to bureaucratic paperwork requirements,” while some corporate media outlets have argued states would struggle to build systems to track compliance.
However, with implementation still years away, Dublois said states have a “lengthy runway to get this done,” adding that “[Centers for Medicare and Medicaid Services] provides guidance to those states well in advance of when those work requirements need to be implemented, and there will be CMS grant funds available to states to help implement them.”
State Medicaid agency data obtained by the FGA through Freedom of Information Act requests reveal that 62% of non-elderly, able-bodied individuals on Medicaid did not work. Additionally, the American Enterprise Institute found in May that Medicaid recipients who do not work spend 4.2 hours per day — or 125 hours a month — watching TV and playing video games, more than 50% above the 80-hour work requirement.
“It’s the common-sense parts of the bill that are hard for liberals to argue against, so they don’t want to look at what’s actually in the bill,” said Schaefer. “A lot of the fearmongering out there is saying, ‘We just want the status quo to run as is. Let’s keep our heads in the sand and let’s not worry that we’re spending a trillion dollars on a program that is supposed to be for very low-income people.’”
