Medicaid is a poverty trap that needs reform, and yes, the reforms are being discussed now in Washington, DC, following some drama in the House of Representatives and personal intervention by President Trump with some of the wavering House members, the House passed a budget resolution, passed by the narrowest of margins, I might add, but that now has to be reconciled with the different piece of legislation that’s in the Senate.

This legislation, their legislation coming together. One of the ironies is that we discussed these things before. One of the thorny issues going forward is going to be the vastly expanded and increasingly expensive Medicaid program. Despite warnings from fiscally responsible people that Congress could not long sustain a 90% federal match for states that expanded their Medicaid programs to include many able bodied people without children, many governors and state legislators succumbed to the political pressure and they massively expanded their Medicaid programs. And we told them then that this would not work over time, Obamacare was not good for the country.

Well, now members of Congress from the Medicaid expanded states are objecting to the idea that Medicaid costs need to be restrained and states need to assume more responsibility for accomplishing that objective. In an essay for the state of black progress, it’s a policy tome that was published by the organization that I founded, the Center for Urban renewal and education. Sally pipes, a doctor and the president of Pacific Research Institute, notes in that tome that the so called Affordable Care Act, also known as Obamacare, funneled many poor people out of private insurance and into Medicaid, with its notorious wait times, Medicaid was already a disaster before they included expansions in Obamacare and once on Medicaid, people face a disincentive to earn enough money to escape from it because of the high marginal tax rate.

As beneficiaries’ income increase, their benefits decrease, they’re caught in a welfare trap which has turned many poor people, especially black people, into wards of the state. And another essay in the state of black progress Galen Institute, President Grace Marie Turner contrasts the efficacy of private versus public health insurance and suggests that the Medicaid program has obstructed black advancement we knew it would, and now it has a significantly higher percentage of blacks than whites are saddled with government health insurance, where they receive worse care and suffer long, long, long wait times.

Turner also explains how government policies create hurdles for medical improvements in such procedures as kidney dialysis, where innovations would benefit many poor people, again, being wards of the government is not beneficial to black people. Many states have devised means to game the Medicaid system to get higher levels of reimbursement. Talk about fraud. Yes, it’s there. It was perceived to going to be there, and now it is there.

And now the Congress is saying we’ve got to do something about this program that was forced down the American people’s throats. Sally pipe suggests that dispersing Medicaid funds to states as block grants would require states to manage their programs in a more disciplined fashion and enable them to save beneficiaries from falling into that poverty trap. We need to have this discussion, and I think that the senators and the House members need to reconcile themselves to the fact that we told them.

So, and this could not go on longer, and cannot continue the way that it is pipe says that we should be working to help people improve their economic station, to create opportunities for them to purchase private insurance on their own and to secure coverage through work. That’s better for taxpayers and individuals. That’s what she says, and I concur. So right now, in the sausage of Washington, DC, Medicaid is on the chopping block and should be.