America
How Trump Saved Medicaid
By restraining spending and restoring fiscal responsibility, program will better serve poor and disabled.
T BY MERRILL MATTHEWS
he reason republicans fought so hard to reform the Medicaid health insurance program — and why they got
so much grief from Democrats and the media for their efforts — was to halt liberals’ decades-long drive to force every American into government-run healthcare. President Donald Trump’s One Big
Beautiful Bill Act (OBBB) takes impor- tant steps in undermining liberals’ goal by restraining Medicaid spend- ing, restoring fiscal responsibility, and returning Medicaid to a program cov- ering the poor and disabled.
HOW MEDICAID WORKS Medicaid is a federal-state program providing health insurance for low- income individuals, the disabled, and nursing home care. The federal government provides
14 NEWSMAX | SEPTEMBER 2025
every state with “matching funds,” which come with regulatory strings attached. States also provide funds and regulations and manage their pro- grams. For every dollar a state spends on Medicaid, the federal government covers between 50% (for 10 states) and 77% (for Mississippi), creating an economic incentive for states to spend more because they only pay a portion of the cost. But there’s more. In their effort to
expand the program, the Affordable Care Act (Obamacare) increased Med- icaid’s federal match to 90% to 100% for the first three years — if states expanded Medicaid to include many adults with higher incomes who weren’t historically eli- gible.
That change even-
sure over time changed that. Today, only 10 red states have never expanded. In addition, Congress passed COV- ID-19-related legislation in 2020 that temporarily increased the federal match and required states to maintain enrollment for nearly all Medicaid beneficiaries. That “continuous enrollment con-
dition” ended March 31, 2023, leading to a gradual decline in the Medicaid population. Even so, the program is still much larger than it was pre-pan- demic.
Today, Medicaid spends about Medicaid spends about
$914 billion
tually increased Med- icaid rolls by 20 mil- lion people. Democrats tried to make Medicaid expansion mandatory, but the U.S. Supreme Court stopped them. Initially, about half of the states refused to expand. But political pres-
$914 billion to cover more than 70 million beneficiaries — down from a peak of 87.4 million in March 2023.
However, the gov- to cover more than
70 million beneficiaries — down from a peak of 87.4 million in March 2023.
ernment spent less than half of that, $402 billion, on 54.5 million enrollees in 2010. Add the 70-plus million in Medicaid
to some 68 million mostly seniors in Medicare — some of whom are also in Medicaid — plus 7.3 million in the Children’s Health Insurance Program (CHIP) and about 22 million receiv-
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