How Medicaid cuts could improve access to care

The news is awash with dire predictions of whether or whe Trump or DOGE will cull the Medicaid rolls.

“Millions could lose health insurance,” warns Newsweek. “Medicaid on the chopping block,” is the CBS News headline.

Florida, meanwhile, has already cut more than 1 million from its Medicaid rolls.

It is noteworthy that these publications accurately report that health insurance was or will be cut, not health care. Journalists often conflate the two out of ignorance, leading people to believe that you must have insurance to receive medical care, or that coverage equals care.

Coverage — that is, possession of health insurance — most certainly does not guarantee timely medical care. People without insurance can still get care, and people with insurance often do not.

Average people understand the difference between coverage and care. A recent Emory University poll shows that Americans’ top healthcare priority is not insurance but “access to care,” even more than affordability.

As counterintuitive as this is, it means that cutting Medicaid rolls could actually increase access to care.

There is a seesaw effect or inverse relationship between the number of people having government-supported health insurance, particularly Medicaid, and access to medical care. As the number of people with such insurance goes up, access to care tends to go down.

The reason this occurs is bureaucratic diversion. As more acquire government-provided insurance, more “healthcare” dollars are diverted to insurance profits and especially to federal bureaucracy, unnecessary rules and regulations, directives, enforcement and non-compliance activities, sometimes referred to with the acronym BURRDEN. These billions of dollars are taken from care providers to pay for those costs.

For example, former President Barack Obama took $716 billion from seniors’ care, from the Medicare Trust, to pay for the BURRDEN infrastructure supporting his namesake legislation, Obamacare.

As money is diverted away from paying providers, less money is available for patient care. Wait times get longer until people die while waiting in line for care (implicitly promised by having insurance) that doesn’t arrive in time to save the patient: death-by-queue.

California and Oregon recently added more than 1 million people who are in the country illegally to their Medicaid rolls. By funding no-charge insurance for these individuals and increasing Medicaid rolls, American tax dollars are being used to decrease access to care for legal residents.

A seesaw can move in two directions. As Obama and Biden made the government insurance side of the seesaw go up, Trump can make that side go down. As the insurance side goes down — that is, as Medicaid rolls are reduced, more money becomes available for care. As the number of Medicaid enrollees decreases, access to care increases.

Medicaid was created for a small segment, less than 2 percent, of the population, “to increase benefits under the Old-Age, Survivors, and Disability Insurance System.” Over the decades, Washington incrementally expanded eligibility culminating in the Affordable Care Act expansion. Last year, Medicaid was providing no-charge health insurance to 24 percent of the entire U.S. population.

Culling the Medicaid rolls will not only improve access to care and reduce spending, but it will also move the program back toward the limited population for which it was originally intended.

Those who deride Trump for reducing Medicaid or attack Elon Musk for asking where money is going do not understand that Trump and DOGE are simply doing what people want people in Washington to do.

Elected officials and their bureaucratic appointees are supposed to make our lives better with timely, affordable medical care and less debt burden on our children.

Deane Waldman, M.D., MBA is professor emeritus of Pediatrics, Pathology and Decision Science, former director of the Center for Healthcare Policy at Texas Public Policy Foundation, former Director of New Mexico Health Insurance Exchange and author of 12 books, including, ” Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.”  Contact him on X @DrDeaneW or  www.deanewaldman.com. 

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