The test of an antipoverty program isn’t how many people it covers but how many it helps to self-sufficiency.
Saturation coverage of what the president did or did not say about immigrants and their homelands may have given the impression that nothing else of much significance is happening in Washington. But few things are more important to America’s financial health than entitlement reform, and last Thursday the Trump administration backed state work requirements for recipients of Medicaid, which covers more Americans than any other health-care program.
Medicaid dates to 1965, and the intention was to provide medical care to the truly needy. It was part of Lyndon B. Johnson’s “war on poverty,” a broader effort both to address the privations of the poor and to reduce government dependency. Instead, dependency has increased. According to the Kaiser Family Foundation, Medicaid now insures more than 70 million people, or 1 out of 5 Americans. The number of beneficiaries has more than doubled since 2000.
Federal and state governments share Medicaid costs. States pay for the services Medicaid recipients receive, then get money from Washington to offset part of those expenses. Crucially, the entitlement is open-ended, meaning that additional state enrollees automatically trigger more subsidies from Washington.
Until recently, Medicaid eligibility was mostly limited to impoverished women and children, the disabled and seniors in nursing homes who couldn’t afford long-term care without government assistance. In 2010, however, ObamaCare extended eligibility to healthy, working-age adults who were living above the poverty level. Today, Medicaid is not only the third-largest program in the federal budget but also the fastest-growing. At the state level, where balanced budgets are legally required, ever-growing Medicaid expenses have left less money for things like education and infrastructure that ultimately are more important to reducing the level of poverty.
Jason L. Riley is a senior fellow at the Manhattan Institute, a columnist at The Wall Street Journal, and a Fox News commentator.