We're members of the House Freedom Caucus. The US must choose: either $20 trillion in debt or Medicaid reform

In 10 years, the United States is on course to add $20 trillion to the national debt, setting the total sum owed by American taxpayers at over $56 trillion. Every year we spend in the red, interest on the debt continues to accumulate, until by 2051, when interest alone will be the largest line item in the federal budget. Put simply, we are on a collision course with a total financial crisis, and Congress may only have a handful of chances left to turn back. To prevent a total collapse of the U.S. dollar and give the American people the opportunities they deserve, lawmakers must reform Medicaid. To do anything less borders on malfeasance. 

While the urgency of our nation’s debt crisis is lost on many, cutting waste, fraud and abuse has been a priority of President Donald Trump’s administration since day one. The Department of Government Efficiency (DOGE) and Elon Musk have already uncovered billions of dollars in waste. From excessive Politico Pro subscriptions to Democrat pet projects overseas, taxpayers have been totally robbed.  

But, even if DOGE meets its quota for cuts and the freezes on wasteful federal grants aren’t dragged out in litigation, these savings won’t scratch the surface of what’s required to save America from its looming debt crisis. 

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For lawmakers who claim to be on board with cutting the waste, fraud and abuse? — and delivering on Trump’s historic mandate — this is it. Nothing you do in the next two years will come close to the importance of implementing the $880 billion required in savings to programs under the House Energy and Commerce Committee’s jurisdiction.  

Congress must face up to the threat posed by an ever-growing budget. (Fox News Digital)

We are not asking you to slash Medicaid, only turn back the clock and reverse its explosive expansion in the last few years that has put it on an unsustainable course.  

In the last five years, federal Medicaid spending has skyrocketed from $409 billion in 2019 to $618 billion in 2024, a 51% increase. Despite being 60 years old, a third of Medicaid’s growth has occurred in those same five years. And in the next decade, the Congressional Budget Office projects that Medicaid will cost more than $1 trillion annually, rivaling the size of Saudi Arabia’s current economy. 

When Obamacare introduced an entirely new class of able-bodied adults to Medicaid, the program exploded, and the federal government took on the majority of the costs. Under President Joe Biden, the Centers for Medicare & Medicaid Services (CMS) withdrew 13 waivers for Medicaid work requirements, once again dramatically expanding the program and costing taxpayers billions.  

Medicaid was never meant to be this expansive. 

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Medicaid was intended to assist vulnerable populations like the disabled, pregnant women, children and people in poverty. Today, able-bodied, working-capable adults are on course to become the largest subgroup on Medicaid. 

Nationwide, there are an estimated 24.6 million able-bodied, working-capable adults on Medicaid, 60% of whom report no earned income. Coupled with the Biden administration’s unilateral expansion of food stamps, the federal government is effectively discouraging a substantial portion of the able-bodied American population from seeking employment altogether. 

The "safety net" has become a full-blown poverty trap, keeping Americans in an endless cycle of dependency and diverting resources from those who truly need help. In some states, higher provider rates for expansion enrollees have created an explicit financial incentive for healthcare providers to discriminate against traditional enrollees. Single moms, infants and the disabled are being pushed aside in favor of able-bodied adults without dependents.  

Medicaid takes a huge chunk of the federal budget and if it is not cut, we will watch the national debt grow to over $50 trillion. (iStock)

Medicaid was meant to be a temporary bridge, not a final destination. You want to help your constituents? Give them the proper incentive structure to grow and thrive. Put them on the path to financial stability. 

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We have a duty to safeguard taxpayers and ensure that Medicaid does not bankrupt us. Cut the waste. Cut the fraud. Cut the abuse.  

Reimplementing Clinton-era work requirements alone would save roughly $120 billion over 10 years and put more workers back in our economy. Site neutrality could save over $471 billion. Normalizing the federal reimbursement rate for the expansion population under Medicaid would save nearly $600 billion. You could even take Biden’s advice and eliminate Medicaid provider taxes that he called a scam and save the taxpayer $612 billion over 10 years. 

Medicaid was intended to assist vulnerable populations like the disabled, pregnant women, children and people in poverty. Today, able-bodied, working-capable adults are on course to become the largest subgroup on Medicaid.?

Even if lawmakers are hesitant to make these changes, many of these measures can still be phased in — saving taxpayers hundreds of billions without cutting anyone’s benefits. Not to mention the additional hundreds of billions that could be saved by cracking down on improper payments, which have reached a rate of over 25% in recent audits. 

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We need to bring the rhetoric back into reality. Medicaid reforms are not the end of entitlement programs. They are a necessary step toward real solutions to address our nation’s debt crisis and secure the financial future of generations to come. By making targeted reforms, lawmakers can execute President Trump’s mandate for change. 

A deal to help save the country is on the table. Take it. 

Republican Chip Roy represents Texas' 21st Congressional District in the United States House of Representatives. He is the former first assistant attorney general of Texas.

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Rep. Andy Harris, a Republican, represents Maryland's 1st Congressional District.

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